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Uterine prolapseBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/uterine-prolapse/DS00700
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Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then slips down into or protrudes out of the vagina.
Uterine prolapse can happen to women of any age, but it often affects postmenopausal women who've had one or more vaginal deliveries. Damage to supportive tissues during pregnancy and childbirth, effects of gravity, loss of estrogen, and repeated straining over the years all can weaken your pelvic floor and lead to uterine prolapse.
If you have mild uterine prolapse, treatment usually isn't needed. But if uterine prolapse makes you uncomfortable or disrupts your normal life, you might benefit from treatment.
Uterine prolapse varies in severity. You may have mild uterine prolapse and experience no signs or symptoms. If you have moderate to severe uterine prolapse, you may experience:
- Sensation of heaviness or pulling in your pelvis
- Tissue protruding from your vagina
- Urinary problems, such as urine leakage or urine retention
- Trouble having a bowel movement
- Low back pain
- Feeling as if you're sitting on a small ball or as if something is falling out of your vagina
- Sexual concerns, such as sensing looseness in the tone of your vaginal tissue
- Symptoms that are less bothersome in the morning and worsen as the day goes on
When to see a doctor
Uterine prolapse doesn't require treatment unless it's severe. If your signs and symptoms become bothersome and disrupt your normal activities, make an appointment with your doctor to discuss your options.
Pregnancy and trauma incurred during childbirth, particularly with large babies or after a difficult labor and delivery, are the main causes of muscle weakness and stretching of supporting tissues leading to uterine prolapse. Loss of muscle tone associated with aging and reduced amounts of circulating estrogen after menopause also may contribute to uterine prolapse. In rare circumstances, uterine prolapse may be caused by a tumor in the pelvic cavity.
Certain factors may increase your risk of uterine prolapse:
- One or more pregnancies and vaginal births
- Giving birth to a large baby
- Increasing age
- Frequent heavy lifting
- Chronic coughing
- Prior pelvic surgery
- Frequent straining during bowel movements
- Genetic predisposition to weakness in connective tissue
- Being Hispanic or white
Some conditions, such as obesity, chronic constipation and chronic obstructive pulmonary disease (COPD), can place a strain on the muscles and connective tissue in your pelvis and may play a role in the development of uterine prolapse.
Possible complications of uterine prolapse include:
- Ulcers. In severe cases of uterine prolapse, part of the vaginal lining may be displaced by the fallen uterus and protrude outside your body, rubbing on underwear. The friction may lead to vaginal sores (ulcers). In rare cases, the sores could become infected.
- Prolapse of other pelvic organs. If you experience uterine prolapse, you might also have prolapse of other pelvic organs, including your bladder and rectum. A prolapsed bladder (cystocele) bulges into the front part of your vagina, which can lead to difficulty in urinating and increased risk of urinary tract infections. Weakness of connective tissue overlying the rectum may result in a prolapsed rectum (rectocele), which may lead to difficulty having bowel movements.
Preparing for your appointment
Make an appointment with your family doctor or gynecologist if you have signs or symptoms of uterine prolapse that bother you or interfere with your normal activities.
Here's some information to help you prepare for your appointment and know what to expect from your doctor.
What you can do
- Write down any symptoms you've had, and for how long.
- Make note of key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.
- Bring a friend or relative along, if possible. Having someone else there may help you remember important information or provide details on something that you missed or forgot.
- Write down questions to ask your doctor, listing the most important ones first in case time runs short.
For uterine prolapse, some basic questions to ask your doctor include:
- What is the most likely cause of my symptoms?
- Are there any other possible causes?
- Do I need any tests to confirm the diagnosis?
- What are the goals of treatment in my case?
- What treatment approach do you recommend?
- Am I at risk of complications from this condition?
- What is the risk that this problem will recur in the future?
- Do I need to follow any restrictions?
- Are there any self-care steps I can take?
- Should I see a specialist?
During your appointment, don't hesitate to ask other questions as they occur to you.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- What symptoms are you experiencing?
- When did you first notice these symptoms?
- Have your symptoms gotten worse over time?
- Do your symptoms include pain? If yes, how severe is the pain?
- Does anything in particular trigger your symptoms, such as coughing or heavy lifting?
- Do your signs and symptoms include urine leakage (urinary incontinence)?
- Have you had a chronic or severe cough?
- Is heavy lifting involved in your work or daily activities?
- Do you strain during bowel movements?
- Are you currently being treated or have you recently been treated for any other medical conditions?
- What medications are you taking, including over-the-counter and prescription drugs as well as vitamins and supplements?
- Do any of your first-degree relatives — such as a parent or sibling — have a history of uterine prolapse or any other pelvic problems?
- How many children have you delivered? Were your deliveries vaginal or cesarean?
- Do you plan to have children in the future?
- Do you have any other concerns?
Tests and diagnosis
Tests or exams to diagnose uterine prolapse include:
- Pelvic exam. During this exam, your doctor may ask you to bear down as if having a bowel movement, which can help assess how far the uterus has slipped into your vagina. To check the strength of your pelvic muscles, your doctor may ask you to tighten (contract) them, as if you're stopping the stream of urine. You may be examined while lying down and while standing up.
- Questionnaire. You may fill out a form that helps your doctor assess how uterine prolapse affects your quality of life. This information also helps guide treatment decisions.
Imaging tests, such as an ultrasound or magnetic resonance imaging (MRI), aren't generally needed for uterine prolapse. But they're sometimes helpful in assessing the degree of prolapse.
Treatments and drugs
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If you have mild uterine prolapse, either without symptoms or with symptoms that don't bother you, you probably don't need treatment. However, your pelvic floor may continue to lose tone, making uterine prolapse more severe as time goes on. Check back with your doctor to monitor the extent of your prolapse and review your symptoms.
Simple self-care measures, such as performing exercises called Kegels to strengthen your pelvic muscles, may provide symptom relief. Maintaining a healthy weight and avoiding heavy lifting may help reduce pressure on supportive pelvic structures.
For more-severe cases of uterine prolapse, treatment options include:
Vaginal pessary. This device fits inside your vagina and holds your uterus in place. Used as temporary or permanent treatment, vaginal pessaries come in many shapes and sizes, so your doctor will measure and fit you for the proper device. You'll also learn how to insert, remove and clean the pessary. You may be able to take the pessary out overnight and reinsert it each day.
But a vaginal pessary may be of little use if you have severe uterine prolapse. Also, a vaginal pessary can irritate vaginal tissues, possibly to the point of causing sores (ulcers) on vaginal tissues, and it may interfere with sexual intercourse.
Surgery. To repair damaged or weakened pelvic floor tissues, doctors often use a vaginal approach to surgery, although sometimes doctors recommend an abdominal surgery. A hysterectomy, which removes your uterus, also may be needed.
As an alternative to vaginal and abdominal surgery, your doctor may recommend minimally invasive (laparoscopic) surgery. This procedure involves smaller abdominal incisions, special surgical instruments and a lighted camera-type device (laparoscope) to guide the surgeon.
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.
Which surgery and surgical approach your doctor recommends depends on your individual needs and circumstances. Each surgery has pros and cons that you'll need to discuss with your surgeon.
If you plan to have more children, you might not be a good candidate for surgery to repair uterine prolapse. 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, the risks of surgery might outweigh the benefits. In these instances, pessary use may be your best treatment choice for bothersome symptoms.
Talk with your doctor to learn your options, including the benefits and risks.
Lifestyle and home remedies
Depending on the severity of your condition, these self-care measures may provide relief:
- Perform Kegel exercises.
- Avoid constipation by eating high-fiber foods and drinking plenty of fluids.
- Avoid heavy lifting and straining.
- Try to control coughing.
- Lose weight if you're overweight or obese.
Kegel exercises strengthen your pelvic floor muscles, which support the uterus, bladder and bowel. A strong pelvic floor provides better support for your pelvic organs and relief from symptoms associated with uterine prolapse.
To perform Kegel exercises, follow these steps:
- Tighten (contract) your pelvic floor muscles — the muscles you use to stop urinating.
- Hold the contraction for five seconds, then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing for three seconds.)
- Work up to holding the contractions for 10 seconds at a time.
- Do three sets of 10 repetitions each day.
Ask your health care provider for feedback on whether you're using the right muscles. Kegel exercises may be most successful when they're taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you're tightening the proper muscles with optimal intensity and length of time.
Once you've learned the proper method, you can do Kegel exercises discreetly just about anytime, whether you're sitting at your desk or relaxing on the couch.
Although uterine prolapse isn't always preventable, you may be able to decrease your risk if you:
- Perform Kegel exercises on a regular basis. These exercises can strengthen your pelvic floor muscles — especially important after you have a baby.
- Treat and prevent constipation. Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans and whole-grain cereals.
- Avoid heavy lifting and lift correctly. When lifting, use your legs instead of your waist or back.
- Control coughing. Get treatment for a chronic cough or bronchitis, and don't smoke.
- Avoid weight gain. Talk with your doctor to determine your ideal weight and get advice on weight-loss strategies, if you need them.
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