Uterine Prolapse

What is uterine prolapse?

Uterine prolapse is when your uterus slips into your vagina.

What increases my risk for uterine prolapse?

Your uterus may prolapse if the tissue and muscles supporting your uterus become weak or damaged. The following increases your risk of uterine prolapse:

  • Aging: Aging and decreased hormones can cause your pelvic muscles to become weaker.

  • Pregnancy or childbirth: This causes increased pressure and may stretch and weaken your pelvic muscles. You may have had trauma during childbirth from forceps or your baby's head.

  • Straining: Constipation, severe coughing, or lifting heavy objects may cause increased pressure inside your abdomen.

  • Family history: If your mother or sister has had uterine prolapse, you may have a higher risk for prolapse.

  • Obesity: If you weigh more than your caregiver recommends, it may increase your risk for uterine prolapse. Extra weight puts pressure on the tissues and muscles holding up your uterus and may cause them to weaken.

  • Surgery: Pelvic surgery may increase your risk for uterine prolapse.

  • Collagen diseases: You may have a disease, such as Marfan's syndrome and Ehlers-Danlos syndrome, that makes your pelvic muscles weak.

What are the signs and symptoms of uterine prolapse?

  • Pelvic pressure or heaviness

  • A soft bulge or lump in your vagina that may protrude through your vaginal opening

  • Pain in your lower back, pelvis, or vagina

  • Pain during sex

How is uterine prolapse diagnosed?

Your caregiver will ask about your health history. Tell him about pregnancies or prior surgeries. You may need the following:

  • Pelvic exam: Your caregiver gently puts a speculum in your vagina. This may help find how far your uterus has prolapsed. Your caregiver may also ask you to tighten the muscles of your pelvis as if you are trying to stop urinating. This helps find how strong your pelvic muscles are. Your caregiver may also check your prolapse when you are standing to see how far your uterus has fallen into your vagina.

  • Post-void residual: This test is done to see if you are able to empty your bladder completely. Your caregiver will have you urinate. Then he uses an ultrasound to check for urine in your bladder. He may use a catheter to drain any remaining urine.

How is uterine prolapse treated?

The goal of treatment is to correct your uterine prolapse and relieve your signs and symptoms. Treatment may include any of the following:

  • Medicines: Estrogen may help strengthen the pelvic muscles and keep your uterine prolapse from getting worse. This may be taken as a pill, applied as a cream, or inserted into your vagina.

  • Vaginal devices: You may need a device, such as a pessary or sphere, to hold your uterus in place and support your muscles. These devices may help decrease pressure on other pelvic organs, or help you do Kegel exercises.

  • Surgery: You may need one of the following surgeries to fix your uterine prolapse:

    • Surgery to fix weakened tissue: The muscles and tissues that hold your uterus in place will be tightened. Your caregiver may use a mesh patch or a tissue graft to support or hold your uterus in place.

    • Hysterectomy: Your uterus will be removed during this surgery.

    • Obliterative surgery: All or part of your vagina will be closed to hold your uterus in place. With obliterative surgery, you will no longer be able to have vaginal sex.

What are the risks of uterine prolapse?

  • Pessaries may cause you to have a vaginal infection if they are not cared for properly. You may get a urinary tract infection, have kidney swelling, or a fistula (a tunnel between your vagina and anus). Pessaries may also cause irritation or bleeding in your vagina. You may bleed more than expected during surgery and need a blood transfusion. You may leak urine after surgery and feel pain during sex. If your caregiver used mesh during surgery to hold up your uterus, it may become infected. The mesh may also break down and you may need another surgery to remove it. Your bladder or other organs in your pelvis may be injured during surgery. Even after surgery, your uterus may prolapse again.

  • If your uterine prolapse is not treated, your uterus may fall further down into your vagina. Your bladder and bowel may also prolapse, and your symptoms may be harder to treat.

How do I manage my symptoms?

  • Do Kegel exercises: These exercises strengthen the muscles that hold your uterus in place. They also tighten the muscles you use when you urinate or have a bowel movement. Tighten muscles in your pelvis (muscles you use to stop urinating). Hold the muscles tight for 5 seconds, then relax for 5 seconds. Gradually work up to holding the muscles contracted for 10 seconds. Do at least 3 sets of 10 repetitions a day.

  • Avoid straining: Do not lift heavy objects, stand for long periods of time, or strain to have a bowel movement. Prevent constipation by drinking plenty of liquids and eating foods high in fiber. Ask how much liquid to drink every day. High fiber foods include fresh fruits, vegetables, and whole grains.

  • Maintain a healthy weight: Ask your caregiver if you need to lose weight and how much you need to lose. Weighing too much can put pressure on the tissues and muscles of your uterus and make your symptoms worse. Ask him to help you with a weight loss program.

When should I contact my caregiver?

Contact your caregiver if:

  • You are leaking urine or bowel movement.

  • You have a fever.

  • You have foul-smelling fluid coming from your vagina.

  • You see blood coming from your vagina that is not from your monthly period.

  • You have questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • You have bleeding from your vagina that does not stop.

  • You have a mass coming out of your vagina that you cannot push back in.

  • You are unable to urinate or have a bowel movement.

  • You have severe abdominal pain.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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