Uterine prolapse is a condition that occurs when the pelvic floor muscles are no longer strong enough to support the uterus. As a result, the uterus descends toward or through the vagina.
In the US, the Women's Health Initiative found some degree of prolapse in 44% of participating women. Among these women, 14% of prolapse cases were uterine prolapse.
This article will examine the causes of uterine prolapse, its symptoms, forms of treatment and methods of prevention for the condition.
You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.
Fast facts on uterine prolapse
Here are some key points about uterine prolapse. More detail and supporting information is in the main article.
- One study found that women in the US have an 11% lifetime risk of uterine prolapse
- Women with a high body mass index have an increased risk of uterine prolapse
- There are four grades of uterine prolapse severity
- The symptoms of uterine prolapse typically worsen later in the day
- Cases of 1st- and 2nd-degree uterine prolapse without symptoms may not require treatment
- Uterine prolapse can usually be diagnosed by a physical examination
- Kegel exercises are an important form of treatment for mild forms of uterine prolapse
- In the UK, 95% of hysterectomies are performed to treat uterine prolapse.
What is uterine prolapse?
The uterus, also known as the womb, is held above the vagina by the pelvic floor muscles and ligaments.
Uterine prolapse is a condition in which a woman's uterus (womb) slips into the vagina. In some cases, the uterus can protrude from the vaginal opening.
This condition occurs when the muscles and ligaments within the pelvis become weak or lax and are unable to adequately support the uterus.
Uterine prolapse can be categorized as incomplete or complete:
- Incomplete uterine prolapse: when an incomplete uterine prolapse occurs, the uterus is partially displaced into the vagina but does not protrude
- Complete uterine prolapse: when a complete uterine prolapse occurs, there is a portion of the uterus protruding out of the vaginal opening.
Uterine prolapse is graded by its severity, determined by how far the uterus has descended:
- 1st grade: descended to the upper vagina
- 2nd grade: descended to the introitus
- 3rd grade: cervix has descended outside the introitus
- 4th grade: cervix and uterus have both descended outside the introitus.
In some cases, uterine prolapse can cause complications, including ulceration of exposed tissue and prolapse of other pelvic organs such as the bladder (cystocele) or rectum (rectocele).
Symptoms of uterine prolapse
Symptoms of uterine prolapse can vary depending on its severity.
Typical symptoms of uterine prolapse include:
- Pelvic heaviness or pulling
- Vaginal bleeding or an increase in vaginal discharge
- Difficulties with sexual intercourse
- Urinary leakage, retention or bladder infections
- Bowel movement difficulties, such as constipation
- Lower back pain
- Uterine protrusion from the vaginal opening
- Sensations of sitting on a ball or that something is falling out of the vagina
- Lax vaginal tissue.
Mild cases of uterine prolapse may be asymptomatic. Symptoms that do present often become worse in the latter part of the day.
Causes of uterine prolapse
Uterine prolapse is the result of lax pelvic floor muscles that can be caused by a multitude of conditions:
- Pregnancy and childbirth: not only can pregnancy be a contributing factor, but trauma during childbirth, a large baby or a vaginal delivery can increase a woman's risk of developing uterine prolapse
- Age: increasing age places a woman at higher risk for developing uterine prolapse; menopausal woman are at a higher risk due to lower levels of circulating estrogen
- Frequent heavy lifting
- Straining during bowel movements
- Chronic coughing (chronic obstructive pulmonary disease, for example)
- A history of pelvic surgery
- Genetic predisposition to having weakened connective tissue.
On the next page, we look at the diagnosis, treatment and prevention of uterine prolapse.