What Is Uterine Prolapse?

When the pelvic floor muscles become too weak to support the uterus, the reproductive organ can begin to drop into the vagina. In some cases, the uterus can protrude out of the vagina. This is called uterine prolapse.

Although only about 3% of people will experience symptoms, proper health screening is important for the early detection, diagnosis, and treatment of uterine prolapse.

This article discusses the symptoms, causes, treatment, and prevention of uterine prolapse.

What Is Uterine Prolapse?

The pelvic floor muscles support the uterus, rectum, vagina, and bladder and help stabilize the core. Made of muscle, connective tissue, and ligaments, the pelvic floor facilitates bodily functions like urinating, having bowel movements, and enjoying sex.

Unfortunately, when the pelvic floor muscles weaken, the uterus is no longer supported and begins to sag into the vagina or protrude out. Uterine prolapse is a type of pelvic organ prolapse (POP).

The stages of uterine prolapse are:

• Stage 1: The uterus drops into the upper part of the vagina.
• Stage 2: The uterus drops to the opening of the vagina.
• Stage 3: The uterus protrudes out of the vagina.
• Stage 4: The uterus is entirely out of the vagina.

Symptoms of Uterine Prolapse

Sometimes the symptoms of uterine prolapse can be absent or very subtle. Your healthcare provider may discover the condition inadvertently during an exam. Other people experience significant discomfort, especially while walking or standing. Symptoms of uterine prolapse include:

• Fullness or heaviness in the pelvis
• Low-back pain
• Inability to insert a tampon or applicator into the vagina
• Painful sex
• Constipation
• Incontinence (urinary leaking)
• Urinary retention (unable to empty the bladder)
• Seeing or feeling a bulge coming out of the vagina
  

Talk to a healthcare provider if you're having symptoms of uterine prolapse.

Causes of Uterine Prolapse

The main cause of uterine prolapse is weakened pelvic floor muscles. Strain and stretching of the pelvic floor connective tissue can decrease the muscle's ability to hold the uterus. Eventually, the uterus begins to sag or drop into the vagina.

The causes of weakened pelvic floor muscles include:

• Pregnancy and childbirth: The strain and stretching that occurs with pregnancy and vaginal childbirth weaken the pelvic floor muscles. Multiple vaginal births increase the risk.
• Menopause: Dropping estrogen levels lead to decreased pelvic floor muscle strength.
• Heavy lifting: Long-term or repeated heavy lifting can overload and weaken the pelvic floor muscles. Chronic coughing from smoking or asthma, straining, and having obesity can cause abdominal pressure resulting in uterine prolapse.
• Aging: Although uterine prolapse can affect people of all ages, most people who have it are over age 60.

Diagnosis of Uterine Prolapse

About 50% of people with a uterus will be diagnosed with some degree of uterine prolapse upon physical exam; only 3% of those will have symptoms. A healthcare provider will use a speculum to visualize the inside of the vagina. They will also assess for infection. If no bulge is seen, they may ask to examine you in the standing position.

Other tests may include:

• Rectal exam: Evaluates sphincter tone
• Urinalysis: Checks for a urinary tract infection (UTI)
• Bladder scanner: Estimates the amount of urine in your bladder after voiding (peeing).

Treatment of Uterine Prolapse

Uterine prolapse does not go away without treatment; even then, not all treatments cure the condition. Depending on the severity, untreated uterine prolapse can cause pain, infection, and the inability to urinate or have bowel movements.

Treatment options for uterine prolapse include:

• Pelvic floor muscle training: Doing 45–60 pelvic floor exercises (Kegels) daily, divided into sets of two or three, can improve the symptoms but does not reverse or treat the prolapse.
• Vaginal pessary: A plastic device is placed into the vagina to help support the pelvic organs. The device is fitted for comfort. This option is not appropriate for people with dementia or pelvic pain.

Surgery

People with a uterus have a nearly 13% lifetime risk of undergoing surgery for POP. Surgical interventions to correct or improve uterine prolapse include:

• Hysterectomy: Removal of the uterus
• Hysteropexy: Surgically lifts the uterus back into place
• Colpocleisis: Sewing together the walls of the vagina and shortening the vagina

When deciding which surgical intervention is best for you, it's important to consider your personal beliefs (religious, cultural, spiritual) and your desire for sexual function now and in the future.

Prevention of Uterine Prolapse

Although you can't completely prevent uterine prolapse, there are lifestyle choices that can reduce the likelihood of getting it. Measures to help prevent uterine prolapse include:

• Maintain a healthy weight: Obesity and weight gain increase abdominal pressure.
• Prevent constipation: Drink plenty of fluids and try to get 25 grams of fiber daily.
• Perform pelvic floor exercises: Get regular physical activity and strengthen the pelvic floor muscles by doing Kegels.
• Control coughing: One way is to eliminate smoking.
• Avoid heavy lifting: Use proper body mechanics to lift something heavy.
• Consider hormone replacement therapy during menopause.
  

Coping With Uterine Prolapse

Support for people with uterine prolapse is lacking, which can lead to feeling misunderstood and lonely. It's natural to feel disappointed and sad at first, but with time and support, you can find ways to cope with the condition.

Coping strategies that might be useful if diagnosed with uterine prolapse include:

• Ask for support from trusted family and friends.
• Educate yourself on ways to reduce symptoms of uterine prolapse.
• Incorporate a healthy lifestyle into daily practice.
• Be honest with your partner about feeling insecure or self-conscious.
  
• Continue to have intercourse if you can. Use good quality lubrication, try lying on your side or back with your hips elevated on a pillow, and take your time.
• Seek counseling from a therapist who specializes in sexual health.
  

Summary

Uterine prolapse occurs when the pelvic floor muscles are too weak to hold the uterus in place, and it drops into the vagina. Symptoms include pelvic heaviness, constipation, and seeing or feeling the uterus in the vagina. Childbirth, menopause, and age are contributing factors to uterine prolapse. Practicing a healthy lifestyle and performing pelvic floor exercises daily can help prevent prolapse of the uterus. There are also surgical procedures that can reduce the symptoms or cure the condition.