Uterine prolapse is the "dropping" of the uterus from its normal position at the top of the vagina. It drops to a lower part of the vagina and may even drop outside the vagina. This is caused by a relaxation of the ligaments that support the uterus within the pelvis. .
Uterine prolapse occurs more commonly in white women. Certain pregnancy problems may have caused injury to the pelvic ligaments and muscles. These include: multiple vaginal birthsgiving birth to large babies (more than 9 pounds) difficult instrumented deliveries (forceps, vacuum)
Other factors that may contribute to prolapse are: presence of a pelvic tumor diabetes obesity asthma chronic bronchitis
Symptoms may not occur until many years after women have given birth. This suggests that aging and shrinkage of these muscles also adds to the problem. Uterine prolapse sometimes occurs in women who have never given birth. In these cases, the condition is due to a familial tendency towards weakening of the muscles that hold the uterus in.
There are many different degrees of prolapse. Incomplete prolapse occurs when the uterus drops only partway into the vagina. Complete prolapse occurs when the uterus and cervix protrude out of the vagina and the vagina becomes inverted. Along with uterine prolapse there may be relaxation of the front and back portions of the vagina. This can cause a part of the bladder (cystocele) or rectum (rectocele) to protrude into the vagina.
Mild prolapse may not cause any symptoms. With more severe prolapse, a woman may have: a falling out sensationa feeling like she is sitting on a ballsensation of pelvic heavinesslow backachelower abdominal discomfortincreased vaginal discharge increased urinary tract infections increased desire to urinate or more frequent urinationstress incontinence, or leakage of urine that is worsened by coughing, sneezing, or lifting objectsa feeling of not having completely emptied the bladderconstipation painful bowel movements
While uterine prolapse is not always avoidable, some cases can be avoided by: doing Kegel exercises during pregnancy and after giving birth, to strengthen pelvic muscles taking hormone replacement therapy for a long time during and after menopause to maintain the health of the pelvic tissues
A healthcare professional can tell during a pelvic exam if the cervix is in a lowered position in the vagina. The pelvic exam may also show a part of the bladder or rectum protruding into the vagina.
The long-term effects of uterine prolapse depend on how severe it is and how long a woman has had the condition. Some long-term effects include: abnormal uterine bleedingincreased vaginal dischargechronic vaginal infectionschronic bladder infections, known as recurrent cystitispartial urethral obstructionhemorrhoidssmall bowel obstruction
Uterine prolapse is not contagious, and poses no risk to others.
Treatment for uterine prolapse depends on many things, including: the severity of the prolapsethe severity of the symptomsthe presence of other signs and symptoms a woman's wishes to preserve her fertilitythe woman's age
Treatment options include: pessary, a plastic doughnut-shaped device placed into the vagina to push up the uterusuterosacral ligament suspension procedure, an operation to provide muscle support to the uterusestrogen therapy given directly into the vagina with creams ,rings or suppositories hysterectomy, or surgery to remove the uterus
The side effects depend on the treatment. The use of hormone replacement therapy may cause nausea, weight gain, abdominal bloating, increased vaginal discharge, and breast tenderness. After a hysterectomy a woman will need 6 to 8 weeks to recuperate. Surgery can be complicated by bleeding, infection, or reactions to anesthesia.
After surgical treatment of a prolapsed uterus, a woman should: avoid lifting heavy objectsprevent constipation by drinking plenty of fluids, using stool softeners for a short time, and increasing her fiber intakeperform Kegel exercises dailyavoid smokinglose weight through diet and exercise, if she is overweightcontinue with hormone replacement therapy, if she was using it before surgeryavoid wearing tight girdles or other garments that put pressure on the abdomen
Any new or worsening symptoms should be reported to the healthcare professional.
The Merck Manual of Medical Information, Home edition, 1997
Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998
Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000