Uterine Prolapse occurs when the uterus (womb) slips out of place and into the vaginal canal. The severity of
Uterine Prolapse is defined as:
- First degree (mild) – The cervix (the lower opening of the uterus into the vagina) protrudes into the lower third of the vagina.
- Second degree (moderate) – The cervix protrudes past the vaginal opening.
- Third degree (severe) – The entire uterus protrudes past the vaginal opening.
Other organs, such as the ovaries or bladder, may also be out of place.
Causes
Uterine Prolapse is caused by weakened muscles and ligaments that support the uterus and upper vagina. Rarely, it may result from disorders of the nerves leading to the pelvis.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
- Multiple pregnancies and vaginal deliveries
- Retroverted uterus (positioned backwards from normal)
- Age: Past menopause
- Obesity
- Large uterine or ovarian tumors
- Activities increasing the pressure in the abdomen and pelvis:
- Severe or long-standing constipation
- Chronic coughing
- Heavy lifting
Symptoms
There may be no symptoms for mild cases of
Uterine Prolapse. Symptoms for more severe cases may include:
- Sensation of fullness in the vagina
- Sensation of pulling in the pelvis
- Pain in the vagina, lower back, or lower abdomen
- Vaginal discharge (particularly in premenopausal women)
- Leakage of urine
- Frequent urinary tract infections
- Protrusion of pink tissue from the vagina that may be irritated or itchy
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam, including a thorough pelvic exam.
Treatment
Treatment may include:
Kegel Exercises
For mild cases of uterine prolapse, Kegel exercises are recommended to strengthen the pelvic muscles. These exercises are easy to do and can be done anywhere, at any time. To perform Kegel exercises:
- Squeeze the pelvic muscles as though you are trying to hold back urine.
- Hold this position for a count of ten, then release slowly.
- Do this ten times, four times daily.
Pessary Insertion
This is a rubbery, doughnut-shaped device. It is inserted by your doctor into the upper portion of the vagina. A pessary helps to prop up the uterus and bladder, and temporarily prevent sagging into the vagina. It will need to be removed for cleaning and before sexual intercourse.
Surgery
Surgery may be necessary to correct uterine prolapse. These procedures are generally not done until you have finished having children. Surgical procedures include:
Vaginal Hysterectomy –removal of the uterus through the vagina. This procedure will permanently resolve uterine prolapse, but also results in infertility.
Resuspension of the Uterus – this involves removal of the cervix. It allows you to keep your uterus, but is associated with high rates of infertility and premature labor. This is a less common procedure.
You and your doctor should discuss all risks and benefits when considering these surgical options.