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Uterine prolapse is a condition in which the uterus descends into the vaginal canal due to weakness of the pelvic floor muscles and ligaments. This is often a result of childbirth or the natural weakening of the pelvic muscles that occurs with aging or other factors that strain the pelvic muscles. Treatment varies from pelvic floor exercises, a pessary device, to surgery. Early detection before the condition has progressed to a further descent is essential to prevent additional descent and the complications that may result.

What is Meant by Uterine Prolapse?

Uterine prolapse is a condition in which the uterus, which is supported by a complex system of muscles, ligaments, and tissue within the pelvic region, drops down to or protrudes from the vagina. This happens when the supporting structures of the pelvic floor that generally keep the uterus in place become damaged or weak from childbirth, aging, chronic coughing, heavy lifting, or changes in hormones. The condition can cause discomfort, urinary and bowel problems, and pressure or fullness in the pelvic area.

What Causes Uterine Prolapse?

These factors can increase a woman's risk of developing uterine prolapse:​

  • Childbirth: Having a vaginal delivery, particularly if you had a big baby or needed a lengthy labor, can weaken your pelvic floor muscles and stretch your pelvic tissues.
  • Aging: As you age, your pelvic muscles naturally weaken. The process can be exacerbated in women by the decrease in estrogen that accompanies menopause.
  • Hysterectomy: Having a hysterectomy or any other surgery that weakens the pelvic floor muscles may later result in POP.
  • Chronic constipation: Chronic straining may cause muscle or tissue damage and is frequently associated with pelvic floor disorders.
  • Chronic coughing: Conditions such as bronchitis or the habit of smoking can lead to weakness of the muscles.
  • Obesity: Obesity is a significant cause of several other health conditions, and it also makes you more likely to develop pelvic floor problems. That’s because excess fat puts more pressure on the pelvic floor muscles.
  • Heavy Lifting: Repeatedly lifting can strain your pelvic muscles over time. This is another one of the many reasons we always recommend lifting with your legs and being careful to engage your core correctly when you lift heavy objects.
  • Genetics: Some women are simply born with weaker connective tissue than others. If your mother or grandmother had a prolapsed bladder, or if you have a family history of pelvic floor problems, you are more likely to develop these issues, too.
  • Tumors: This is significantly less common than the others on the list, but not unheard of. Sometimes, pelvic tumors can cause a prolapsed bladder, along with other symptoms.

Preventive treatments can help strengthen the pelvic muscles and lower the chance of uterine prolapse, such as pelvic floor exercises (Kegels) and keeping a healthy weight.

What are the Symptoms of Uterine Prolapse?

Degrees of prolapse range from mild to severe, and symptoms usually depend on the prolapse stage. Women with mild cases of prolapse may not have any symptoms. But when symptoms do occur, they may include:

  • Pelvic heaviness or dragging: A sensation of fullness or pressure in the pelvic region.
  • Tissue protrusion: Tissue that can be seen protruding from the vagina or felt outside; it can feel like sitting on a ball or something being in the vagina.
  • Sexual discomfort: Pain or discomfort during intercourse.
  • Urinary problems: Involuntary leakage of urine (incontinence), frequent urination, or a sense of incomplete bladder emptying. Some women may also experience repeated bladder or urinary tract infections.
  • Difficulties with Bowel movements: Constipation or a sense of incomplete bowel evacuation.
  • Backache: Lower back pain that is relieved by lying down.
  • Vaginal discharge or bleeding: Because of inflammation or ulceration of the exposed vaginal tissue.
  • Vaginal looseness: Women may have a change in the tightness of the vaginal canal.

It is important to note that while these symptoms can be suggestive of uterine prolapse, they can also be associated with other pelvic floor disorders. It is critical to undergo a proper clinical examination by a healthcare professional who can diagnose uterine prolapse accurately.

How is Uterine Prolapse Diagnosed?

The following methods are used to identify uterine prolapse:

1. Medical History:

  • The physician will ask about the patient’s symptoms, obstetric history, including the number of pregnancies and vaginal deliveries, past surgeries, and any other pertinent medical conditions the patient might have.

2. Pelvic Examination: 

  • The woman is placed in the gynecological examination position on her back with her feet in stirrups. The doctor will visualize the vagina, cervix, and uterus with a bright light while at the same time manually palpating and assessing the three structures. 

3. Further Testing: Depending on the symptoms and the results of the pelvic examination, additional testing might also be ordered:

  • Bladder function test (urodynamic testing): This test measures how well the bladder, sphincters, and urethra store and release urine. This test is beneficial if urinary incontinence is a problem.
  • Magnetic resonance imaging (MRI) or ultrasound: Although not usually needed to diagnose uterine prolapse alone, these imaging tests can provide a more detailed view of the pelvic organs. When this additional information is required, an MRI exam or ultrasound might help show if the patient has other conditions common in women with prolapse.

Uterine prolapse should be evaluated by a healthcare provider, preferably a gynecologist or urogynecologist.

Treatment Methods for Uterine Prolapse

The treatment for uterine prolapse depends on the severity of the condition, the patient’s age, overall health, symptoms, and whether she plans on having children in the future. Standard treatment methods include:

  • Observation: Mild cases of prolapse that are not causing symptoms may be managed by watchful waiting. Regular checkups can help determine if the prolapse is getting worse.
  • Pelvic Floor Exercises: Pelvic floor exercises, often referred to as Kegel exercises, are a set of exercises designed to strengthen the pelvic floor muscles, which provide support to the pelvic organs, including the bladder, uterus, and rectum
  • Vaginal Pessary: A pessary is a removable device that is inserted into the vagina to help hold up your pelvic organs and keep the uterus in place. Pessaries can be fitted in all different shapes and sizes according to your needs.
  • Estrogen Replacement Therapy: For some women, the pelvic muscles become weaker after menopause due to decreased levels of estrogen. Estrogen replacement therapy can be given in the form of vaginal creams, pills, or patches to help resolve this issue.
  • Surgery: Surgery is considered if other treatments are ineffective or the prolapse is severe. Surgical options include:
  • Vaginal Hysterectomy: Removal of the uterus through the vagina.
  • Uterosacral or Sacrospinous Ligament Suspension: This procedure involves attachment of the uterus or vaginal vault (in women who have had a hysterectomy) to nearby ligaments.
  • Sacral Colpopexy: This procedure is usually done laparoscopically and involves attachment of the vaginal vault to the sacrum using mesh.
  • Anterior and Posterior Vaginal Repair: Correction of a cystocele or rectocele by repairing the front (anterior) or back (posterior) wall of the vagina.

The treatment course should be individualized, and treatment decisions should be made jointly by the patient and his or her healthcare team after weighing the pros and cons based on the patient’s preferences and individual clinical circumstances. 

What are the Complications of Uterine Prolapse?

If  Uterine Prolapse is not treated or severe, it can result in the following complications:

  • Ulceration and infection: If the uterus or vaginal tissue is protruding from the body, it may become chafed, which could lead to the forming of ulcers. The ulcers may become infected.
  • Urinary Problems: The prolapse can lead to:
  1. Urinary incontinence: An involuntary leakage of urine.
  2. Urinary retention: Inability to empty the bladder.
  3. Recurrent urinary tract infections UTIs: These are due to incomplete emptying of the bladder or the prolapse itself.
  • Difficulty in Bowel Evacuation: A prolapse might cause difficulties in having bowel fun or cause constipation.
  • Sexual Problems: Women with Uterine prolapse might have discomfort or even feel pain during intercourse.
  • Quality Of Life: The symptoms and the physical changes associated with uterine prolapse might affect self-esteem, body image, and generally, the quality of life and may cause emotional and psychological challenges.
  • Exacerbation Associated Pelvic Floor Disorders: Any pelvic floor disorder, such as cystocele (bladder prolapse) or a rectocele (rectum prolapse), the presence of uterine prolapse might worsen the problems associated with the combined condition.
  • Complications of Pessary Use: If a pessary is not adequately cared for or if it doesn’t fit correctly, it can cause:
  1. Irritation or ulceration of the vagina.
  2. Discharge and odor from the vagina.
  3. Infections.

If uterine prolapse is suspected or if a person is experiencing symptoms, a healthcare provider should be contacted for an evaluation.

How to Prevent Uterine Prolapse?

Not all cases of uterine prolapse can be prevented, but much can be done to reduce the risk or slow the condition’s progression. Some preventive strategies for uterine prolapse include the following health tips:

  • Pelvic floor exercises: Exercises that involve contracting and relaxing the pelvic floor muscles, called Kegels, can strengthen those muscles and provide better support for the uterus.
  • Maintain a healthy weight: Being overweight can put extra pressure on the pelvic floor muscles. Achieving and maintaining a healthy weight through a balanced diet and regular exercise can help decrease the risk.
  • Avoid straining: Too much during bowel movements or lifting heavy objects can weaken the pelvic floor muscles. Use proper lifting techniques, and talk to a doctor about chronic constipation.
  • Limit high-impact activities: Running and intense jumping can strain the pelvic floor. While it’s important to stay active, a person may want to incorporate low-impact activities like swimming, cycling, or walking.
  • Treat chronic cough: A long-lasting cough, which may be due to smoking or a lung or respiratory condition, can increase the risk of prolapse. It is essential to treat the underlying cause of the cough.
  • Prompt treatment of pelvic infections: Infections weaken the pelvic tissues, so immediate treatment of such conditions as pelvic inflammatory disease is critical.
  • Childbirth considerations: Elective cesarean delivery to prevent prolapse is not recommended as a routine procedure, but discussing with a healthcare provider the different methods of childbirth and their risks can be helpful.

While these tips can help prevent uterine prolapse, it’s important to remember that factors such as age and genes can’t be controlled. Therefore, women need to perform regular self-examinations and consult with a healthcare provider to detect any issues at earlier stages, in cases when treatments could be less delicate and more effective.

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