Definition and Overview

Uterine prolapse occurs when the uterus (womb) slips out of its normal position in the pelvis and protrudes out of the vagina. It happens when the uterus loses its strong support from pelvic floor muscles and ligaments that are supposed to keep it in place.

The pelvic floor is consists of connective tissue, muscles, and ligaments that support pelvic organs, such as the uterus and the bladder. The supporting tissues can be weakened by a number of reasons including pregnancy, vaginal childbirth, and menopause. Depending on the severity of the damage to the pelvic floor, uterine prolapse can be mild, moderate, or severe. Mild cases do not require treatment unless patients experience discomfort and if the condition affects their quality of life. Severe cases, which may cause difficulties in passing stool or urine, may require surgery.

Uterine prolapse has four stages, each indicating how far the uterus has descended.

  • Stage I - The uterus has reached the upper half of the vagina

  • Stage II - The uterus is close to the opening of the vagina

  • Stage III - The uterus protrudes out of the vagina

  • Stage IV - Also referred to as complete uterine prolapse, this stage means that the uterus is completely out of the vagina.

Uterine prolapse can affect women of any age but it is most common in women over 50.

Causes of Condition

Uterine prolapse occurs when the pelvic floor and connective tissues that support the uterus are weakened, stretched, or damage due to:

  • Certain medical conditions that weaken the connective tissues

  • Chronic constipation that leads to repeated straining

  • Chronic coughing due to long-term lung conditions, including asthma and bronchitis

  • Damage to supporting tissues during pregnancy and childbirth

  • Difficult labour and delivery

  • Fibroids

  • Heavy lifting

  • Loss of muscle tone

  • Low levels of sex hormone oestrogen due to ageing or menopause

  • Multiple births (such as twins or triplets)

  • Obesity

  • Pelvic surgery complications

  • Pelvic tumours

Key Symptoms

Uterine prolapse symptoms range from mild to severe depending on the stage of the condition. Patients with stages III and IV uterine prolapse usually experience the following:

  • Urinary and bowel movement problems

  • Tissue protruding from the vaginal opening

  • Low back pain

  • Heaviness or pressure in the vagina or pelvis

  • Discomfort during sexual intercourse

  • Vaginal bleeding/discharge

  • Difficulty inserting tampons

The symptoms of uterine prolapse are usually less bothersome in the morning but worsen progressively throughout the day.

Who to See and Types of Treatments Available

Uterine prolapse is diagnosed by reviewing the patient’s symptoms and through a pelvic exam wherein a speculum is used to examine the vaginal canal and uterus. Patients are typically asked to bear down as if they are having a bowel movement to assess the degree of prolapse.

Uterine prolapse treatment is not always necessary especially in mild cases where there are no bothersome symptoms. Home remedies such as doing Kegel exercises on a regular basis, maintaining a healthy weight, and avoiding heavy lifting can help strengthen supportive pelvic structures. If muscles continue to weaken, the following treatment methods can be considered:

  • Vaginal pessary - Patients who elect not to undergo surgical procedures for the treatment of uterine prolapse and those who wish to get pregnant in the future can opt to use a vaginal pessary, a medical device that is inserted into the vagina to provide structural support. Although very effective, this form of treatment has downsides. It can increase a patient’s risk of vaginal irritation, vaginal discharge, bleeding, and ulceration. It can also cause painful intercourse for both the patient and her partner.

  • Surgery - In severe cases, surgery for uterine prolapse is recommended to provide a definitive cure and long-lasting symptoms relief. The surgery can focus on strengthening weakened pelvic floor structures using tissue either from the patient’s own body or a donor. Hysterectomy, or the removal of the uterus, is also an option for women who no longer wish to get pregnant in the future.

Uterine prolapse surgery can be performed via traditional open method, which requires an incision in the abdominal wall or through the vagina. It can also be performed using minimally invasive method that uses small incisions where a laparoscope and specialised surgical instruments are inserted. The surgeon performs the procedure using imaging technology for guidance. This option is very popular among surgeons and patients because it minimises the risk of scarring, hospital stay, and recovery time.

References:

  • Frequently asked questions. Gynecologic problems FAQ012. Pelvic support problems. American College of Obstetricians and Gynecologists.

  • http://www.acog.org/~/media/For%20Patients/faq012.ashx.

  • Lentz GM. Anatomic defects of the abdominal wall and pelvic floor: abdominal and inguinal hernias, cystocele, urethrocele, enterocele, rectocele, uterine and vaginal prolapse: diagnosis and management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 20.

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