Uterine Prolapse

What is uterine prolapse?

In uterine prolapse, your uterus (womb) moves from its normal position down into your vagina. The uterus may be only slightly out of position, or it may descend so far that it can be seen outside the vagina.

The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.

How does it occur?

Uterine prolapse occurs when your muscles and ligaments that support your uterus are weakened or stretched so that they no longer hold the uterus in place. This can be caused by:

• childbirth
• normal aging
• inherited weak ligaments and muscles
• prolonged heavy lifting

The prolapse can be worsened by being overweight, chronic coughing, straining to move your bowels, and lifting heavy objects.

What are the symptoms?

With mild prolapse, you may not have any symptoms, even though the opening to your uterus (cervix) may be sagging down into your vagina.

With moderate prolapse, you may have a heavy sensation in your lower abdomen, or you may feel as if you are sitting on a ball. You also may feel low back pain and lower abdominal discomfort. The pain and discomfort may get worse after you have been standing a long time. You may feel pain when you have sexual intercourse. All of your symptoms may be worse just before your menstrual period.

With severe prolapse, the uterus may feel like a large lump in the vagina or may even be visible from the outside.

Some women with prolapse will leak urine when they lift, cough, or laugh. Others may have difficulty urinating. Also, difficulty moving the bowels is common.

How is it diagnosed?

Your provider will ask about your symptoms and do a pelvic exam.

What is the treatment?

One way to treat uterine prolapse is with a pessary. A pessary is a plastic or rubber device that is inserted into your vagina. There are different types of pessaries. They may be round or egg-shaped rings, they may be rectangular, or they may be other shapes like a mushroom. Some are put into the vagina and then filled with air or water.

Uterine prolapse may also be treated with surgery:

• A vaginal hysterectomy may be done to remove the uterus through the vagina and the support ligaments of the vagina are tightened. You will no longer have periods or be able to have children after this surgery.
• A uterine suspension is another possible surgical treatment. This procedure shortens and ties the ligaments of the uterus to other ligaments and muscles in the pelvis.

How long will the effects last?

The only way to attempt to permanently fix uterine prolapse is through surgery. Wearing a pessary will correct it temporarily.

How can I take care of myself?

A lot can be done to improve or prevent a prolapsed uterus:

• If you are overweight, lose weight and try to maintain a healthy weight.
• Eat high-fiber foods so that you will be able to move your bowels without straining.
• Drink plenty of fluids.
• Strengthen your pelvic muscles by alternately contracting and relaxing them as though trying to stop a flow of urine in midstream (Kegel exercises). It is especially helpful to do this after you have delivered a baby.
• Avoid wearing tight girdles or other garments that put pressure on your abdomen.
• Avoid frequent heavy lifting. When you do lift, bend your knees and hips and keep your back straight.
• Treat a chronic cough. If you are a smoker, quit. Treat and control asthma or chronic bronchitis.