Uterine Prolapse

What is uterine prolapse?

Uterine prolapse means that your uterus (womb) has moved from its normal position down into your vagina. The uterus may be only slightly out of position, or it may move down so far that it can be seen outside the vagina.

The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.

How does it occur?

Uterine prolapse occurs when the muscles and ligaments that support your uterus are weakened or stretched so much that they no longer hold the uterus in place. This can be caused by:

• childbirth
• normal aging
• inherited weak ligaments and muscles
• a lot of heavy lifting

The prolapse can be worsened by being overweight, chronic coughing, and straining to move your bowels.

What are the symptoms?

If the prolapse is mild, you may not have any symptoms.

If the prolapse is moderate or severe, you may:

• have a feeling of heaviness or discomfort in your lower belly
• feel as if you are sitting on a ball
• have low back pain
• find that standing a long time makes the pain and discomfort worse
• have pain when you have sex
• leak urine when you lift, cough, or laugh
• have trouble urinating
• have trouble moving your bowels.

All of your symptoms may get worse just before you start a menstrual period.

With severe prolapse, the uterus may feel like a large lump in the vagina. It may even be visible from the outside.

How is it diagnosed?

Your provider will ask about your symptoms and do a pelvic exam.

What is the treatment?

Uterine prolapse can be treated with a pessary. A pessary is a plastic or rubber device that is inserted into the vagina. It may be a round or egg-shaped ring, it may look more like a donut, or it may be other shapes, like a mushroom. Some types of pessaries can be put into the vagina and then filled with air or water. They may be easier to insert than the plastic or rubber devices.

Uterine prolapse may also be treated with surgery. The uterus may be removed through the vagina or a cut in the abdomen, and then the surgeon may tighten the support ligaments of the vagina. Laparoscopy (belly-button telescope surgery) may be used to try to resuspend the uterus and tissue around the vagina. A procedure called uterine suspension shortens and ties the ligaments of the uterus to other ligaments and muscles in the pelvis.

You will no longer have periods or be able to have children after surgery that removes the uterus.

How long will the effects last?

Depending on your symptoms, uterine prolapse may not need to be treated. If your symptoms get worse and uterine prolapse is not fixed, the symptoms might keep getting worse over time. If the uterus comes down outside the vagina, then your skin can get rubbed and you may get sores, bleeding, and infection.

The only way uterine prolapse might be fixed permanently is through surgery. Wearing a pessary will correct it temporarily.

How can I take care of myself or prevent uterine prolapse?

A lot can be done to improve or prevent a prolapsed uterus:

• If you are overweight, lose weight and try to keep a healthy weight.
• Eat high-fiber foods to help you move your bowels without straining.
• Drink plenty of fluids.
• Strengthen your pelvic muscles by doing Kegel exercises. When you do Kegels, you alternately contract and relax your pelvic muscles as though you were trying to stop a flow of urine in midstream. It is especially helpful to do these exercises after you have delivered a baby.
• Avoid wearing tight girdles or other garments that put pressure on your belly.
• Avoid frequent heavy lifting. When you do lift, bend your knees and hips and keep your back straight.
• Treat a chronic cough. Treat and control asthma or chronic bronchitis.
• If you are a smoker, quit.