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 include the ulceration of exposed tissue and prolapse of other pelvic organs, such as the bladder or the rectum.

This article covers the stages, causes, and treatments for uterine prolapses.

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Medical professionals categorize uterine prolapses as incomplete or complete:

In an incomplete uterine prolapse, the uterus partially displaces the vagina but does not protrude. By contrast, a portion of the uterus protrudes from the vaginal opening in a complete uterine prolapse. This opening is also known as the introitus.

Doctors grade the condition by its severity. They determine this by how far the uterus has descended:

GradeSeverity
First gradeThe uterus descends into the upper vagina.
Second gradeThe uterus descends into the introitus.
Third gradeThe cervix descends outside the introitus.
Fourth gradeThe cervix and uterus both descend outside the introitus.

Pelvic floor muscles can become weak for several reasons:

Symptoms vary depending on how severe the prolapse is.

Typical symptoms include:

In mild cases, there may be no symptoms, or symptoms may change in severity throughout the day.

A healthcare professional will ask about symptoms and perform a physical examination. While examining the pelvis, they will evaluate organ placement and vaginal tone.

An ultrasound or MRI may help assess the severity of the prolapse.

Prolapse up to the third degree may spontaneously resolve. More severe cases may require medical treatment.

Options include vaginal pessary and surgery.

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.

Talk with your doctor about if this treatment is right for you.

Surgery

Surgeons can repair a prolapsed uterus through the vagina or abdomen. It involves skin grafting or using donor tissue or other material to provide uterine suspension.

In severe cases, doctors may recommend a hysterectomy. This procedure removes the uterus and, often, other parts of the reproductive system.

Some strategies can reduce the risk of uterine prolapse developing and stop it from worsening.

These include, but are not limited to:

  • performing pelvic floor exercises, such as Kegel exercises
  • 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.

The most common risk factors for uterine prolapse include:

  • Multiple pregnancies and births: The risk for uterine prolapse increases with each successive pregnancy and birth. Vaginal deliveries may weaken pelvic floor muscles and connective tissues.
  • Overweight: People with a BMI over 25 are at a higher risk than people with a lower BMI. Excess weight can weaken pelvic muscles.
  • Previous hysterectomy: People who have had pelvic surgery, including a hysterectomy, may be more likely to experience prolapse.
  • Age: The structures supporting the uterus and vagina lose their strength as people age. It is diagnosed most often in people ages 60 to 69.
  • Ethnicity: Studies show Hispanic and non-Hispanic white Americans are more likely to develop uterine prolapse than Asian Americans and African Americans.
  • Tissue disorders: Connective tissue disorders may impact the ligaments responsible for holding the uterus and pelvic organs in place. These disorders may include Ehlers-Danlos syndrome and Marfan syndrome.
  • Pelvic floor disorders: Patients with pelvic organ prolapse, which includes uterine prolapse, have a high rate of coexisting pelvic floor disorders. This includes urinary incontinence, overactive bladder, and fecal incontinence.
  • Increased abdominal pressure: People who regularly lift heavy objects may be more likely to experience this condition. People who have constipation or a chronic cough may also. These conditions and situations put increased pressure on the muscles in the abdomen, which can lead to weakening.

Although it can be uncomfortable, uterine prolapse is not a life threatening condition. In fact, many patients may not experience symptoms or show signs of the condition until it has advanced to a later stage.

People who do have a detectable bulge or pressure in their vagina may be able to treat the prolapse without surgery. Noninvasive treatments, including exercises, may help the prolapse resolve. A vaginal pessary may be necessary to support the organs, too. Surgery is often reserved for the most severe cases. However, it is highly successful.

Certain risk factors increase a person’s chances of developing uterine prolapse. These include overweight and having a history of multiple pregnancies and births. These individuals should have regular pelvic exams to check for signs of uterine prolapse.

Catching the condition in early stages may allow a person more time to strengthen the pelvic floor muscles and prevent more significant prolapse.