What is Uterine Prolapse?
Uterine prolapse occurs when the uterus drops or sags into the vaginal canal area. It occurs when the pelvic floor muscles and ligaments that support the uterus become weakened or damaged, allowing the uterus to shift from its normal position. Uterine prolapse can range from mild, where the cervix is still within the vagina, to severe, where the uterus protrudes outside the vaginal opening.
Who can get Uterine Prolapse?
Even though uterine prolapse can affect women of all ages, it is most commonly seen later in life. Almost one-half of all women between ages 50 and 79* have some degree of pelvic organ prolapse. There are common factors that increase your risk of uterine prolapse also.
What causes Uterine Prolapse?
Uterine prolapse can be caused by various factors, mostly from conditions that weaken pelvic muscles and supportive tissue. Causes of weakened pelvic muscles and tissues include
Pregnancy and Childbirth
As a rule of thumb, any activity that puts pressure on the pelvic muscles can increase your risk of uterine prolapse. A major life event that can intensify this type of pressure is childbirth. During pregnancy, the pelvic floor muscles are put under strain and can over-stretch and weaken creating more risk for uterine prolapse. In addition, the pressure exerted during vaginal childbirth can also contribute to the condition. Women with more than one vaginal birth are considered a high-range risk category.
Age and Hormonal Changes
With age, the pelvic floor muscles naturally weaken, and hormone levels that help maintain muscle strength and tissue elasticity, decrease naturally during menopause. The main hormone that is depleted is estrogen. This particular hormone helps keep your pelvic muscles strong. Without it, you're at a higher risk of developing a prolapse.
Chronic straining in the bathroom
Conditions that involve chronic straining during bowel movements, such as chronic constipation, can place excessive pressure on the pelvic floor muscles, leading to prolapse.
Pushing out urine can also lead to a weakened pelvic floor. When pushing out urine, several things can occur to the pelvic floor muscles. Creating muscle confusion. A healthy pelvic floor coordinates contractions and relaxation correctly during specific activities to remain functional. When urination occurs, the pelvic floor muscles relax to release the waste. If consistent pushing is occurring, it is contracting and counterintuitive to what should happen naturally. The strained muscles could get confused and be more lax as a result. Often this begins as urinary incontinence but could be as serious as a uterine prolapse over time.
Connective Tissue Disorders
Certain connective tissue disorders, such as Ehlers-Danlos syndrome or Marfan syndrome, can weaken the supportive structures of the pelvis, increasing the risk of uterine prolapse.
Types of Uterine Prolapse
Uterine prolapse can be categorized into different stages based on the degree of descent:
- First-Degree Prolapse: The cervix descends into the lower part of the vagina.
- Second-Degree Prolapse: The cervix protrudes near or at the vaginal opening.
- Third-Degree Prolapse: The cervix and uterus extend beyond the vaginal opening.
Symptoms of Uterine Prolapse
Uterine prolapse may cause various symptoms, which can vary depending on the severity of the prolapse. Common symptoms include:
- A sensation of heaviness, pulling in the pelvis, a feeling of fullness and/or pressure in this area (it may feel like sitting on a small ball)
- A feeling of something coming out of the vagina. In extreme cases, uterine tissue can bulge out of your vagina
- Pain or discomfort in the lower abdomen or pelvis often experience while walking
- Backache, particularly in the lower back
- Problems with sexual intercourse, such as pain or difficulty with penetration.
- Urinary symptoms include urinary incontinence, urinary frequency, or urinary tract infections.
- Bowel symptoms, such as constipation or difficulty emptying the bowels completely
When to see a Physician for Uterine Prolapse
It is recommended to seek medical attention if you experience symptoms of uterine prolapse or notice a bulge or protrusion from the vaginal opening. Additionally, consider scheduling an appointment with a healthcare provider specializing in pelvic floor disorders if:
Symptoms that can interfere with daily activity
It can be difficult to lead a functioning lifestyle alongside pelvic discomfort, lower back pain, urinary or bowel problems, and/or difficulties with sexual intercourse. Consulting with a physician can provide early intervention methods to manage, relieve symptoms, and prevent further deterioration of the prolapse. A physician can evaluate your condition and recommend appropriate treatment options to alleviate your symptoms.
Difficulty with Emptying the Bladder or Bowels
If you experience difficulty fully emptying your bladder or bowels, such as incomplete emptying, frequent urinary tract infections, or persistent constipation, it is essential to consult a healthcare provider. These symptoms may indicate advanced uterine prolapse and require medical evaluation and intervention.
Concerns about Sexual Intercourse
If uterine prolapse is affecting your sexual activity and causing discomfort or pain during intercourse, it is recommended to discuss these concerns with a healthcare provider. They can guide managing symptoms and potential treatment options.
Desire for Pregnancy
If you are planning to conceive or have concerns about the impact of uterine prolapse on pregnancy, it is advisable to consult a healthcare provider specializing in pelvic floor disorders. They can evaluate your condition, discuss potential implications, and provide appropriate guidance based on your individual circumstances.
Remember, early diagnosis and intervention can help manage uterine prolapse effectively, alleviate symptoms, and improve overall quality of life. A healthcare provider experienced in pelvic floor disorders can conduct a thorough evaluation, discuss treatment options, and develop a personalized plan tailored to your needs and preferences.
Treatments for Uterine Prolapse
The treatment options for uterine prolapse depend on the severity of the condition and the individual's symptoms, preferences, and overall health. Common treatment approaches include:
Pelvic Floor Exercises
Pelvic floor exercises can help strengthen the pelvic floor muscles and support the uterus. You can work with a pelvic floor physical therapist to create a custom exercise plan. Another great supplement to in-person physical therapy is an at-home program that can help keep you on track with your daily exercises. Every Mother's app-based proven program offers pelvic floor muscle training guided by pelvic PTs to help reduce symptoms while improving strength, and function in the core and pelvic floor.
A pessary is a device inserted into the vagina to provide support and lift to the uterus, alleviating prolapse symptoms. Different types and sizes of pessaries are available, and they need to be properly fitted and regularly cleaned.
Maintaining a healthy weight can reduce the strain on the pelvic floor muscles. One contributing factor to uterine prolapse is weight gain. Excess weight can stretch the muscles and connective tissue on top of the abdomen. This inward pressure is extremely similar to the strain on the abdominal wall during the later stages of pregnancy.
Ensuring a diet rich in fiber and staying adequately hydrated can help prevent constipation and reduce the need for straining during bowel movements.
Avoiding Heavy Lifting
Minimizing activities that involve heavy lifting or straining can help reduce pressure on the pelvic floor muscles. Lifting heavy objects without engaging the transverse abdominis can strain the pelvic floor muscles.
In cases where the uterus is significantly prolapsed and causing troublesome symptoms, a surgical procedure called a hysterectomy may be recommended. This involves the removal of the uterus.
Repair of the Pelvic Floor
Surgical procedures can be performed to repair and reinforce the weakened pelvic floor muscles and ligaments. This can be done through various techniques, such as a sacrocolpopexy, sacrospinous ligament fixation, or anterior/posterior vaginal repair.
It is important to discuss the potential risks, benefits, and expected outcomes of each treatment option with a healthcare provider specializing in pelvic floor disorders. They will guide you in making an informed decision based on your circumstances.
Common Questions about Uterine Prolapse
Can uterine prolapse be prevented?
While it may not always be possible to prevent uterine prolapse, some steps can reduce the risk. These include maintaining a healthy weight, practicing pelvic floor exercises, avoiding heavy lifting, managing chronic constipation, and seeking prompt treatment for chronic cough or respiratory conditions that can lead to prolonged straining.
Can uterine prolapse resolve on its own?
Mild cases of uterine prolapse may improve with conservative measures, such as pelvic floor exercises and lifestyle modifications. However, more severe cases are unlikely to resolve without medical intervention.
Can I still have children if I have uterine prolapse?
It is generally recommended to address uterine prolapse before planning for pregnancy. Treatment options can be discussed with a healthcare provider, as they can provide guidance based on individual circumstances and desired family planning goals.
Will uterine prolapse affect sexual intercourse?
Uterine prolapse can cause discomfort during sexual intercourse. However, with appropriate treatment and management, many individuals can resume a satisfying sexual relationship.