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Uterine Prolapse
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Uterine Prolapse

(Pelvic Floor Hernia; Pudendal Hernia; Pelvic Relaxation)

En Español (Spanish Version)

Definition

Uterine prolapse occurs when the uterus (womb) slips out of place and into the vaginal canal due to weakening of the muscles and ligaments of the lower abdomen (called the “pelvic floor”), which normally support the uterus and other organs in the pelvis. The severity of uterine prolapse is defined as:

  • First degree (mild)—the cervix (the lower opening of the uterus into the vagina) protrudes into the lower third of the vagina
  • Second degree (moderate)—the cervix protrudes past the vaginal opening
  • Third degree (severe)—the entire uterus protrudes past the vaginal opening

Recently, more sophisticated methods of measuring and describing the degree of prolapse have been developed. These resemble three-dimensional engineering diagrams.

Other organs, such as the ovaries or bladder, may also be out of place due to the weakening of the pelvic floor tissues.

Uterine Prolapse

uterine prolapse

© 2008 Nucleus Medical Art, Inc.

Causes

The uterus is normally supported by pelvic connective tissue, the pubococcygeus muscle, and held in position by special ligaments. Weakening of these tissues causes the uterus to descend into the vaginal canal.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. The following factors are associated with an increased risk of uterine prolapse:

  • Multiple pregnancies and vaginal deliveries—Uterine prolapse occurs most commonly in women who have had one or more vaginal births. Tissue trauma sustained during childbirth, especially with large babies or difficult labor and delivery, is typically the cause of muscle weakness.
  • Retroverted uterus (positioned backwards from normal)
  • Age (especially the years past menopause )—The loss of muscle tone and the relaxation of muscles, which are both associated with normal aging and a reduction in the female hormone estrogen, are also thought to play an important role in the development of uterine prolapse.
  • Obesity —places additional strain on the supportive muscles of the pelvis
  • Large uterine or ovarian tumors—Prolapse can also be caused by a pelvic tumor; however, this is fairly rare.
  • Activities increasing the pressure in the abdomen and pelvis, including:
  • Race: Caucasian

Symptoms

There may be no symptoms for mild cases of uterine prolapse. Symptoms for more severe cases may include:

  • Sensation of fullness in the vagina
  • Sensation of pulling in the pelvis
  • Pain in the vagina, lower back, or lower abdomen
  • Vaginal discharge
  • Leakage of urine
  • Difficulty voiding urine
  • Frequent urinary tract infections
  • Protrusion of pink tissue from the vagina that may be irritated or itchy

Diagnosis

Your healthcare provider will ask about your symptoms and medical history, and perform a physical exam, including a thorough pelvic exam.

Treatment

Treatment may include:

Kegel Exercises

For mild cases of uterine prolapse, Kegel exercises are recommended to strengthen the pelvic muscles. These exercises are easy to do and can be done anywhere, at any time. To perform Kegel exercises:

  • Squeeze the pelvic muscles as though you are trying to hold back urine.
  • Hold this position for a count of ten, then release slowly.
  • Do this ten times, four times daily.

Referral to a Specialist

You may be referred to a gynecologist or a urogynecologist for further evaluation or surgery.

Pessary Insertion

This is a rubbery, doughnut-shaped device. It is inserted by your doctor into the upper portion of the vagina. A pessary helps to prop up the uterus and bladder, and temporarily prevents sagging into the vagina. It will need to be removed for cleaning and before sexual intercourse.

Surgery

Surgery may be necessary to correct uterine prolapse. These procedures are generally not done until you have finished having children. Surgical procedures include:

  • Vaginal hysterectomy —removal of the uterus through the vagina. This procedure will permanently resolve uterine prolapse, but also results in infertility .
  • Vaginal repair—This is usually done with a hysterectomy. The repair can be done with sutures and with insertion of mesh or slings.
  • Colpocleisis—This is a procedure that cures the prolapse, but results in a foreshortened vagina that will not permit intercourse.

You and your doctor should discuss all risks and benefits when considering these surgical options.

Complications

Urinary tract infections and other urinary symptoms may occur due to the frequently associated cystocele . This is a hernia-like disorder in women that occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into the vagina.

Constipation and hemorrhoids may also occur as a result of the associated rectocele (a similar condition to cystocele, only the rectum protrudes into the vagina).

In more severe cases of prolapse, ulceration and infection may occur.

Prevention

To help prevent uterine prolapse:

  • Do Kegel exercises regularly, especially before and after childbirth.
  • Avoid constipation. Straining from constipation stresses the pelvic muscles.
  • Maintain a healthy weight through diet and exercise.
  • Don't smoke. If you smoke, quit. Smoking may cause chronic coughing, which weakens pelvic muscles.
  • Limit heavy lifting.
  • If you are menopausal , discuss hormone replacement therapy (HRT) with your doctor. HRT at menopause helps retain muscle tone, which may prevent uterine prolapse. However, there are health risks associated with this treatment. Discuss all risks and benefits with your doctor.

RESOURCES:

American College of Obstetricians and Gynecologists
http://www.acog.org

The National Women's Health Information Center
http://www.4woman.gov

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://sogc.medical.org/

Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm

References:

Harvard Guide to Women's Health . Harvard University Press; 1996.

National Library of Medicine, Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001508.htm .



Last reviewed January 2008 by Ganson Purcell Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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