The uterus (womb) is a muscular structure that’s held in place by pelvic muscles and ligaments. If these muscles or ligaments stretch or become weak, they’re no longer able to support the uterus, causing prolapse.
Uterine prolapse occurs when the uterus sags or slips from its normal position and into the vagina (birth canal).
Uterine prolapse may be incomplete or complete. An incomplete prolapse occurs when the uterus is only partly sagging into the vagina. A complete prolapse occurs when the uterus falls so far down that some tissue protrudes outside of the vagina.
Women who have a minor uterine prolapse may not have any symptoms. Moderate to severe prolapse may cause symptoms, such as:
- the feeling that you’re sitting on a ball
- vaginal bleeding
- increased discharge
- problems with sexual intercourse
- the uterus or cervix protruding out of the vagina
- a pulling or heavy feeling in the pelvis
- constipation or difficulty passing stool
- recurring bladder infections or difficulty emptying your bladder
If you develop these symptoms, you should see your doctor and get treatment right away. Without proper attention, the condition can impair your bowel, bladder, and sexual function.
The risk of having a prolapsed uterus increases as a woman ages and her estrogen levels decrease. Estrogen is the hormone that helps keep the pelvic muscles strong. Damage to pelvic muscles and tissues during pregnancy and childbirth may also lead to prolapse. Women who’ve had more than one vaginal birth or are postmenopausal are at the highest risk.
Any activity that puts pressure on the pelvic muscles can increase your risk of a uterine prolapse. Other factors that can increase your risk for the condition include:
- chronic cough
- chronic constipation
Your doctor can diagnose uterine prolapse by evaluating your symptoms and performing a pelvic exam. During this exam, your doctor will insert a device called a speculum that allows them to see inside of the vagina and examine the vaginal canal and uterus. You may be lying down, or your doctor may ask you to stand during this exam.
Your doctor may ask you to bear down as if you’re having a bowel movement to determine the degree of prolapse.
Treatment isn’t always necessary for this condition. If the prolapse is severe, talk with your doctor about which treatment option is appropriate for you.
Nonsurgical treatments include:
- losing weight to take stress off pelvic structures
- avoiding heavy lifting
- doing Kegel exercises, which are pelvic floor exercises that help strengthen the vaginal muscles
- wearing a pessary, which is a device inserted into the vagina that fits under the cervix and helps push up and stabilize the uterus and cervix
The use of vaginal estrogen has been well-studied and shows improvement in vaginal tissue regeneration and strength. While using vaginal estrogen to help augment other treatment options may be helpful, on its own it doesn’t reverse the presence of a prolapse.
Surgical treatments include uterine suspension or hysterectomy. During uterine suspension, your surgeon places the uterus back into its original position by reattaching pelvic ligaments or using surgical materials. During a hysterectomy, your surgeon removes the uterus from the body through the abdomen or the vagina.
Surgery is often effective, but it’s not recommended for women who plan on having children. Pregnancy and childbirth can put an immense strain on pelvic muscles, which can undo surgical repairs of the uterus.