What Is Uterine Prolapse?

Overview 

Are you experiencing discomfort or pain in your pelvic area? Have you noticed a visible bulge or protrusion from your vagina? If so, you may be experiencing uterine prolapse. 

Uterine prolapse is a condition where the uterus descends from its normal position and protrudes into the vagina. It is a common condition that can occur due to weakened pelvic muscles and tissues, often as a result of pregnancy and childbirth.

If you or someone you know is experiencing symptoms of uterine prolapse, it's important to understand the various stages of the condition, its causes, and the available treatment options. Read on to learn more about uterine prolapse and how it can be managed and treated.

Introduction 

Uterine prolapse occurs when the uterus slides, or descends, into the vaginal canal as a result of loose pelvic muscles and ligaments. The uterus is located in the pelvis, between the urinary bladder and the end of the large intestine (the rectum). The uterus hangs in the pelvis, suspended by certain ligaments (uterosacral and cardinal ligaments) from the bone that forms the posterior pelvis wall (the sacrum).  A loosening of these ligaments causes prolapse of the uterus into the vaginal vault. 

Uterine prolapse is not dangerous, but it can have negative effects on a female or AFAB’s (an individual assigned female at birth) life.  It can lead to sexual dysfunction, body dysmorphia, constipation and incontinence (of either the bowel or the bladder). 

Although uterine prolapse can happen at any age, it is more common in females who have had several children or who have experienced menopause.¹

Stages of uterine prolapse

The Pelvic Organ Prolapse Quantification (POP-Q) system is used to classify the progression of uterine prolapse. The categorisation is based on the location of the most distal part of the prolapsed uterus segment concerning the hymen of the vagina. 

The severity of uterine prolapse is classified into the following stages:²

• Stage 0: No prolapse
• Stage 1: The uterus is slightly lower than its normal position (the distal portion extends further than 1 cm above the hymen)
• Stage 2: The uterus has descended further into the vaginal canal (distal portion more than 1 cm from the hymen)
• Stage 3: The uterus begins to protrude out of the vaginal opening (the distal portion extends further than 1 cm below the hymen but is still shorter than the full vaginal length by 2 cm)
• Stage 4: The uterus has completely protruded out of the vaginal opening (vaginal eversion)²

Causes of uterine prolapse

Uterine prolapse occurs when the pelvic muscles and ligaments that support the uterus become weakened or damaged. This can happen due to a variety of reasons, such as:

• Childbirth: the strain of giving birth can weaken the pelvic muscles and cause uterine prolapse
• Ageing: as females age, the muscles and tissues in the pelvic area can weaken, leading to uterine prolapse
• Menopause: the decrease in estrogen levels during menopause can lead to weakened pelvic muscles and tissues.
• Chronic coughing: chronic coughing can put pressure on the pelvic area and lead to uterine prolapse
• Obesity: being overweight or obese can put extra pressure on the pelvic muscles and cause them to weaken.^3,4

Signs and symptoms of uterine prolapse

The symptoms of uterine prolapse can vary, depending on the severity of the prolapse. As the prolapse worsens, symptoms will emerge and potentially intensify over time.

 Some common symptoms include:

• A sensation of pressure or weight in the pelvic region
• Lower back pain
• Pain or discomfort during sex
• Urinary incontinence or difficulty urinating
• Constipation or difficulty with bowel movements
• A noticeable protrusion or bulging from the vagina
• Bladder infection 
• Vaginal Bleeding or increased discharge ³

Management and treatment for uterine prolapse

Treatment of uterine prolapse depends on the severity of the condition and the individual's symptoms. Some common management and treatment options include.^{2, 3}

 Lifestyle changes

 Many women find relief after making changes to their lifestyles. Losing weight relieving constipation and avoiding its recurrence, quitting smoking to manage a chronic cough, and avoiding activities that cause them to strain their pelvic muscles have all been found to manage uterine prolapse symptoms. 

Pelvic floor exercises

Kegel exercises are specific pelvic floor exercises that can help strengthen the pelvic muscles and improve symptoms. 

Support for the uterus

The use of a pessary, which is a donut-shaped device that is inserted into the vagina to provide support for the uterus, can also alleviate symptoms. In severe cases, surgery may be required to correct the prolapse and repair any damaged pelvic muscles or tissues. Uterine prolapse can be treated with a hysterectomy, which can be performed either vaginally or trans-abdominally.²,³

Diagnosis of uterine prolapse

A pelvic exam frequently yields the diagnosis of uterine prolapse. During the pelvic examination, your doctor might ask you to push as though you were going to the toilet. This might aid your healthcare practitioner in determining how far the uterus has retracted into the vagina. They may also request you to contract your pelvic muscles as if to stop a stream of urine. This examination measures the pelvic muscles' strength. You may also be asked to complete a questionnaire. This helps your doctor determine how uterine prolapse impacts your life. Treatment decisions are aided by this information. ³

In some cases, additional tests, such as an ultrasound or magnetic resonance imaging (MRI) may be required to determine the severity of the prolapse and the extent of damage to the pelvic muscles or tissues.¹

Risk factors

Some common risk factors for uterine prolapse include:²

• Multiple pregnancies and childbirth
• Menopause
• Ageing
• Obesity
• Chronic coughing
• Chronic constipation 
• Heavy weight lifting 
• Connective tissue disorders 
• Family history of pelvic organ prolapse  

Complications

Although uterine prolapse is not life-threatening, it can lead to prolapse of other pelvic organs if left untreated. Cystocele and rectocele are the prolapse of the urinary bladder and rectum, respectively.⁷ 

If left untreated, uterine prolapse can also lead to other complications, such as:

• Recurrent urinary tract infections
• Chronic constipation
• Difficulty with sexual intercourse
• Difficulty with daily activities due to discomfort and pain

FAQs

How can I prevent uterine prolapse? 

Weight maintenance, pelvic floor exercises, as well as avoidance of forceful excretion, constipation and hard lifting, can help prevent uterine prolapse.

How common is uterine prolapse?

According to the latest data, It has been estimated that roughly 9 per cent of the female population suffers from uterine prolapse worldwide. However, it is estimated to be close to 20% in low and middle-income countries, though these percentages vary greatly (from 3.5% to 56.4%). ⁴

When should I see a doctor?

If you can palpate a lump in or around your vagina or if you experience any other signs of prolapse, you should seek medical attention. Uterine prolapse symptoms can develop gradually as the day passes; hence, they would not be evident in the morning. 

Summary

The term uterine prolapse refers to a condition in which the uterus protrudes into the vagina from its natural position. It is caused by weak pelvic muscles and ligaments, which frequently occur as a result of pregnancy, childbirth, menopause, ageing, obesity, chronic coughing, and predisposition to pelvic organ prolapse. The presence of a bulge or a protrusion from the vagina, as well as a sensation of weight or pressure in the pelvic area, may act as a sign that you have uterine prolapse. Complications could include persistent constipation, recurring urinary tract infections, and difficulties performing everyday tasks. Treatment options include surgery, pessaries, and Kegel exercises. The condition can be prevented by avoiding straining activities and strengthening the pelvic floor.