Uterine Prolapse

Uterine prolapse is a condition in which the muscles and tissues that hold a woman's uterus (womb) in place become stretched, damaged or weakened, causing the uterus to sag or drop down out of its normal position and into the vagina. Mild cases of uterine prolapse are common. They often cause no symptoms and don't generally require treatment. Uterine prolapse frequently affects postmenopausal women who've had one or more vaginal deliveries.

Factors that may weaken the pelvic muscles and lead to uterine prolapse include:

• Pregnancy and childbirth, including trauma from large babies, multiple deliveries, or difficult labor and delivery
• Aging
• Loss of estrogen after menopause
• Repeated straining over the years (from coughing, obesity, chronic constipation)
• Family history

Women with mild cases of uterine prolapse may not experience any symptoms. In moderate or severe cases, where the uterus slips further out of position and places pressure on the bladder, bowel and other organs, symptoms may include:

• A feeling of heaviness or pulling in the pelvis
• Pain in the pelvis, abdomen or lower back
• Pain during intercourse
• Tissue protruding from the opening of the vagina
• Recurrent bladder infections
• Unusual or excessive discharge from the vagina
• Constipation
• Voiding difficulties, including involuntary urine leakage (incontinence)

Standing or walking may worsen these symptoms as added pressure is placed on the pelvic muscles.

The doctor will perform a pelvic exam to see if the uterus is lower than normal and feel for any bulges caused by the uterus protruding into the vaginal canal. You may be examined both while lying down and while standing. You may also be asked to strain or cough during the exam. Imaging tests might be used to gather more information about the uterine prolapse.

Treatment options include:

Lifestyle changes. Such as losing weight, not smoking, doing Kegel exercises to strengthen pelvic floor muscles, and avoiding heavy lifting or straining.

Vaginal pessary. A device inserted into the vagina to prop up the uterus and hold it in place.

Surgery. To restore the normal position of the uterus. Uterine prolapse surgery can be performed either through the vagina or the abdomen, including minimally invasive laparoscopic surgery to decrease pain and speed recovery. Possible procedures include hysterectomy to remove the uterus and excess vaginal tissue, and uterine suspension to put the uterus back into its normal position.

The risk of developing the condition increases with age. During menopause, the ovaries stop producing hormones that regulate a woman's monthly menstrual cycle, and she stops having regular periods. One of these hormones, estrogen, helps keep the pelvic muscles strong. Women who have had vaginal deliveries are also at higher risk. Additional factors that may increase your risk of uterine prolapse include:

• Giving birth to a large baby
• Frequent heavy lifting
• Chronic coughing
• Frequent straining during bowel movements

While prevention may not be possible in all cases, steps can be taken to reduce your risk of developing uterine prolapse, including:

• Maintain a healthy weight
• Exercise regularly, including Kegel exercises to strengthen pelvic floor muscles
• Eat a healthy, high-fiber diet
• Don't smoke
• Talk with your doctor about estrogen replacement therapy after menopause
• Use correct lifting techniques