A Complete Overview of Uterine Prolapse
By Kristi Patrice Carter
A uterine prolapse occurs when the muscles and ligaments holding the uterus, or womb, in place have weakened causing it to fall or droop down into the vaginal canal. The word prolapse is used to indicate a descent or change in the normal positioning of the uterus.
Causes and risk factors for developing uterine prolapse include:
- Age: Women of advanced age who have given birth several times may be at risk for a prolapsed uterus due to weakened muscles and a loss of muscle tone.
- Being overweight: Being overweight or obese causes additional strain and pressure on the pelvic muscles, weakening them over time, possibly leading to a prolapsed uterus.
- Menopause: A natural loss of hormones, such as estrogen, after entering into menopause may cause a loss of muscle tone and a weakening of the uterine walls.
- Physical exertion: Women who lift weights excessively may be prone to uterine prolapse due to the added strain and pressure on the abdominal muscles.
- Pregnancy: Giving birth vaginally multiple times, or having a difficult or unusually long labor may lead to uterine prolapse, which is caused by added strain on the muscles that hold the uterus in place.
- Race: For reasons that are still largely unknown, Caucasian women are affected more often by uterine prolapse than women of other races.
- Surgery: Radical surgery performed in the pelvic area may lead to a loss of muscle tone and cause the uterus to prolapse.
Classic symptoms that may indicate a prolapsed uterus include:
- Difficulty walking or standing
- Difficulty urinating or trouble having a bowel movement
- Lower back pain
- Painful sexual intercourse
- Pressure in the pelvic area
- The sensation that something is falling out of the vagina
A complete medical history is necessary to ascertain whether or not uterine prolapse is a possibility, or if the symptoms experienced are being caused by another condition. A physical examination will be performed to determine if the uterus has in fact prolapsed. The doctor will examine you in several positions, including standing, lying down, and ask you to cough or strain to increase abdominal pressure.
Treatment options for uterine prolapse depend on the severity of the condition, how weakened the supporting structures around the uterus have become, and the patient’s overall health. In mild to moderate cases, exercises that strengthen the pelvic muscles may be helpful in thwarting the prolapse. These exercises that isolate and tighten the pelvic floor muscles are called Kegel exercises, named after Dr. Arnold Kegel who popularized the practice.
A pessary is a small plastic ring that is inserted into the vagina for support. This method of treatment is useful for patients who are not good candidates for surgery or who simply do not want to have a surgical procedure. Before the insertion of the pessary, the uterus and cervix are positioned into their normal place within the pelvis. Pessaries should not be used in women with acute pelvic infections or other similar complications as the device may cause additional discomfort, vaginal discharge or ulcerations, and bleeding.
Surgery is another treatment option for uterine prolapse, depending upon whether or not future pregnancies are a factor, and also the severity of the condition. The uterus can be repaired or completely removed in a procedure known as a hysterectomy. The vaginal walls, urethra, and bladder may also be repaired during surgery, which can either be performed abdominally, vaginally, or via a laparoscopic procedure.