Muscles, ligaments, and other structures hold the uterus in the pelvis. If these tissues are weak or stretched, the uterus drops into the vaginal canal. This is called prolapse.
This condition is more common in women who have had 1 or more vaginal births.
Other things that can cause or lead to uterine prolapse include:
Lack of estrogen after menopause
Conditions that put pressure on the pelvic muscles, such as chronic cough and obesity
Pelvic tumor (rare)
Repeated straining to have a bowel movement due to long-term constipation can make the problem worse.
Symptoms may include:
Pressure or heaviness in the pelvis or vagina
Problems with sexual intercourse
Leaking urine or sudden urge to empty the bladder
Uterus and cervix that bulge into the vaginal opening
Repeated bladder infections
Increased vaginal discharge
Symptoms may be worse when you stand or sit for a long time. Exercise or lifting may also make symptoms worse.
Exams and Tests
Your health care provider will do a pelvic exam. You will be asked to bear down as if you are trying to push out a baby. This shows how far your uterus has dropped.
Uterine prolapse is mild when the cervix drops into the lower part of the vagina.
Uterine prolapse is moderate when the cervix drops out of the vaginal opening.
Other things the pelvic exam may show are:
The bladder and front wall of the vagina are bulging into the vagina (cystocele).
The rectum and back wall of the vagina (rectocele) are bulging into the vagina.
The urethra and bladder are lower in the pelvis than usual.
You do not need treatment unless you are bothered by the symptoms.
Many women will get treatment by the time the uterus drops to the opening of the vagina.
The following can help you control your symptoms:
Lose weight if you are obese.
Avoid heavy lifting or straining.
Get treated for a chronic cough. If you cough is due to smoking, try to quit.
Your provider may recommend placing a rubber or plastic donut-shaped device, into the vagina.This is called a pessary. This device holds the uterus in place.
The pessary may be used for short-term or long-term. The device is fitted for your vagina. Some pessaries are similar to a diaphragm used for birth control.
Pessaries must be cleaned regularly. Sometimes they need to be cleaned by the provider. Many women can be taught how to insert, clean, and remove a pessary.
Side effects of pessaries include:
Foul smelling discharge from the vagina
Irritation of the lining of the vagina
Ulcers in the vagina
Problems with normal sexual intercourse
Surgery should not be done until the prolapse symptoms are worse than the risks of having surgery. The type of surgery will depend on:
The severity of the prolapse
The woman's plans for future pregnancies
The woman's age, health, and other medical problems
The woman's desire to retain vaginal function
There are some surgical procedures that can be done without removing the uterus, such as a sacrospinous fixation. This procedure involves using nearby ligaments to support the uterus. Other procedures are also available.
Often, a vaginal hysterectomy is used to correct uterine prolapse. Any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time.
Most women with mild uterine prolapse do not have symptoms that require treatment.
Vaginal pessaries can be effective for many women with uterine prolapse.
Surgery often provides very good results. However, some women may need to have the treatment again in the future.
Ulceration and infection of the cervix and vaginal walls may occur in severe cases of uterine prolapse.
Winters JC, Togamai JM, Chermansky CJ. Vaginal and abdominal reconstructive surgery for pelvic organ prolapse. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 72.
Daniel N. Sacks MD, FACOG, obstetrics & gynecology in private practice, West Palm Beach, FL. Review Provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.