The uterus, or womb, is said to be prolapsed when it has moved downward from its normal position. This can happen when the tissues that normally support the uterus - the pelvic floor muscles and ligaments - become stretched and weak. The uterus drops down the vagina closer to the vaginal opening, occasionally even protruding through it. The bladder and bowel can also drop down.
This condition is very common, and while it may not necessarily cause symptoms, a prolapsed uterus (also called uterine prolapse) can affect a woman's physical and sexual activity as well as her quality of life.
Causes of prolapsed uterus
Causes of uterine prolapse include:
- Childbirth, which is probably the single biggest risk factor for developing a uterine prolapse. This risk is increased if the baby was large, if the pushing stage during labour was prolonged, or if the delivery was by forceps or resulted in a third-degree tear (a tear into the tissues of the anus or back passage).
- Deterioration of muscles, ligaments and connective tissue that occurs with age and low levels of oestrogen after menopause. This can affect the tissues that hold the uterus in place.
- Increased pressure within the abdomen, which often occurs with constipation, chronic cough and frequent heavy lifting. The risk is increased by conditions such as overweight and obesity.
- An inherited tendency to weakness in the ligaments and other connective tissues.
Symptoms of prolapsed uterus
The most common symptom of uterine prolapse is the awareness of a 'heaviness' in the vagina and a sensation of 'something coming down'. Sometimes a woman can feel a distinct lump or bulge in her vagina or even have tissue protruding through the vaginal opening. There is often associated backache.
These symptoms usually improve when lying down and are less noticeable in the morning, getting worse during the course of the day or after exertion.
Uterine prolapse may also cause urinary problems such as difficulty passing urine or emptying the bladder completely, problems holding urine or frequent urinary tract infections. It might also cause discomfort or pain during sexual intercourse. Occasionally, it can also interfere with bowel movements.
Your doctor can usually diagnose uterine prolapse from your symptoms and a vaginal examination. Imaging tests may sometimes be used to assess the degree of prolapse.
Prevention of prolapsed uterus
You may not be able to prevent uterine prolapse, but the following might help reduce your risk:
- Keep your weight in the normal range;
- Practice pelvic floor exercises;
- Avoid constipation and straining with bowel movements;
- Avoid heavy lifting; and
- If you have a lung problem then use your preventive and treatment medicines to limit coughing.
If there are no symptoms from the uterine prolapse, then treatment is generally not required.
Women with mild symptoms should avoid anything that makes the condition worse, such as heavy lifting or constipation. If you are overweight or obese, then losing weight might help. Pelvic floor exercises are often useful in alleviating symptoms and preventing the prolapse from becoming worse.
Uterine prolapse can also be treated with a vaginal ring pessary, although these are not used in Australia as commonly as in the past. The device, shaped like a doughnut, is individually fitted and positioned to prop up the cervix and the uterus. A pessary may be temporary or permanent and needs to be removed and cleaned or changed regularly. A pessary may be useful for women with uterine prolapse symptoms who wish to have more children and for those who are not well enough or do not wish to have an operation.
Women with a prolapsed uterus often require surgery, especially when other treatment options have failed. Surgery may include removal of the uterus (hysterectomy). Prolapse can recur after surgery, with either the same or a different type of prolapse. Surgery can also cause new symptoms, such as stress incontinence (leakage of urine when coughing or straining). However, for many women surgery is curative.
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