Uterine Prolapse

What is uterine prolapse?

• Uterine prolapse is when your uterus falls down into your vagina. A woman's uterus (womb) is the organ where a fetus (unborn baby) grows during pregnancy. The uterus is found inside the pelvis, which is the area from your belly button to your groin. Your uterus is held in place by strong tissues and muscles. With uterine prolapse, these tissues and muscles cannot hold up your uterus properly. Your uterus may press on other organs inside your pelvis, such as your bladder (organ that holds urine), bowel, and vagina.
  
  
• You may have a small uterine prolapse that causes no symptoms. Uterine prolapses that do not cause any discomfort may not need treatment. With a more severe (very bad) prolapse, your uterus and other tissues may bulge out of your vagina. You may feel pain, and you may leak urine. Treating your uterine prolapse may help to place your uterus back in its normal place. Treatment may relieve your symptoms such as feeling pain and pressure, and stop any urine leakage.

What causes uterine prolapse?

When the tissues and muscles holding your uterus in place are damaged or weak, your uterus may prolapse. The following may increase your risk for damaged or weakened tissues and muscles:

• Age: The tissues and muscles holding your uterus in place may weaken as you age. Menopause also occurs as a women ages causing the vagina to shrink and become weaker. Menopause is when you no longer have your monthly period.
  
  
• Childbirth: Having a baby stretches and tears the tissues and muscles holding up your uterus. Your risk of uterine prolapse increases every time you give birth vaginally. When forceps are needed to help you give birth, they may damage your muscles and cause muscle weakness. Having a long labor or a large baby may also increase your risk for uterine prolapse. Your risk may also be increased if you are younger than 25 years old the first time you have a baby.
  
  
• Constipation: Your stools may often be hard, dry, and difficult to pass. When you have to push hard to have BM's, the tissues and muscles holding up your uterus may weaken.
  
  
• Connective tissue disease: Diseases such as Ehlers-Danlos syndrome make the connective tissues of your body weak. This includes the tissues that hold up your uterus.
  
  
• Family history: If your mother or sister has had uterine prolapse, you may have a higher risk for prolapse also.
  
  
• Obesity: Weighing more than what your caregiver suggests may increase your risk for uterine prolapse. The extra weight may push on the tissues and muscles holding up your uterus causing them to weaken.
  
  
• Surgery: Having had surgery in the area of your pelvis may increase your risk for uterine prolapse.

What are the signs and symptoms of uterine prolapse?

• Feeling pressure or heaviness in your vagina or pelvis.
  
  
• Seeing or feeling something falling or sticking out of your vagina.
  
  
• Pain in your lower back, pelvis, or vagina.
  
  
• Feeling pain when having sex.

What other problems may I have with uterine prolapse?

• Other organs in your pelvis may also prolapse. You may have a cystocele (bladder prolapse), rectocele (bowel prolapse), or both. Ask your caregiver for more information about these conditions.
  
  
• The muscles that hold up your uterus are also used when urinating and having a BM. If these muscles are weak, you may have problems such as:
  
  
  • Leaking urine or BM.
    
    
  • Having to urinate more often than usual.
    
    
  • Taking longer to urinate than usual.
    
    
  • Feeling like there is something blocking your BM.
    
    
  • Feeling like you still have to urinate after you think you are done.
    
    
  • Needing to change position to start or continue urinating.
    
    
  • Needing to push into your vagina to start or continue urinating or having a BM.

How is uterine prolapse diagnosed?

Your caregiver may ask about any health problems you have, or have had. He may ask if any of your family members have had uterine prolapse. Your caregiver may also ask about any past surgeries you have had. He may ask about your signs and symptoms, and how many pregnancies and vaginal births you have had. If you have had a baby in the past, tell your caregiver if you had any problems while giving birth. You may need the following to diagnose your uterine prolapse:

• Pelvic exam:
  
  
  • Your caregiver will ask you to lie down with your legs apart and your feet placed in stirrups. He will look closely at your groin and vagina. Your caregiver will insert his fingers into your vagina. He will feel for your prolapse while you are relaxed. He may also ask you to cough while his fingers are inside your vagina. Your caregiver may insert a speculum (plastic or metal instrument) into your vagina. The speculum helps your caregiver see how far your uterus has prolapsed. You may be asked to push against the speculum when it is inside your vagina.
    
    
  • Your caregiver may also check your prolapse while you are standing up. This exam may help your caregiver learn how far your uterus has fallen down into your vagina. The exam may also help your caregiver feel how weak your muscles are.
  
  
• Post-void residual: You may need this test if you have problems such as leaking urine. For this test, you will be asked to urinate after you feel your bladder is full. Once you have urinated, your caregiver will check for any urine left in your bladder. He may use a small soft tube placed inside your bladder to drain the urine. Your caregiver may also use an ultrasound to check for urine in your bladder. An ultrasound is a test that uses sound waves to show pictures of your bladder on a TV-like screen.

How is uterine prolapse treated?

The goal of treatment is to correct your uterine prolapse and relieve your signs and symptoms. Your caregiver will work with you to decide which treatment is best for you. Treatment may include any of the following:

• Pelvic floor muscle exercises: These exercises are done to strengthen the muscles that hold your uterus in place. The exercises also tighten the muscles used for urinating and having a BM. Ask your caregiver about how to do these exercises.
  
  
• Vaginal devices: These devices hold your uterus in place and support your muscles.
  
  
  • Pessary: This is a silicone or plastic device that your caregiver will fit inside your vagina. The pessary pushes your uterus back up into its normal place. The pessary may also decrease any pressure on the other organs in your pelvis. It is important to have regular follow-up visits with your caregiver to check your pessary. Ask your caregiver for more information about how to care for your pessary.
    
    
  • Sphere: This is a ball with a string attached to it. The ball is inserted into your vagina and works by holding up your prolapsed uterus. You will be better able to do your pelvic floor muscle exercises with the sphere in place. Ask your caregiver for more information about how to use the sphere.
  
  
• Hormone cream: Your caregiver may give you hormone cream to put inside your vagina. If you lack certain hormones (chemicals that control how your body works) the tissue lining your vagina may become thin. Lacking hormones may make your vaginal tissue weaker. Replacing your hormones with cream may help stop your vagina from thinning.
  
  
• Surgery: You may need surgery to fix your uterine prolapse if it is severe. You may not be able to have sex or get pregnant after having certain surgeries to fix your prolapse. You and your caregiver will decide together which type of surgery is best for you. Ask your caregiver for more information about the following:
  
  
  • Hysterectomy: During this surgery your uterus will be removed from your body.
    
    
  • Obliterative surgery: During this surgery, all or a 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.
    
    
  • Surgery to fix weakened tissue: During this surgery the muscles and tissues that hold your uterus in place will be tightened. Your caregiver may use a mesh (net-like) to push back your prolapse and hold up your uterus. Your caregiver may also use a tissue graft to hold your uterus in place. A tissue graft may be man-made, or may be tissue from another part of your body. The tissue graft may also be from a donor (another person).

Where can I get more information?

Many women with uterine prolapse are embarrassed about their problem. These feelings are normal. Talk with your caregiver about your feelings and any concerns you may have. You may also contact the following for more information about uterine prolapse:

• The National Women's Health Information Center
  8270 Willow Oaks Corporate Drive
  Fairfax , VA 22031
  Phone: 1- 800 - 994-9662
  Web Address: http://www.womenshealth.gov
  

When should I call my caregiver?

• The pain or fullness in your pelvis gets worse.
  
  
• The bulge from your vagina gets bigger than when you first saw it.

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.

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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.

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