A uterine prolapse is when the uterus descends toward or into the vagina. It happens when the pelvic floor muscles and ligaments become weak and are no longer able to support the uterus.
In some cases, the uterus can protrude from the vaginal opening.
Complications can sometimes result, including ulceration of exposed tissue and prolapse of other pelvic organs such as the bladder or the rectum.
Among women aged 55 years and above, it is one of the most common reasons for undergoing a hysterectomy.
Uterine prolapse can be categorized as incomplete or complete:
- Incomplete uterine prolapse: The uterus is partially displaced into the vagina but does not protrude.
- Complete uterine prolapse: A portion of the uterus protrudes from the vaginal opening.
The condition 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
More severe cases may need surgery, but in the early stages, exercises may help.
Symptoms vary depending on how severe the prolapse is.
Typical symptoms 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
- weak vaginal tissue
In mild cases, there may be no symptoms. Symptoms that appear only sometimes often become worse toward the end of the day.
Pelvic floor muscles can become weak for a number of reasons:
- factors related to delivery, including trauma, delivering a large baby, or having a vaginal delivery
- getting older, especially after menopause, when levels of circulating estrogen drop
- frequent heavy lifting
- straining during bowel movements
- chronic coughing
- a history of pelvic surgery
- genetic factors leading to weakened connective tissue
A health care provider will ask about symptoms and perform a physical examination. While examining the pelvis, the provider will evaluate for organ placement and vaginal tone.
Treatment depends on the stage and severity of the prolapse.
Some strategies can reduce the risk of uterine prolapse developing and stop it from worsening.
- performing Kegel exercises regularly and correctly
- preventing and treating constipation
- avoiding heavy lifting
- using correct body mechanics whenever lifting is necessary
- managing chronic coughing
- maintaining a healthy weight through diet and exercise
- considering estrogen replacement therapy during menopause
If the prolapse shows signs of worsening, other types of treatment may be necessary.
Prolapse up to the third degree may spontaneously resolve. More severe cases may require medical treatment.
Vaginal pessary: This is a vaginal device that supports the uterus and keeps it in position. It is important to follow the instructions on care, removal, and insertion of the pessary. In cases of severe prolapse, a pessary can cause irritation, ulceration, and sexual problems. Discuss with your provider if this treatment is right for you.
Surgery: Surgical repair of a prolapsed uterus can be performed through the vagina or abdomen. It involves skin grafting, or using donor tissue or other material to provide uterine suspension. A hysterectomy may be recommended.
If future pregnancies are intended, surgery may not be recommended, due to the risks of undoing the effects of surgical repair.
Mild uterine prolapse can be treated with Kegel exercises, weight management and avoidance of heavy lifting.
How to do a proper Kegel is vital to the success of the treatment. These exercises can be done anywhere and at any time and can help strengthen the muscles of the pelvic floor.
Your health care provider or physical therapist can instruct you on how to perform a proper Kegel while in the office, at which time proper technique can be evaluated.
Sometimes, a technique called biofeedback may be applied. During biofeedback treatments, a device will monitor proper muscle contraction, the strength of the pelvic floor and timing of Kegels. This reinforces proper technique of the exercises.
To perform a proper Kegel:
- Tighten the pelvic floor muscles, as if you are attempting to stop urinating and hold for 5 seconds
- Take a 5-second break and repeat for three sets, 10 times per day.
The ultimate goal is to hold the contraction for 10 seconds each time the exercise is performed.
Speak with your health care provider if you have any questions or for the evaluation and treatment of symptoms of uterine prolapse. They can make recommendations on a treatment choice that is best for you.