Alternative Names prolapsed uterus, pelvic support relaxation, pelvic floor hernia, procidentia, pudendal hernia
Definition Uterine prolapse is the "dropping" of the uterus from its normal position at the top of the vagina. It drops to a lower part of the vagina and may even drop outside the vagina. This is caused by a relaxation of the ligaments that support the uterus within the abdominal walls.
What is going on in the body? Uterine prolapse occurs more commonly in white women, and in women who:
have given birth vaginally to many children
have given birth to large babies
have had forceps deliveries
These things may have caused injury to the pelvic ligaments and muscles. Symptoms may not occur until many years after women have given birth. This suggests that ageing and shrinkage of these muscles also adds to the problem.
Uterine prolapse sometimes occurs in women who have never given birth. In these cases, the condition is due to a family tendency to have weak muscles that hold the uterus in place.
Some women have what is known as a "tipped uterus." This type of uterus is especially at risk to prolapse. This is due to its alignment along the same line as the vagina. It may be subject to a "piston-like effect." This happens when a woman uses her abdominal muscles, which push the uterus down into the vagina.
There are many different degrees of prolapse. Incomplete prolapse occurs when the uterus drops only partway into the vagina. Complete prolapse occurs when the uterus and cervix protrude out of the vagina and the vagina becomes inverted. Along with uterine prolapse there may be relaxation of the front and back portions of the vagina. This can cause a part of the bladder or rectum to protrude into the vagina.
What are the signs and symptoms of the condition? Mild prolapse may not cause any symptoms. With more severe prolapse, a woman may have:
How is the condition diagnosed? A doctor can tell during a pelvic examination if the cervix is in a lowered position in the vagina. The pelvic examination may also show a part of the bladder or rectum protruding into the vagina.
What are the long-term effects of the condition? The long-term effects of uterine prolapse depend on how severe it is and how long a woman has had the condition. Some long-term effects include:
incarceration of the uterus within the pelvis. This occurs with rapid growth of a pregnant uterus that becomes trapped in the pelvis, cutting off its blood supply.
What are the risks to others? Uterine prolapse is not contagious, and poses no risk to others.
What are the treatments for the condition? Treatment for uterine prolapse depends on many things, including:
the severity of the prolapse
the severity of the symptoms
the presence of other signs and symptoms
a woman's wishes to preserve her fertility
the woman's age
Treatment options include:
pessary, a plastic doughnut-shaped device placed into the vagina to push up the uterus
round ligament suspension procedure, an operation to provide muscle support to the uterus
What are the side effects of the treatments? The side effects depend on the treatment. The use of hormone replacement therapy may cause nausea, weight gain, abdominal bloating, increased vaginal discharge, and breast tenderness. After a hysterectomy a woman will need 6 to 8 weeks to recuperate. There are possible side effects with any surgery. These include bleeding, infection, and allergic reactions to anaesthesia.
What happens after treatment for the condition? After surgical treatment of a prolapsed uterus, a woman should:
avoid lifting heavy objects
prevent constipation by drinking plenty of fluids, using stool softeners for a short time, and increasing her fibre intake
avoid wearing tight girdles or other garments that put pressure on the abdomen
How is the condition monitored? Any new or worsening symptoms should be reported to the doctor.
Author: Eva Martin, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
