Uterine Prolapse

Muscles, ligaments, and other tissues normally hold the hollow, pear-shaped uterus in its proper position in the lower abdomen. Nestled between the bladder and rectum, the uterus or womb is sometimes affected by age-related changes or the stress of pregnancy, labor, and birth.

If pelvic floor muscles are no longer able to support the uterus, what’s referred to as uterine prolapse may occur.

How Uterine Prolapse Occurs

Uterine prolapse is usually a gradual process. If it’s related to pregnancy, the weakening of supporting pelvic muscles may trigger the prolapse process after birth. Age-related prolapse in women may be affected by a loss of estrogen and a progressive relaxation of pelvis-supporting muscles. Uterine prolapse usually starts with the cervix dropping into the vagina. Eventually, the cervix may slip outside of the vagina just before the entire uterus.

Signs of Uterine Prolapse

If uterine prolapse is mild, there may be no noticeable symptoms experienced. If the prolapse is moderate or severe, a woman may feel an unusual sense of heaviness in the pelvic area. Tissue may visibly protrude from the vagina if the prolapse is severe. Women may also have related issues with urinary incontinence (UI), bowel movements, lower back pain, urine retention, and changes with vaginal muscle tone that results in a loss of sensation during intimate moments. Additionally, uterine prolapse is sometimes associated with:

• Bulging (herniation) in the upper front of the vaginal wall (cystocele)
• Herniation affecting the rear part of the vaginal wall (enterocele)
• Lower rear vaginal wall herniation (rectocele)

Diagnosis & Treatment

Uterine prolapse is usually diagnosed during a pelvic exam. This process typically involves manually examining the vaginal area to determine how far uterine tissue has prolapsed. A patient may be asked to bear down as if having a bowel movement so the prolapse can be fully assessed. A patient may also be asked to tighten pelvic muscles if attempting to stop urination to get an idea of how much muscle tension has been lost. Bladder functions may be tested with an intravenous pyelogram (IVP) or renal sonography as well. If there is a need to rule out other pelvic problems, an ultrasound may be done.

If symptoms are minor, treatment typically involves self-care recommendations such as performing pelvic strengthening exercises. Some post-menopausal women with mild uterine prolapse benefit from estrogen cream. Another option is the use of plastic or removable rubber ring that’s inserted into the vagina (vaginal pessary). With a severe prolapse of the uterus, surgery may be necessary. Options include the repair of weakened pelvic floor tissues with synthetic material or the patient’s own tissue and minimally invasive laparoscopic procedures. A hysterectomy may be performed if uterine prolapse is severe.

The risk of experiencing uterine prolapse could be reduced by strengthening pelvic floor muscles with Kegel exercises, eating high-fiber foods to minimize issues with constipation and straining, and using proper lifting techniques to avoid placing too much strain on pelvic and lower abdominal muscles. It can be just as helpful to maintain a healthy weight, avoid smoking, and seek treatment for conditions that result in chronic coughing.