Uterine Prolapse

Uterine prolapse at a glance:

  • Uterine prolapse occurs when the uterus drops (prolapses) into the vagina.
  • The uterus (womb) is normally supported in the pelvic area by ligaments, muscles and tissues. When this structure of support weakens, a uterine prolapse can occur.
  • This weakening can be caused by childbirth, age and other risk factors.
  • Treatments range from exercises that strengthen pelvic floor muscles to surgery.

Causes of uterine prolapse

Uterine prolapse often occurs in postmenopausal women who have experienced tissue damage from one or more vaginal deliveries, particularly with a large baby. However, any woman can experience uterine prolapse.

Causes include:

  • Weakness in the pelvic muscle, ligaments and tissues due to age or loss of estrogen with menopause
  • Conditions that result in straining the pelvic area, such as constipation and coughing due to asthma
  • Being overweight
  • Previous surgery in the pelvic area
  • Frequent heavy lifting
  • Genetic disposition to a weakening of supporting tissues

Uterine prolapse is one of several types of pelvic organ prolapse (POP) in which an organ drops (prolapses) into the vaginal wall. Other forms of pelvic organ prolapse (such as bladder, rectum, small bowel) are often present when uterine prolapse occurs.

Symptoms

There are different degrees of uterine prolapse, with the first degree involving the cervix dropping into the vagina and the most severe involving the uterus being entirely outside the vagina.

General symptoms include:

  • A sensation that something is in the vagina or coming out of the vagina opening
  • A feeling often described as sitting on a small ball
  • Urination and bowel movement difficulty
  • Pain during sex
  • Lower back pain
  • Symptoms that worsen throughout the day

Treatments for uterine prolapse

Mild cases of uterine prolapse require observation but no treatment. If symptoms become aggravating, treatments may be beneficial. Kegel exercises to strengthen the pelvic floor muscles are the first line of treatment, followed by fitting and inserting a pessary ring in the vaginal canal to provide support for the uterus.

For more severe cases, surgery can repair the supporting structure of the uterus. This can be performed through the vagina or abdominally, depending on the patient and the extent of the uterine prolapse. Various forms of tissue repair may be involved, including the use of grafts and synthetic meshes.

Minimally invasive surgery via a small abdominal incision is sometimes an option. Removal of the uterus (hysterectomy) may be necessary.

Surgery is not recommended if the patient plans to have children afterward.

If you have uterine prolapse, contact us to request an appointment with one of the University of Colorado’s Urogynecologists to learn more about your treatment options.