What is a uterine prolapse?
Almost half of all women aged 50 to 79 have some amount of uterine prolapse and they may have other pelvic organ prolapse as well.
A uterine prolapse occurs when the pelvic muscles become weak, causing the uterus to push into the vagina. This condition is not life-threatening, but it can cause discomfort and pain.
Almost half of all women aged 50 to 79 have some amount of uterine prolapse and they may have other pelvic organ prolapse as well. This condition can be an effect of aging.
Symptoms of uterine prolapse
Uterine prolapse symptoms may include:
- Lower back pain
- Pain, discomfort, or numbness during sex
- Feeling or seeing a bulge or lump coming out of your vagina
- Pressure or heaviness in your vagina
- Leaking urine, especially when you cough, sneeze, or exercise
- Sudden urge to urinate
- Repeated bladder infections
- Vaginal bleeding
- Extra vaginal discharge
- Dragging sensation inside your vagina
Standing or sitting for a long time may make symptoms worse. Heavy lifting and exercise may also worsen symptoms.
Causes of uterine prolapse
Uterine prolapse occurs when the tissues and muscles of the pelvic floor are weak or stretched and can’t support the uterus. The uterus becomes too heavy and bulges into the vagina.
Sometimes, the bladder, rectum, and front and back vaginal walls may also bulge into the vagina. The urethra and bladder may also be lower in the pelvis than usual.
Certain factors may increase the risk of uterine prolapse, including:
- Childbirth
- Vaginal delivery
- Aging
- Being overweight
- Smoking
- Being Caucasian
- Not enough estrogen after menopause
- Chronic cough
- Pelvic tumor
- Long-term constipation
People who experience a long second stage of labor during birth, give birth to large babies, or have episiotomies – incisions in the perineum during childbirth – may also be at risk for uterine prolapse.
Tests for uterine prolapse
Your doctor may perform a few tests to diagnose your uterine prolapse. These may include:
Medical history
Your doctor will take your list of symptoms and your personal and medical history. They will consider the number of births you’ve had, the weight of the babies, and other considerations like long-term constipation or chronic coughing that may strain your muscles.
Physical exam
Your doctor will do a pelvic exam to check your pelvis and vagina. They may ask you to bear down like you would to deliver a baby. This will help determine if or how much of the uterus is bulging into the vagina. They may also check if the bladder, the front and back vaginal walls, and the rectum are bulging into the vagina.
Cystoscopy
If you have trouble emptying your bladder or urinary incontinence, your doctor may do a cystoscopy to look at your urethra and bladder.
Imaging tests
Your doctor may request an ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT) scan to check the structure of your uterus, pelvis, and other pelvic organs.
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Treatment for uterine prolapse
Your uterine prolapse may not need treatment unless your symptoms bother you or make you uncomfortable. Your doctor may first recommend lifestyle changes to help. These may include:
- Weight loss
- Smoking cessation
- Fiber-rich diet to help with constipation
- Pelvic floor exercises to strengthen muscles
- No heavy lifting
Your prenatal doctor may recommend pelvic floor therapy after giving birth as a preventative measure. This can include Kegel exercises to strengthen and tone muscles. These exercises may also be beneficial for improving urinary and bowel incontinence.
If your symptoms are severe, or you need other uterine prolapse treatment, your doctor may look at different treatments, including:
Hormone treatment
Your doctor may prescribe estrogen hormone replacement therapy to relieve some of your symptoms.
Pessary
A pessary is a device your doctor may insert into your vagina to help support the pelvic muscles. These can come in a variety of shapes and sizes and they are thought to be quite successful for prolapse. They may help relieve incontinence.
Pessaries must be cleaned regularly. Your doctor will show you how to remove, clean, and insert your pessary. Side effects are possible, including irritation of the vaginal lining, problems with sex, vaginal ulcers, and foul smelling discharge. If these occur, speak to your doctor.
Surgery
Your doctor may suggest uterine prolapse surgery, however it usually isn’t recommended until your symptoms are worse than the risks of surgery. Your doctor may be able to perform different types of surgery depending on the severity of your prolapse, whether you want to have more pregnancies, and your age and health.
Different surgery options may include:
- Hysterectomy to remove the uterus
- Sacrospinous fixation to correct ligaments
- Other procedures to repair a sagging urethra, bladder, rectum, or vaginal walls
Your doctor may be able to perform a vaginal hysterectomy. Removing the uterus through the vagina this way reduces the risk of a large scar.
