Condition 101 About Uterine Prolapse

What is the definition of Uterine Prolapse?

Uterine prolapse occurs when the womb (uterus) drops down and presses into the vaginal area.

What are the alternative names for Uterine Prolapse?

Pelvic relaxation - uterine prolapse; Pelvic floor hernia; Prolapsed uterus; Incontinence - prolapse

What are the causes for Uterine Prolapse?

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:

  • Normal aging
  • Lack of estrogen after menopause
  • Conditions that put pressure on the pelvic muscles, such as chronic cough and obesity
  • Pelvic tumor (rare)

Repeated straining to have a bowel movement due to long-term constipation can make the problem worse.

What are the symptoms for Uterine Prolapse?

Symptoms may include:

  • Pressure or heaviness in the pelvis or vagina
  • Problems with sexual intercourse
  • Leaking urine or sudden urge to empty the bladder
  • Low backache
  • Uterus and cervix that bulge into the vaginal opening
  • Repeated bladder infections
  • Vaginal bleeding
  • Increased vaginal discharge

Symptoms may be worse when you stand or sit for a long time. Exercise or lifting may also make symptoms worse.

What are the current treatments for Uterine Prolapse?

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.

LIFESTYLE CHANGES

The following can help you control your symptoms:

  • Lose weight if you are obese.
  • Avoid heavy lifting or straining.
  • Get treated for a chronic cough. If your cough is due to smoking, try to quit.

VAGINAL PESSARY

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:

  • Foul smelling discharge from the vagina
  • Irritation of the lining of the vagina
  • Ulcers in the vagina
  • Problems with normal sexual intercourse

SURGERY

Surgery should not be done until the prolapse symptoms are worse than the risks of having surgery. The type of surgery will depend on:

  • The severity of the prolapse
  • The woman's plans for future pregnancies
  • The woman's age, health, and other medical problems
  • The woman's desire to retain vaginal function

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 can be done at the same time as the procedure to correct uterine prolapse. Any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time.

What is the outlook (prognosis) for Uterine Prolapse?

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.

What are the possible complications for Uterine Prolapse?

Ulceration and infection of the cervix and vaginal walls may occur in severe cases of uterine prolapse.

Urinary tract infections and other urinary symptoms may occur because of a cystocele. Constipation and hemorrhoids may occur because of a rectocele.

When should I contact a medical professional for Uterine Prolapse?

Call your provider if you have symptoms of uterine prolapse.

How do I prevent Uterine Prolapse?

Tightening the pelvic floor muscles using Kegel exercises helps to strengthen the muscles and reduces the risk of developing uterine prolapse.

Estrogen therapy after menopause may help with vaginal muscle tone.

Female
Uterus

REFERENCES

Kirby AC, Lentz GM. Anatomic defects of the abdominal wall and pelvic floor: abdominal hernias, inguinal hernias, and pelvic organ prolapse: diagnosis and management. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 20.

Magowan BA, Owen P, Thomson A. Pelvic organ prolapse. In: Magowan BA, Owen P, Thomson A, eds. Clinical Obstetrics and Gynaecology. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 10.

Newman DK, Burgio KL. Conservative management of urinary incontinence: behavioral and pelvic floor therapy and urethral and pelvic devices. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 80.

Winters JC, Smith AL, Krlin RM. Vaginal and abdominal reconstructive surgery for pelvic organ prolapse. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 83.

Latest Advances On Uterine Prolapse

  • Condition: Anterior Vaginal Prolapse Stage ?-? and (or) Apical Prolapse and Posterior Vaginal Prolapse (Stage ?-?)
  • Journal: Zhonghua fu chan ke za zhi
  • Treatment Used: Transvaginal Pelvic Floor Reconstruction with TiLOOP Mesh
  • Number of Patients: 50
  • Published —
The study researched the outcomes of transvaginal pelvic floor reconstruction with TiLOOP mesh for treating patients with anterior vaginal prolapse stage ?-? and (or) apical prolapse and posterior vaginal prolapse (stage ?-?).

Clinical Trials For Uterine Prolapse

Clinical Trial
  • Status: Not yet recruiting
  • Phase: N/A
  • Intervention Type: Behavioral
  • Participants: 116
  • Start Date: February 2021
Limits On Vaginal Intercourse After Mid-urEthral Sling (LOVE Trial)
Clinical Trial
  • Status: Recruiting
  • Participants: 50
  • Start Date: January 25, 2021
4K Versus 3D Laparoscopic Colporraphy by Surgeons in Training: a Prospective Randomized Trial