Uterine prolapse occurs when the womb (uterus) drops down and presses into the vaginal area.
Pelvic relaxation - uterine prolapse; Pelvic floor hernia; Prolapsed uterus
Muscles, ligaments, and other structures hold the uterus in the pelvis. If these tissues are weak or stretched, the uterus drops into the vaginal canal. This is called prolapse.
This condition is more common in women who have had 1 or more vaginal births.
Other things that can cause or lead to uterine prolapse include:
Repeated straining to have a bowel movement due to long-term constipation can make the problem worse.
Symptoms may include:
Symptoms may be worse when you stand or sit for a long time. Exercise or lifting may also make symptoms worse.
Your health care provider will do a pelvic exam. You will be asked to bear down as if you are trying to push out a baby. This shows how far your uterus has dropped.
Other things the pelvic exam may show are:
You do not need treatment unless you are bothered by the symptoms.
Many women will get treatment by the time the uterus drops to the opening of the vagina.
The following can help you control your symptoms:
Your provider may recommend placing a rubber or plastic donut-shaped device, into the vagina.This is called a pessary. This device holds the uterus in place.
The pessary may be used for short-term or long-term. The device is fitted for your vagina. Some pessaries are similar to a diaphragm used for birth control.
Pessaries must be cleaned regularly. Sometimes they need to be cleaned by the provider. Many women can be taught how to insert, clean, and remove a pessary.
Side effects of pessaries include:
Surgery should not be done until the prolapse symptoms are worse than the risks of having surgery. The type of surgery will depend on:
There are some surgical procedures that can be done without removing the uterus, such as a sacrospinous fixation. This procedure involves using nearby ligaments to support the uterus. Other procedures are also available.
Often, a vaginal hysterectomy is used to correct uterine prolapse. Any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time.
Most women with mild uterine prolapse do not have symptoms that require treatment.
Vaginal pessaries can be effective for many women with uterine prolapse.
Surgery often provides very good results. However, some women may need to have the treatment again in the future.
Ulceration and infection of the cervix and vaginal walls may occur in severe cases of uterine prolapse.
Call your provider if you have symptoms of uterine prolapse.
Tightening the pelvic floor muscles using Kegel exercises helps to strengthen the muscles and reduces the risk of uterine prolapse.
Estrogen therapy after menopause may help with vaginal muscle tone.
Lentz GM. Anatomic defects of the abdominal wall and pelvic floor: abdominal and inguinal hernias, cystocele, urethrocele, enterocele, rectocele, uterine and vaginal prolapse: diagnosis and management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 20.
Maher CF, Karram M. Surgical procedures to suspend a prolapsed uterus. In: Karram M, Maher CF, eds. Surgical Management of Pelvic Organ Prolapse. Philadelphia, PA: Elsevier Saunders; 2013:chap 5.
Payne CK. Conserative management of urinary incontinence. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 69.
Winters JC, Togamai JM, Chermansky CJ. Vaginal and abdominal reconstructive surgery for pelvic organ prolapse. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 72.