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Uterine prolapse is when the uterus drops toward or into the vagina. It happens when the pelvic floor muscles and ligaments become weak and cannot hold the uterus in its natural anatomical location.
The pelvic floor muscles support the uterus, rectum, vagina, bladder, and other pelvic organs. Commonly, this area weakens due to age and vaginal birth. Uterine prolapse mostly affects women after menopause.
Uterine prolapse is categorize into two: incomplete and complete. Incomplete uterine prolapse occurs when the uterus partially descends in the vagina but has not protruded yet. Whereas, complete prolapse happens when the uterus falls far enough that it protrudes outside the vagina.
Uterine prolapse is also classified according to its severity. Stage I is when the uterus slips in the upper vaginal area. Stage II is when it falls in the lower vaginal area. In Stage III, the uterus protrudes out of the vagina. In Stage IV, the uterus is fully out of the vagina.
In most cases, uterine prolapse is mild with no symptoms. However, the condition may change overtime and may affect a person’s daily activities. In severe cases, treatments may be necessary to restore quality of life.
Symptoms
Symptoms of uterine prolapse varies in the severity of condition. Typically, prolapse from childbirth is mild and has no symptoms. If a prolapse develops and worsen, common symptoms include:
- Bulging in the vagina
- Feeling of sitting on a small ball
- Feeling of heaviness and pulling in the pelvis
- Leaking of urine or incontinence
- Difficulty having bowel movement
- Inability to completely empty the bladder
- Pelvis and lower back pain
- Sensation that the vaginal tissue is rubbing on clothing
- Discomfort or pain during sexual intercourse
Moderate to severe cases of uterine prolapse can cause discomfort. If the person experiences any symptoms, visit a healthcare provider for proper diagnosis. Several treatments are available depending on the severity of the condition.
Causes
Pelvic floor muscles and ligaments supports the uterus. Uterine prolapse happens when the connective tissue is damaged or weakened. The pelvic muscles can deteriorate due to several reasons, such as:
- Vaginal childbirth, having many vaginal delivery
- Delivering a large baby
- First delivery age (increased risk for older women)
- Trauma or difficulty during childbirth
- Obesity
- Lower estrogen level due to menopause
- Long-term constipation, straining of bowel movement
- Chronic coughing or straining
- Repeated heavy lifting
Risk factors
Risk factors of uterine prolapse include:
- Multiple vaginal delivery
- Having first baby at an older age
- Giving birth to a large baby
- Age
- Obesity
- History of pelvic surgery
- Genetics (family history of weak connective tissue)
- Ethnicity, being Hispanic or white
- Increased abdominal pressure (cough, chronic constipation, heavy lifting)
Diagnosis
The discomfort from the symptoms is usually the first reason why a patient seeks a doctor. Diagnosis of uterine prolapse starts with a pelvic exam. The doctor will require few activities during this exam, such as:
- To determine how far the uterus falls into the vagina, the patient will need to squat or bear down as if having a bowel movement.
- To measure how strong the pelvic muscles are, the patient will need to tighten the pelvic muscles as if stopping a urine stream.
The doctor may require having a urodynamic test if there is an extreme urine incontinence to evaluate the bladder functioning and determine the cause of leakage.
Treatment
In mild uterine prolapse with no symptoms, treatment may not be necessary. However, the doctor may suggest monitoring the prolapse for any changes. In moderate to severe cases, treatment may be needed to help relieve the symptoms. Treatment options include:
- Lifestyle changes: Self-care measures include losing weight, avoiding heavy lifting, treating constipation, and doing exercises. These practices could alleviate symptoms or remove excess stress on the pelvic muscles. Doing Kegel exercises helps pelvic floor muscles to become stronger. Different types of Kegel exercises are available and can be performed daily. Changes in diet can also help with relieving constipation and losing weight.
- Vaginal pessary: This is a removable device fitted into the vagina to support the area of a prolapse. Usually, the patient is instructed on how to care, remove, and insert the pessary.
Kegel exercises
Kegel exercises are recommended to manage symptoms of uterine prolapse. It makes the pelvic floor muscles stronger and keep the prolapse from worsening.
To do a Kegel:
- Contract the muscles in the pelvic floor like attempting to keep from passing gas.
- Squeeze the muscles, hold tight for five seconds and then relax for five seconds.
- Slowly progress up to 10-second hold per set.
- Try to do this at least three sets of 10 repetitions per day.
Kegel exercises can be done everyday and anywhere. For beginners who have difficulties in doing Kegel exercises, a technique called biofeedback may be used which is usually done by a physical therapist.
Biofeedback training is a technique to determine if the correct muscles are being used during the exercise. This training may use devices to ensure that the muscles are properly tightened and are able to function effectively. If done successfully, it will improve the symptoms of prolapse in time.
Surgery
In some cases, surgery may be recommended to treat uterine prolapse. Surgical options include vaginal surgery or laparoscopic surgery. If the prolapse only affects the uterus, common surgery includes:
- Hysterectomy: It is a surgical procedure for the removal of the uterus. Getting pregnant is no longer possible after the operation. Hysterectomy can be done through the vagina or through the abdomen.
- Uterus-sparing procedure: Also called as uterine-preserving surgery is recommended to those who plans to get pregnant in the future. The surgery will return the uterus in its original location and ensure that it keeps in place. Continued study is still required to prove the success of this procedure.
However, if it is a prolapse of uterus and other pelvic organs, the surgery will become more complicated. The surgeon may conduct the following, along with hysterectomy:
- Stitch up damaged pelvic floor tissues: During this procedure, the sexual function is preserved by maintaining the width and depth of the vagina. The weakened layers are repaired by the stitches.
- Colpocleisis: It is a procedure that sews the opening of the vagina. People who choose to stop using the vaginal canal for sexual activity have the option of having this procedure. This procedure has a simple post-operative recuperation.
- Mesh to support vaginal tissues: Surgical mesh, made of synthetic material, is implanted to reinforce vaginal tissues from the tailbone. This provides extra support to prolapsed organs.
Generally, surgeries can have complications. Common risks for uterine prolapse are:
- Excessive bleeding
- Infection
- Severe reaction to anesthesia
- Blood clots in the legs or lungs
- Damage to other organs (bladder, ureters, or bowel)
- Urinary incontinence
- Prolapse recurs
The stage of the prolapse will determine the appropriate treatment. For better outcomes, discuss with a doctor for all the treatment choices including the benefits, limitations, and possible complications.
