Uterine prolapse

Uterine prolapse

Definition:

Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then slips down into or protrudes out of the vagina.

Uterine prolapse can happen to women of any age, but it often affects postmenopausal women who've had one or more vaginal deliveries. Damage to supportive tissues during pregnancy and childbirth, effects of gravity, loss of estrogen, and repeated straining over the years all can weaken your pelvic floor and lead to uterine prolapse.

If you have mild uterine prolapse, treatment usually isn't needed. But if uterine prolapse makes you uncomfortable or disrupts your normal life, you might benefit from treatment.


Symptoms:

Uterine prolapse varies in severity. You may have mild uterine prolapse and experience no signs or symptoms. If you have moderate to severe uterine prolapse, you may experience:

• Sensation of heaviness or pulling in your pelvis
• Tissue protruding from your vagina
• Urinary problems, such as urine leakage or urine retention
• Trouble having a bowel movement
• Low back pain
• Feeling as if you're sitting on a small ball or as if something is falling out of your vagina
• Sexual concerns, such as sensing looseness in the tone of your vaginal tissue
• Symptoms that are less bothersome in the morning and worsen as the day goes on

When to see a doctor
Uterine prolapse doesn't require treatment unless it's severe. If your signs and symptoms become bothersome and disrupt your normal activities, make an appointment with your doctor to discuss your options.


Causes:
 Pregnancy and trauma incurred during childbirth, particularly with large babies or after a difficult labor and delivery, are the main causes of muscle weakness and stretching of supporting tissues leading to uterine prolapse. Loss of muscle tone associated with aging and reduced amounts of circulating estrogen after menopause also may contribute to uterine prolapse. In rare circumstances, uterine prolapse may be caused by a tumor in the pelvic cavity.


Complications:

Possible complications of uterine prolapse include:

• Ulcers. In severe cases of uterine prolapse, part of the vaginal lining may be displaced by the fallen uterus and protrude outside your body, rubbing on underwear. The friction may lead to vaginal sores (ulcers). In rare cases, the sores could become infected.
  
• Prolapse of other pelvic organs. If you experience uterine prolapse, you might also have prolapse of other pelvic organs, including your bladder and rectum. A prolapsed bladder (cystocele) bulges into the front part of your vagina, which can lead to difficulty in urinating and increased risk of urinary tract infections. Weakness of connective tissue overlying the rectum may result in a prolapsed rectum (rectocele), which may lead to difficulty having bowel movements.

Treatments and drugs:

If you have mild uterine prolapse, either without symptoms or with symptoms that don't bother you, you probably don't need treatment. However, your pelvic floor may continue to lose tone, making uterine prolapse more severe as time goes on. Check back with your doctor to monitor the extent of your prolapse and review your symptoms.

Simple self-care measures, such as performing exercises called Kegels to strengthen your pelvic muscles, may provide symptom relief. Maintaining a healthy weight and avoiding heavy lifting may help reduce pressure on supportive pelvic structures.

For more-severe cases of uterine prolapse, treatment options include:

• Vaginal pessary. This device fits inside your vagina and holds your uterus in place. Used as temporary or permanent treatment, vaginal pessaries come in many shapes and sizes, so your doctor will measure and fit you for the proper device. You'll also learn how to insert, remove and clean the pessary. You may be able to take the pessary out overnight and reinsert it each day.
  
  But a vaginal pessary may be of little use if you have severe uterine prolapse. Also, a vaginal pessary can irritate vaginal tissues, possibly to the point of causing sores (ulcers) on vaginal tissues, and it may interfere with sexual intercourse.
  
  
• Surgery. To repair damaged or weakened pelvic floor tissues, doctors often use a vaginal approach to surgery, although sometimes doctors recommend an abdominal surgery. A hysterectomy, which removes your uterus, also may be needed.
  
  As an alternative to vaginal and abdominal surgery, your doctor may recommend minimally invasive (laparoscopic) surgery. This procedure involves smaller abdominal incisions, special surgical instruments and a lighted camera-type device (laparoscope) to guide the surgeon.
  
  In some cases, surgical repair may be possible through a graft of your own tissue, donor tissue or some synthetic material onto weakened pelvic floor structures to support your pelvic organs.
  Which surgery and surgical approach your doctor recommends depends on your individual needs and circumstances. Each surgery has pros and cons that you'll need to discuss with your surgeon.
  

If you plan to have more children, you might not be a good candidate for surgery to repair uterine prolapse. Pregnancy and delivery of a baby put strain on the supportive tissues of the uterus and can undo the benefits of surgical repair. Also, for women with major medical problems, the risks of surgery might outweigh the benefits. In these instances, pessary use may be your best treatment choice for bothersome symptoms.

Talk with your doctor to learn your options, including the benefits and risks.