Uterine prolapse is a protrusion of the uterus into the vagina. It occurs when the pelvic muscles and supporting ligaments, which normally hold the uterus in place, become injured or weakened. In mild prolapse a portion of the uterus descends into the top of the vagina. In more severe cases the uterus may protrude through the vaginal opening. Uterine prolapse is often accompanied by a bulging of the bladder (cystocele) or the urethra (urethrocele) into the front wall of the vagina, or a bulging of the rectum into the back wall of the vagina.
What Causes Uterine Prolapse?
- Injury or weakness of the pelvic muscles, usually from multiple or unattended childbirths, is the most common cause of uterine prolapse.
- Constant constipation or recurring bowel irregularity
- Obesity, diabetes mellitus, chronic bronchitis, asthma, certain generalized defects in supporting tissues, and a retroverted uterus (uterus is tipped toward the back of the body) increase the risk.
- Heavy lifting or straining may contribute to uterine prolapse if pelvic muscles are already weakened.
- Repeated coughing may weaken all the pelvic elements
Symptoms of Uterine Prolapse
- In many women, no symptoms
- Discomfort, pain, or a sensation of heaviness or fullness in the lower abdomen and vagina
- A lump located inside or outside of the vagina
- Abnormal vaginal discharge or bleeding
- Uncomfortable sexual intercourse
- Painful and frequent urination
- Pain in the lower back
- Anal pain or a sensation of “sitting on a ball”
- A pink tissue discharge from the vagina that causes itchiness or irritation
- Urinary urgency or frequency; constipation
- Possibly urinary or fecal incontinence
- Urine leakage when laughing, coughing or sneezing
- Visible protrusion of the uterus through the vaginal opening (in severe cases)
Preventing Vaginal Prolapse
- Kegel exercises to strengthen the muscles supporting the uterus may be recommended after childbirth.
- If necessary, weight reduction may be advised.
- Estrogen replacement may be recommended for postmenopausal women.
Vaginal Prolapse Diagnosis
- Gynecological examination
- Pelvic examination
How to Treat Vaginal Prolapse
- Mild cases of uterine prolapse may not require treatment.
- Avoid tight pants, belts, or girdles.
- Minimize straining during urination and bowel movements.
- A small plastic, rubber, or silicone ring known as a pessary may be used to provide support for a mildly prolapsed uterus or when surgery is warranted but the patient has serious medical problems and cannot endure it. The pessary is inserted into the vagina and positioned against the cervix. The pessary should be removed, cleaned, and reinserted every few months.
- Surgery (hysterectomy) may be performed to remove a severely prolapsed uterus, but the supporting tissues must be repaired to avoid prolapse of the vagina after uterine removal.
When to Call a Doctor
- Call a doctor if you develop pelvic pain or discomfort or unusual pelvic protrusion.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media