When the pelvic floor muscles and ligaments weaken and no longer provide enough support for the uterus, this causes the uterus to slip down into or protrude out of the vagina, a condition called uterine prolapse.
Uterine prolapse can occur in women of any age. But it often affects postmenopausal women who’ve had one or more vaginal deliveries.
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Mild uterine prolapse usually doesn’t require treatment. However, you may require treatment if uterine prolapse makes you uncomfortable or disturbs your normal life.
Symptoms of Uterine Prolapse
There are little or no symptoms associated with mild uterine prolapse. Symptoms of moderate to severe uterine prolapse include:
- Tissue protruding from your vagina
- Sensation of heaviness or pulling in your pelvis
- Urinary problems
- Difficulty having a bowel movement
- Feeling as if you’re sitting on a small ball or as if something is falling out of your vagina
- Sexual concerns, vaginal looseness
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Causes of Uterine Prolapse
Uterine prolapse is caused by weakening of pelvic muscles and supportive tissues. Causes of weakened pelvic muscles and tissues include:
- Difficult labor
- Delivery of a large baby
- Always lifting heavy objects
- Being overweight or obese
- Lower estrogen level after menopause
- Chronic constipation or straining with bowel movements
- Chronic cough or bronchitis
Factors that can increase your risk of uterine prolapse include:
- One or more vaginal births
- Giving birth to a large baby
- Being Hispanic or white
- Increasing age
- Prior pelvic surgery
- Chronic constipation or frequent straining during bowel movements
- Family history of weakness in connective tissue
Uterine prolapse is often associated with prolapse of other pelvic organs. You might experience:
- Anterior prolapse (cystocele):Weakness of connective tissue separating the bladder and vagina, causing the bladder to bulge into the vagina. Anterior prolapse is also called prolapsed bladder.
- Posterior vaginal prolapse (rectocele):Weakness of connective tissue separating the rectum and vagina may cause the rectum to bulge into the vagina. You might experience difficulty passing out stool.
Severe uterine prolapse can displace part of the vaginal lining, causing it to protrude outside the body. Vaginal tissue that rubs against clothing can lead to vaginal sores. The sores can rarely become infected.
To reduce your risk of uterine prolapse:
- Perform Kegel exercises frequently.These exercises can strengthen your pelvic floor muscles.
- Treat and prevent constipation.Drink lots of fluids and eat high-fiber foods, such as beans, fruits, vegetables, and whole-grain cereals.
- Avoid heavy lifting and lift correctly.When lifting, use your legs instead of your waist or back.
- Control coughing.Get treatment for a chronic cough or bronchitis, and avoid smoke.
- Avoid weight gain.Maintain a healthy weight.
A diagnosis of uterine prolapse occurs during a pelvic exam. Your doctor may to bear down as if having a bowel movement. Bearing down can help your doctor assess how far the uterus has slipped into the vagina. Also, while examining you, the doctor may ask you to tighten your pelvic muscles as if you’re stopping a stream of urine (kegel). This test checks the strength of your pelvic muscles.
If you have severe incontinence, your doctor might recommend tests to measure how well your bladder functions.
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Treatment depends on how severe uterine prolapse is. Your doctor might recommend:
- Self-care measures. Self-care measures include performing Kegel exercises to strengthen your pelvic muscles, losing weight and treating constipation.
- A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bulging tissues. A pessary must be removed regularly for cleaning.
Your doctor may recommend surgery using minimally invasive (laparoscopic) or vaginal procedure, if uterine prolapse is severe.
Surgery can involve:
- Repair of weakened pelvic floor tissues.This surgery is performed via the vagina but sometimes through the abdomen. The surgeon might graft your own tissue, donor tissue or a synthetic material onto weakened pelvic floor structures to support your pelvic organs.
- Removal of your uterus (hysterectomy).Hysterectomy might be recommended if uterine prolapse is severe. But hysterectomy is major surgery, and recent research suggests the surgery poses long-term health risks, including an increased risk of heart and blood vessel (cardiovascular) diseases.
Talk with your doctor about the best treatment options for you.
Lifestyle and home remedies
Depending on the severity of your uterine prolapse, self-care measures may provide relief. Try to:
- Perform Kegel exercises to strengthen pelvic muscles and support the weakened fascia
- Avoid constipation by eating high-fiber foods and drinking plenty of fluids
- Avoid bearing down to move your bowels
- Avoid heavy lifting
- Control coughing
- Lose weight if you’re overweight or obese
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Kegel exercises strengthen your pelvic floor muscles. A strong pelvic floor provides better support for your pelvic organs, prevents prolapse from deteriorating and relieves symptoms.
To perform Kegel exercises:
- Tighten (contract) your pelvic floor muscles as though you were trying to prevent passing gas.
- Hold the contraction for five seconds, and then relax for five seconds. If this is too difficult, start by holding for two seconds and relaxing for three seconds.
- Work up to holding the contractions for 10 seconds at a time.
- Repeat at least three sets of 10 kegels daily.