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Treatments and drugs
By Mayo Clinic staffLosing weight, stopping smoking and getting proper treatment for contributing medical problems, such as lung disease with coughing, may slow the progression of uterine prolapse.
If you have very mild uterine prolapse, either without symptoms or with symptoms that aren't terribly bothersome, no treatment is necessary. However, your pelvic floor may continue to lose tone, making the uterine prolapse more severe.
Lifestyle changes
Lifestyle changes may be the first step to ease symptoms of uterine prolapse:
- Achieve and maintain a healthy weight, to minimize the effects of being overweight on supportive pelvic structures.
- Perform Kegel exercises, to strengthen pelvic floor muscles.
- Avoid heavy lifting and straining, to reduce abdominal pressure on supportive pelvic structures.
Vaginal pessary
A vaginal pessary fits inside the vagina and is designed to hold the uterus in place. The pessary can be a temporary or permanent form of treatment. Vaginal pessaries come in many shapes and sizes, so your doctor will measure and fit you for a device. Once the pessary is in place, your doctor may have you walk, sit, squat and bear down to make sure that the pessary fits you correctly, doesn't become dislodged and feels reasonably comfortable. You may be asked to return a few days after insertion of the pessary to check that it's still in the correct position. You may be advised to remove the device and clean it with soap and water frequently. Your doctor will show you how to remove and reinsert the pessary. You may be able to leave the pessary out overnight and reinsert it each day to use only during waking hours.
There are some drawbacks to these devices. A vaginal pessary may be of little use for a woman with severe uterine prolapse. Additionally, a vaginal pessary can irritate vaginal tissues, possibly to the point of causing sores or ulcerations. Women with vaginal pessaries that aren't removed frequently for cleaning may report a foul-smelling discharge. Pessaries may interfere with sexual intercourse.
Surgery to repair uterine prolapse
If lifestyle changes fail to provide relief from symptoms of uterine prolapse, or if you'd prefer not to use a pessary, surgical repair is an option. Surgical repair of uterine prolapse usually requires vaginal hysterectomy to remove your uterus and excess vaginal tissue. In some cases, surgical repair may be possible through a graft of your own tissue, donor tissue or some synthetic material onto weakened pelvic floor structures to support your pelvic organs.
Doctors generally prefer to perform uterine prolapse repair vaginally because vaginal procedures are associated with less pain after surgery, faster healing and a better cosmetic result. However, vaginal surgery may not provide as lasting a fix as abdominal surgery. And if you don't have your uterus removed during surgery, prolapse can recur. Laparoscopic techniques — using smaller abdominal incisions, a lighted camera-type device (laparoscope) to guide the surgeon and specialized surgical instruments — offer a minimally invasive approach to abdominal surgery.
You might not be a good candidate for surgery to repair uterine prolapse if you plan to have more children. Pregnancy and delivery of a baby put strain on the supportive tissues of the uterus and can undo the benefits of surgical repair. Also, for women with major medical problems, anesthesia for surgery might pose too great a risk. Pessary use may be your best treatment choice for bothersome symptoms in these instances.
- Kohli N, et al. An overview of the clinical manifestations, diagnosis, and classification of pelvic organ prolapse. http://www.uptodate.com/home/index.html. Accessed March 2, 2010.
- Tarnay CM. Pelvic organ prolapse. In: DeCherney AH, et al. Current Diagnosis & Treatment Obstetrics & Gynecology. 10th ed. New York, N.Y.: McGraw-Hill Medical; 2007. http://www.accessmedicine.com/content.aspx?aid=2390520. Accessed March 3, 2010.
- Lentz GM. Anatomic defects of the abdominal wall and pelvic floor: Abdominal and inguinal hernias, cystocele, urethrocele, enterocele, rectocele, uterine and vaginal prolapse, and rectal incontinence: Diagnosis and management. In: Katz VL, et al. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/186922005-2/0/1524/131.html?tocnode=53759383&fromURL=131.html. Accessed March 3, 2010.
- Hughes D, et al. Pelvic organ prolapse. In: Schorge JO, et al. Williams Gynecology. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aid=3159899. Accessed March 3, 2010.
- American College of Obstetricians and Gynecologists. ACOG practice bulletin: Pelvic organ prolapse. Obstetrics & Gynecology. 2007;110:717.
- Doshani A, et al. Uterine prolapse. British Medical Journal. 2007;335:819.
- Rosenblatt PL. Laparoscopic surgery for repair of pelvic floor defects. http://www.uptodate.com/home/index.html. Accessed March 2, 2010.
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