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Uterine prolapse

Overview

Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken and no longer provide enough support for the uterus. As a result, the uterus slips down into or protrudes out of the vagina.

Uterine prolapse can occur in women of any age. But it often affects postmenopausal women who've had one or more vaginal deliveries.

Mild uterine prolapse usually doesn't require treatment. But if uterine prolapse makes you uncomfortable or disrupts your normal life, you might benefit from treatment.

Uterine prolapse

Normally, supporting ligaments and other connective tissues hold your uterus in place inside your pelvic cavity. Weakening of these supportive structures allows the uterus to slip down into the vagina. As a result, the vagina also is pulled down and may turn inside out. Doctors refer to this downward movement of the uterus as uterine prolapse.

Symptoms

Mild uterine prolapse generally doesn't cause signs or symptoms. Signs and symptoms of moderate to severe uterine prolapse include:

  • Sensation of heaviness or pulling in your pelvis
  • Tissue protruding from your vagina
  • Urinary problems, such as urine leakage (incontinence) or urine retention
  • Trouble having a bowel movement
  • Feeling as if you're sitting on a small ball or as if something is falling out of your vagina
  • Sexual concerns, such as a sensation of looseness in the tone of your vaginal tissue

Often, symptoms are less bothersome in the morning and worsen as the day goes on.

When to see a doctor

See your doctor to discuss your options if signs and symptoms of uterine prolapse become bothersome and disrupt your normal activities.

Causes

Uterine prolapse results from the weakening of pelvic muscles and supportive tissues. Causes of weakened pelvic muscles and tissues include:

  • Pregnancy
  • Difficult labor and delivery or trauma during childbirth
  • Delivery of a large baby
  • Being overweight or obese
  • Lower estrogen level after menopause
  • Chronic constipation or straining with bowel movements
  • Chronic cough or bronchitis
  • Repeated heavy lifting

Risk factors

Factors that can increase your risk of uterine prolapse include:

  • One or more pregnancies and vaginal births
  • Giving birth to a large baby
  • Increasing age
  • Obesity
  • Prior pelvic surgery
  • Chronic constipation or frequent straining during bowel movements
  • Family history of weakness in connective tissue
  • Being Hispanic or white

Complications

Uterine prolapse is often associated with prolapse of other pelvic organs. You might experience:

  • Anterior prolapse (cystocele). Weakness of connective tissue separating the bladder and vagina may cause the bladder to bulge into the vagina. Anterior prolapse is also called prolapsed bladder.
  • Posterior vaginal prolapse (rectocele). Weakness of connective tissue separating the rectum and vagina may cause the rectum to bulge into the vagina. You might have difficulty having bowel movements.

Severe uterine prolapse can displace part of the vaginal lining, causing it to protrude outside the body. Vaginal tissue that rubs against clothing can lead to vaginal sores (ulcers.) Rarely, the sores can become infected.

Diagnosis

A diagnosis of uterine prolapse generally occurs during a pelvic exam.

During the pelvic exam your doctor is likely to ask you:

  • To bear down as if having a bowel movement. Bearing down can help your doctor assess how far the uterus has slipped into the vagina.
  • To tighten your pelvic muscles as if you're stopping a stream of urine. This test checks the strength of your pelvic muscles.

You might fill out a questionnaire that helps your doctor assess how uterine prolapse affects your quality of life. This information helps guide treatment decisions.

If you have severe incontinence, your doctor might recommend tests to measure how well your bladder functions (urodynamic testing).

Pelvic exam

In a pelvic exam, your physician inserts two gloved fingers inside your vagina. While simultaneously pressing down on your abdomen, he or she can examine your uterus, ovaries and other organs.

Treatment

Treatment depends on the severity of uterine prolapse. Your doctor might recommend:

  • Self-care measures. If your uterine prolapse causes few or no symptoms, simple self-care measures may provide relief or help prevent worsening prolapse. Self-care measures include performing Kegel exercises to strengthen your pelvic muscles, losing weight and treating constipation.
  • Pessary. A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bulging tissues. A pessary must be removed regularly for cleaning.

Surgery

If uterine prolapse is severe, your doctor might recommend surgery. Minimally invasive (laparoscopic) or vaginal surgery might be an option.

Surgery can involve:

  • Repair of weakened pelvic floor tissues. This surgery is generally approached through the vagina but sometimes through the abdomen. The surgeon might graft your own tissue, donor tissue or a synthetic material onto weakened pelvic floor structures to support your pelvic organs.
  • Removal of your uterus (hysterectomy). Hysterectomy might be recommended if uterine prolapse is severe.
Pessary types

Pessaries come in many shapes and sizes. The device fits into your vagina and provides support to vaginal tissues displaced by pelvic organ prolapse. Your health care provider can fit you for a pessary and help you decide which type would best suit your needs.

Preparing for an appointment

You may be referred to a gynecologist.

Here's some information to help you get ready for your appointment.

What you can do

  • List symptoms you've been having, and for how long
  • List all medications, vitamins and supplements you take, including the doses
  • List key personal and medical information, including other conditions, recent life changes and stressors
  • Prepare questions to ask your doctor

For uterine prolapse, some basic questions to ask your doctor include:

  • What can I do at home to ease my symptoms?
  • What are the chances that the prolapse will worsen if I don't do anything?
  • What treatment approach do you recommend?
  • What's the likelihood that the uterine prolapse will recur if I have it surgically treated?
  • What are the risks of surgery?

During your appointment, don't hesitate to ask other questions as they occur to you.

What to expect from your doctor

Questions your doctor is likely to ask include:

  • What symptoms are you experiencing?
  • When did you first notice your symptoms? Have they worsened over time?
  • Do you have pelvic pain?
  • Do you ever leak urine?
  • Have you had a severe or ongoing cough?
  • Do you do any heavy lifting in your job or daily activities?
  • Do you strain during bowel movements?
  • Has anyone in your family ever had uterine prolapse or any other pelvic problems?
  • How many children have you given birth to? Were your deliveries vaginal?
  • Do you plan to have children in the future?

Lifestyle and home remedies

Depending on the severity of your uterine prolapse, self-care measures may provide relief. Try to:

  • Perform Kegel exercises to strengthen pelvic muscles and support the weakened fascia
  • Avoid constipation by eating high-fiber foods and drinking plenty of fluids
  • Avoid bearing down to move your bowels
  • Avoid heavy lifting
  • Control coughing
  • Lose weight if you're overweight or obese

Kegel exercises

Kegel exercises strengthen your pelvic floor muscles. A strong pelvic floor provides better support for your pelvic organs, prevents prolapse from worsening and relieves symptoms associated with uterine prolapse.

To perform Kegel exercises:

  • Tighten (contract) your pelvic floor muscles as though you were trying to prevent passing gas.
  • Hold the contraction for five seconds, and then relax for five seconds. If this is too difficult, start by holding for two seconds and relaxing for three seconds.
  • Work up to holding the contractions for 10 seconds at a time.
  • Aim for at least three sets of 10 repetitions each day.

Kegel exercises may be most successful when they're taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you're tightening the muscles properly for the best length of time.

Once you've learned the proper method, you can do Kegel exercises discreetly just about anytime, whether you're sitting at your desk or relaxing on the couch.

Prevention

To reduce your risk of uterine prolapse, try to:

  • Perform Kegel exercises regularly. These exercises can strengthen your pelvic floor muscles — especially important after you have a baby.
  • Treat and prevent constipation. Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans and whole-grain cereals.
  • Avoid heavy lifting and lift correctly. When lifting, use your legs instead of your waist or back.
  • Control coughing. Get treatment for a chronic cough or bronchitis, and don't smoke.
  • Avoid weight gain. Talk with your doctor to determine your ideal weight and get advice on weight-loss strategies, if you need them.

Advanced diagnosis and treatment

Uterine prolapse is often associated with other pelvic floor disorders. Mayo Clinic has advanced imaging to assist with diagnosis of complex pelvic floor conditions, including the full range of urodynamic testing.

Nonsurgical treatment often involves intensive pelvic floor retraining exercises, biofeedback training and constipation education classes led by a dietitian and a nurse educator. Research indicates that about half of women who have only verbal instructions in Kegel exercises don't perform them effectively. At Mayo Clinic, physical therapists work with you to help you learn to perform Kegel exercises effectively.

Other nonsurgery specialty services offered at Mayo Clinic include:

  • Minimally invasive injection therapies
  • Botox injections of the urinary tract
  • Neuromodulation for the urinary tract

If surgery is needed, Mayo Clinic specialists have experience with procedures to repair complex pelvic floor conditions, including management of mesh complications.

If you need a hysterectomy, your Mayo Clinic surgeon will choose minimally invasive surgery — performed through an incision in the vagina or through small abdominal incisions (laparoscopic surgery) — whenever possible. Depending on your needs, you may be a candidate for robotic hysterectomy.

Last updated: August 2nd, 2017

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