Uterine Prolapse

Uterine Prolapse Overview

Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken until they no longer provide enough support for the uterus. As a result, the uterus slips down into or protrudes out of the vagina.

Uterine prolapse most often affects people after menopause who’ve had one or more vaginal deliveries.

Mild uterine prolapse usually doesn’t require treatment. But uterine prolapse that causes discomfort or disrupts daily life might benefit from treatment.

Uterine Prolapse Symptoms

Mild uterine prolapse is common after childbirth. It generally doesn’t cause symptoms. Symptoms of moderate to severe uterine prolapse include:

  • Seeing or feeling tissue bulge out of the vagina
  • Feeling heaviness or pulling in the pelvis
  • Feeling like the bladder doesn’t empty all the way when you use the bathroom
  • Problems with leaking urine, also called incontinence
  • Trouble having a bowel movement and needing to press the vagina with your fingers to help have a bowel movement
  • Feeling as if you’re sitting on a small ball
  • Feeling as if you have vaginal tissue rubbing on clothing
  • Pressure or discomfort in the pelvis or low back
  • Sexual concerns, such as feeling as though the vaginal tissue is loose

Uterine Prolapse Causes

Uterine prolapse results from the weakening of pelvic muscles and supportive tissues. Causes of weakened pelvic muscles and tissues include:

  • Vaginal delivery
  • Age at first delivery (older women are at higher risk of pelvic floor injuries compared with younger women)
  • Difficult labor and delivery or trauma during childbirth
  • Delivery of a large baby
  • Being overweight
  • Lower estrogen level after menopause
  • Chronic constipation or straining with bowel movements
  • Chronic cough or bronchitis
  • Repeated heavy lifting

Uterine Prolapse Diagnostics

Cervical cancer develops slowly and over many years. Before turning to cancer, the cells in your cervix go through a lot of changes. The once normal cells in your cervix start to appear irregular or abnormal. These abnormal cells may go away, stay the same or turn into cancer cells.

Regular gynecological screenings with a Pap test can detect most cases of cervical cancer. A Pap test, or Pap smear, is a test that collects cells from your cervix. These cells are examined for signs of precancers or other irregularities.

If your Pap comes back as abnormal, further testing is necessary. This could include an HPV test, which is a specific test that checks the cells of your cervix for HPV infection. Certain types of HPV infection are linked to cervical cancer.

Your healthcare provider may also examine your cervix and take a sample of tissue for a biopsy if they suspect you have cancer. There are many techniques that can be used to obtain the tissue, like punch biopsy or endocervical curettage. In other cases, a wire loop or conization are used to gather tissues from the cervix for biopsy.

If the biopsy confirms cancer, further tests will determine whether the disease has spread (metastasized). These tests might include:

  • Liver and kidney function studies.
  • Blood and urine tests.
  • X-rays of your bladder, rectum, bowels and abdominal cavity.

Uterine Prolapse Treatment

There are surgical and nonsurgical options for treating uterine prolapse. Your healthcare provider will pick your treatment path based on the severity of your prolapse, your general health, age and whether or not you want children in the future. Treatment is generally effective for most people. Treatment options can include:

Nonsurgical options

  • Exercise: Special exercises, called Kegel exercises, can help strengthen your pelvic floor muscles. 
  • Vaginal pessary: A pessary is a rubber or plastic doughnut-shaped device that fits around or under the lower part of your uterus (cervix). This device helps prop up your uterus and hold it in place. A healthcare provider will fit and insert the pessary, which must be cleaned frequently and removed before sex.
  • Diet and lifestyle: Changes to your diet and lifestyle may be helpful in relieving symptoms like constipation. Increasing your water and fiber intake may lessen how often you strain to poop. Maintaining a healthy weight for your body type puts less pressure on your pelvic muscles when you stand or walk.

Surgical options

  • Hysterectomy and prolapse repair: Uterine prolapse may be treated by removing your uterus in a surgical procedure called a hysterectomy. This may be done through a cut (incision) made in your vagina (vaginal hysterectomy) or through your abdomen (abdominal hysterectomy). Hysterectomy is major surgery, and removing your uterus means pregnancy is no longer possible.
  • Prolapse repair without hysterectomy: This procedure involves putting your uterus back into its normal position. Uterine suspension may be done by reattaching the pelvic ligaments to the lower part of your uterus to hold it in place. The surgery can be done through your vagina or through your abdomen depending on the technique your provider uses.