Uterine Prolapse

What is uterine prolapse?

Uterine prolapse is a condition in which a woman's uterus (womb) sags or slips out of its normal position. The uterus may slip enough that it drops partway into the vagina (birth canal), creating a lump or bulge. This is called incomplete prolapse. In a more severe case called complete prolapse the uterus slips so far out of place that some of the tissue drops outside of the vagina.

What are the symptoms of uterine prolapse?

Women with mild cases of uterine prolapse may have no obvious symptoms. However, as the uterus slips further out of position, it can place pressure on other pelvic organs such as the bladder or bowel causing a variety of symptoms, including:

Symptoms may be worsened by prolonged standing or walking. This is due to the added pressure placed on the pelvic muscles by gravity.

What causes uterine prolapse?

The uterus is held in place within the pelvis by a group of muscles and ligaments. As these structures weaken, they become unable to hold the uterus in position, and it begins to sag. There are several factors that may contribute to the weakening of the pelvic muscles, including:

Who gets uterine prolapse?

Uterine prolapse most often occurs in women who have had more than one baby through normal vaginal delivery and in post-menopausal women. Menopause occurs when a woman's ovaries stop producing the hormones that regulate her monthly menstrual cycle, and she stops having regular menstrual periods. One of these hormones, estrogen, helps keep the pelvic muscles strong.

How common is uterine prolapse?

Uterine prolapse is fairly common, and the risk of developing the condition increases with age.

How is uterine prolapse diagnosed?

The doctor will perform a pelvic examination to determine if the uterus has lowered from its normal position. During a pelvic exam, the doctor inserts a speculum (an instrument that lets the clinician see inside the vagina) and examines the vagina and uterus. The doctor will feel for any bulges caused by the uterus protruding into the vaginal canal.

How is uterine prolapse treated?

There are surgical and non-surgical options for treating uterine prolapse. The treatment chosen will depend on the severity of the condition, as well as the woman's general health, age and desire to have children. Treatment generally is effective for most women. Treatment options include the following:

Non-surgical options

Exercise Special exercises, called Kegel exercises, can help strengthen the pelvic floor muscles. This may be the only treatment needed in mild cases of uterine prolapse. To do Kegel exercises, tighten your pelvic muscles as if you are trying to hold back urine. Hold the muscles tight for a few seconds and then release. Repeat 10 times. You may do these exercises anywhere and at any time (up to four times a day).

Vaginal pessary A pessary is a rubber or plastic doughnut-shaped device that fits around or under the lower part of the uterus (cervix), helping to prop up the uterus and hold it in place. A health care provider will fit and insert the pessary, which must be cleaned frequently and removed before sex.

Estrogen replacement therapy (ERT) Taking estrogen may help to limit further weakness of the muscles and other connective tissues that support the uterus. However, there are some drawbacks to taking estrogen, such as an increased risk of blood clots, gallbladder disease and breast cancer. The decision to use ERT must be made with your doctor after carefully weighing all of the risks and benefits.

Surgical options

Hysterectomy Uterine prolapse may be treated by removing the uterus in a surgical procedure called hysterectomy. This may be done through an incision made in the vagina (vaginal hysterectomy) or through the abdomen (abdominal hysterectomy). Hysterectomy is major surgery, and removing the uterus means pregnancy is no longer possible.

Uterine suspension This procedure involves putting the uterus back into its normal position. This may be done by reattaching the pelvic ligaments to the lower part of the uterus to hold it in place. Another technique uses a special material that acts like a sling to support the uterus in its proper position. Recent advances include performing this with minimally invasive techniques and laparoscopically (through small band aid sized incisions) that decrease post operative pain and speed recovery.

What are the complications of uterine prolapse?

Left untreated, uterine prolapse can interfere with bowel, bladder and sexual functions.

Can uterine prolapse be prevented?

It may not be possible to prevent all cases of uterine prolapse, but there are steps that can be taken to help reduce the risk:

Proper techniques for lifting

 

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: 10/7/2013

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