The uterus (womb) is a muscular structure that is held in place by pelvic muscles and ligaments. If these muscles or ligaments stretch or become weak, they are no longer able to support the uterus, causing prolapse. Uterine prolapse occurs when the uterus sags or slips from its normal position and into the vagina (birth canal).
Uterine prolapse may be incomplete or complete. An incomplete prolapse occurs when the uterus is only partly sagging into the vagina. A complete prolapse describes a situation in which the uterus falls so far down that some tissue rests outside the vagina.
The risk of having a prolapsed uterus increases as a woman ages and estrogen (hormone that helps keep the pelvic muscles strong) levels decrease. Damages to pelvic muscles and tissues during pregnancy and childbirth may also lead to prolapse. Women who have had more than one vaginal birth and post-menopausal women are at the highest risk.
According to the Cleveland Clinic, any activity that puts pressure on the pelvic muscles can increase your risk of a uterine prolapse. Other factors that can increase your risk for the condition include obesity, chronic coughing, chronic constipation, and injury during childbirth. (Cleveland Clinic, 2010)
Women who have a minor uterine prolapse may not have any symptoms. Moderate to severe prolapse may cause symptoms such as:
- feeling like you are sitting on a ball
- vaginal bleeding or increased discharge
- problems with sexual intercourse
- seeing the uterus or cervix coming out from the vagina
- pulling or heavy feeling in pelvis
- recurrent bladder infections
If you do develop uterine prolapse that causes symptoms, it is important to see your doctor and get treatment right away. Without proper attention, the condition can cause impairment in bowel, bladder, and sexual function.
Your doctor can diagnose uterine prolapse by evaluating your symptoms and performing a pelvic exam. During this exam, your doctor will insert a speculum (device that allows the doctor to see inside of the vagina) to examine the vaginal canal and uterus. You may be lying down, or your doctor may ask you to stand during this exam.
To determine the degree of prolapse, your doctor may ask you to “bear down” as if you were having a bowel movement.
Treatment is not always necessary for this condition. If prolapse is severe, talk with your doctor about which treatment option is appropriate for you.
Nonsurgical treatments include:
- weight loss (to take stress off of pelvic structures)
- avoiding heavy lifting
- Kegel exercises (pelvic floor exercises that help strengthen the vaginal muscles)
- estrogen replacement therapy
- pessary (a device inserted into the vagina that fits under the cervix and helps push up and stabilize the uterus and cervix)
Surgical treatments include:
- hysterectomy (the uterus is removed from the body, either through the abdomen or through the vagina)
- uterine suspension (the uterus is placed back into its original position by reattaching pelvic ligaments or using surgical materials)
Surgery is often effective, but it is not recommended for women who plan on having children in the future. Pregnancy and childbirth can put an immense strain on pelvic muscles, which can undo surgical repairs to the uterus.
Uterine prolapse may not be preventable in every situation. However, there are things you can do to reduce your risk, including getting regular physical exercise, maintaining a healthy weight, practicing Kegel exercises, and using estrogen replacement therapy during menopause.