What is uterine prolapse?

Uterine prolapse occurs when the muscles and tissue in your pelvis weaken. The weakness lets the uterus drop down into your vagina. Sometimes it comes out through your vaginal opening.

What causes uterine prolapse?

Uterine prolapse is caused when the muscles and tissue of the pelvic floor weaken. They can’t support the weight of the uterus. This lets it drop into your vagina. Childbirth and aging are most often linked with this condition.

Who is at risk for uterine prolapse?

You are more likely to have uterine prolapse if you:

• Gave birth (highest risk), especially if your baby had a high birth weight

• Had a vaginal delivery instead of a C-section

• Have reached menopause

• Are overweight

• Are a smoker

• Prolapse runs in your family

What are the symptoms of uterine prolapse?

Many with this condition have no symptoms. If symptoms start, they may include:

• Leaking urine

• Unable to completely empty your bladder

• Heavy or full feeling in your pelvis

• Bulging in your vagina or feeling like something is falling out

• Low back pain

• Aching or a feeling of pressure in your lower belly (abdomen) or pelvis

• Constipation, accidentally leaking stool, or straining when moving the bowels

• Bleeding or discharge

How is uterine prolapse diagnosed?

If your healthcare provider thinks that you have a prolapsed uterus, they will probably do a physical exam to check your pelvis. If you also have urinary incontinence or feel like you can’t empty your bladder, your healthcare provider may do a procedure called a cystoscopy. This allows them to look at your bladder and urethra. Your provider may do a test called urodynamics. It looks at how well your bladder and urethra are working.

Your healthcare provider might also order a test such as an MRI or CT scan. The MRI procedure uses a magnet and radio waves to create images. A CT scan uses X-rays to make the image. This will allow your healthcare provider to get a good look at your kidneys and other pelvic organs.

How is uterine prolapse treated?

If your symptoms bother you or you’re not comfortable during everyday activities, talk with your healthcare provider about treatment options. Lifestyle changes, such as losing weight, may help.

Pelvic floor muscle training can also help improve symptoms. This can strengthen muscles around your uterus. A physical therapist or other healthcare provider can give you specific exercises to do. One example is Kegel exercises. They strengthen your pelvic floor muscles. To do Kegel exercises, squeeze the muscles you use to control the flow of urine. Hold for up to 8 to 10 seconds, then release. Repeat this 8 to 12 times, 3 times a day. Try to do these exercises every day but at least 3 to 4 times per week.

A pessary can also ease symptoms. This is a device your healthcare provider inserts into your vagina to support your pelvic organs.

Surgery to rebuild the area is another option. A hysterectomy may be done at the same time. This is surgery to remove your uterus. This can be done through your vagina using a laparoscope or through your belly (abdomen). The healing time is faster when the surgery is done through the vagina than with surgery that needs a cut (incision) in the abdomen. There also are fewer complications.

Can uterine prolapse be prevented?

There is no certain way to prevent uterine prolapse. The following can help lower your risk:

• Lose weight if you’re overweight.

• Follow a diet rich in fiber and fluids to prevent constipation and straining.

• Don't do heavy lifting.

• Quit smoking if you smoke.

• Get treatment for a chronic cough right away. It can place extra pressure on your pelvic organs.

• Do Kegel exercises to strengthen your pelvic floor muscles.

These actions may also help if you already have uterine prolapse.

See your healthcare provider when symptoms first start to bother you. Don’t wait until your discomfort becomes severe. Regular pelvic exams can help find uterine prolapse in its early stages.

Key points for uterine prolapse

• Uterine prolapse occurs when the muscles and tissue in your pelvis weaken.

• This allows your uterus to drop down into your vagina.

• Common symptoms include urine leaking, fullness in your pelvis, bulging in your vagina, low back pain, and constipation.

• There are different ways to treat uterine prolapse. They include lifestyle changes, a pessary, or surgery to rebuild the area and possibly remove the uterus.

• You may be able to prevent this condition with weight loss, a high-fiber diet, not smoking, and Kegel exercises.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Write down your questions before your visit.

• Bring someone with you to help you ask questions. They can also help you remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.

#TomorrowsDiscoveries: Pelvic Floor and Women’s Health – Dr. Victoria Handa

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Dr. Victoria Handa and her team at the Johns Hopkins Women's Center for Pelvic Health and Reconstructive Surgery study how childbirth leads to long-term physical and functional changes in a woman’s body.