Uterine Prolapse

A uterine prolapse occurs when the muscles and tissue in your pelvis weaken, providing inadequate support for the uterus. The uterus then drops down into your vagina, in some cases coming out through your vaginal opening. Mild uterine prolapses don't require treatment, but if the prolapse becomes chronically uncomfortable, you may benefit from treatment.

Who's At Risk?

Uterine prolapse can affect women of any age, but often affects women who've had one or more vaginal births or are postmenopausal. Nearly half of all women between the ages of 50 and 79 have experienced a uterine prolapse or some other form of pelvic organ prolapse.

Symptoms of Uterine Prolapse

Symptoms will vary with the severity of your case. Mild uterine prolapses sometimes lack any symptoms at all. For more serious cases, common symptoms include:

  • tissue protruding from your vaginal opening
  • pressure, heaviness or a pulling sensation in the pelvis or vagina
  • urinary leakage or urinary stress incontinence
  • problems with sexual intercourse, such as sensing looseness in the vaginal tissue
  • lower back pain
  • trouble having bowel movements
  • vaginal bleeding
  • increased vaginal discharge

Symptoms may be worse when you stand or sit for a long time. Exercise or lifting may also make symptoms worse.

Diagnosing Uterine Prolapse

Diagnosing a uterine prolapse is generally a straightforward process that doesn't include ultrasound or magnetic resonance imaging (MRI) unless your doctor needs to assess the degree of prolapse in serious cases. The most common forms of diagnosing uterine prolapse are:

  • Questionnaire: Often a simple questionnaire can help your doctor rule out or diagnose uterine prolapse. A questionnaire can also help assess the degree to which uterine prolapse may be affecting your life and help guide treatment.
  • Pelvic exam: Your doctor may ask you to bear down as if having a bowel movement, which can help assess how far the uterus has slipped into your vagina. Your doctor may also ask you to tighten your pelvic muscles as if stopping the stream of urine to check the strength of your pelvic muscles. This exam may be performed while you are lying down or while standing up.

Lifestyle Changes To Manage Uterine Prolapse

Treatment is generally not required for uterine prolapse unless symptoms are chronically uncomfortable or cause a decrease in quality of life. Symptoms of uterine prolapse can get worse as time goes on and the pelvic floor continues to lose muscle tone. You can manage mild uterine prolapse symptoms and slow the advance of the condition with the following measures:

  • Kegel Exercises: Kegel exercises strengthen the pelvic muscles, maintaining muscle tone and providing you with some relief from symptoms. Squeeze the muscles you use to stop urine flow for five seconds, then release for five, performing three sets of 10 exercises each day. Eventually your muscles will strengthen to allow 10-second intervals.
  • Maintaining a Healthy Weight: Proper nutrition and exercise can help manage symptoms of uterine prolapse by putting less stress on the pelvic muscles and keeping as much tone as possible.
  • Avoid Heavy Lifting: Heavy lifting can aggravate symptoms of uterine prolapse and strain supportive pelvic structures.

Non-surgical Options For Treating Uterine Prolapse

When symptoms become too severe to manage through lifestyle changes, non-surgical techniques can be used to help treat your problems. Common treatments include:

Vaginal pessary

A vaginal pessary is a device that fits inside your vagina to hold the uterus in place. Used to treat moderate uterine prolapse, the device can be a temporary or permanent treatment option. Your doctor will custom-fit a device for you, which you will learn how to use (insert, remove and clean) to help alleviate your symptoms. A vaginal pessary is generally not used for severe cases of uterine prolapse and can irritate the vaginal tissue, causing sores and interfering with sexual intercourse.

Estrogen replacement therapy (ERT)

Estrogen replacement therapy (ERT) may help limit further weakness of the pelvic muscles and connective tissue supporting the uterus. There are some side effects, such as an increased risk of blood clots, gallbladder disease and breast cancer.

Surgical Options for Treating Uterine Prolapse

If necessary, minimally invasive surgical procedures can often be used to successfully treat more severe cases of uterine prolapse:

Uterine Suspension via Laparoscopy

A laparoscopy procedure can be used to perform a uterine suspension that supports the uterus and the structure of the pelvic floor, grafting your own tissue, donor tissue or syhthetic materials to support your uterus. During a laparoscopy, a small incision is made in the abdomen through which your doctor will use a laparoscope, a thin flexible tube containing a video camera, to generate images that can be seen on a computer screen. Your surgeon can then use precise equipment to perform minimally invasive procedures to treat uterine prolapse.

Hysterectomy

A hysterectomy is used in the most severe cases of uterine prolapse with most procedures performed being partial hysterectomies (removal of part of the uterus but not the cervix). Your doctor will decide which hysterectomy is right for your specific condition. Any sagging of the vaginal walls, urethra, bladder or rectum can be surgically corrected at the same time.

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