Uterine Prolapse

Uterine Prolapse

Alternate Names

  • prolapsed uterus
  • pelvic support relaxation
  • pelvic floor hernia
  • procidentia
  • pudendal hernia
  • Female reproductive organs

Definition

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. .

What is going on in the body?

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 births
  • giving 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.

Risks

What are the causes and risks of the condition?

Prevention

What can be done to prevent the condition?

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

Diagnosed

How is the condition diagnosed?

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.

Long Term Effects

What are the long-term effects of the condition?

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 bleeding
  • increased vaginal discharge
  • chronic vaginal infections
  • chronic bladder infections, known as recurrent cystitis
  • partial urethral obstruction
  • hemorrhoids
  • small bowel obstruction

Other Risks

What are the risks to others?

Uterine prolapse is not contagious, and poses no risk to others.

Treatments

What are the treatments for the condition?

Treatment for uterine prolapse depends on many things, including:
  • the severity of the prolapse
  • the severity of the symptoms
  • the presence of other signs and symptoms
  • a woman's wishes to preserve her fertility
  • the woman's age
Treatment options include:
  • pessary, a plastic doughnut-shaped device placed into the vagina to push up the uterus
  • uterosacral ligament suspension procedure, an operation to provide muscle support to the uterus
  • estrogen therapy given directly into the vagina with creams ,rings or suppositories
  • hysterectomy, or surgery to remove the uterus

Side Effects

What are the side effects of the treatments?

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 Treatment

What happens after treatment for the condition?

After surgical treatment of a prolapsed uterus, a woman should:
  • avoid lifting heavy objects
  • prevent constipation by drinking plenty of fluids, using stool softeners for a short time, and increasing her fiber intake
  • perform Kegel exercises daily
  • avoid smoking
  • lose weight through diet and exercise, if she is overweight
  • continue with hormone replacement therapy, if she was using it before surgery
  • avoid wearing tight girdles or other garments that put pressure on the abdomen

Monitor

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare professional.

Sources

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

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