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Uterine Prolapse

(Pelvic Floor Hernia; Pudendal Hernia; Pelvic Relaxation)

Definition

Uterine prolapse is the slipping of the uterus into the vaginal canal. The severity of uterine prolapse is defined as:

  • First degree—the cervix protrudes into the lower part of the vagina
  • Second degree—the cervix protrudes past the vaginal opening
  • Third degree—the entire uterus protrudes past the vaginal opening

Uterine Prolapse

uterine prolapse
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Causes    TOP

The uterus is normally supported by muscles and ligaments. Weakening of the tissue causes the uterus to sag into the vaginal canal.

Risk Factors    TOP

Uterine prolapse is more common in Caucasians.

Factors that may increase your chances of uterine prolapse:

Symptoms    TOP

Symptoms may include:

  • Pelvic pressure or aching
  • A feeling of vaginal fullness or heaviness
  • A feeling of pulling in the pelvis
  • Vaginal discharge
  • Urinary urgency and frequency
  • Urination when laughing, sneezing, coughing, or exercising
  • Pain with sexual intercourse
  • Protrusion of pink tissue from the vagina that may be irritated or itchy

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. Uterine prolapse without symptoms may be diagnosed during routine examinations. Your doctor may refer you to a gynecologist, who will do a pelvic exam.

Treatment    TOP

Talk with your doctor about the best treatment plan for you. First or second degree prolapse without symptoms may not require treatment. Treatment options include:

Kegel Exercises

Kegel exercises involve tensing the muscles around the vagina and anus, holding for several seconds, then releasing. The repetition of this exercise will help to tone pelvic muscles. You may be asked to do this up to 100 times a day.

Medication

Your doctor may recommend estrogen therapy. This may help prevent further weakness of the pelvic floor. Talk to your doctor about the risks and benefits associated with hormone replacement therapy.

Pessary Insertion    TOP

Your doctor may insert a pessary into the upper portion of the vagina. A pessary is a rubbery, doughnut-shaped device. It helps to prop up the uterus and bladder. Pessary placement is more often used in older women.

Surgery    TOP

Surgery may be needed for severe uterine prolapse. These procedures are usually not done until you have finished having children. Options include:

  • Hysterectomy—This is the removal of the uterus. This will permanently resolve uterine prolapse.
  • Vaginal repair—This is usually done with a hysterectomy. The repair can be done with sutures or with insertion of mesh and slings.
  • Colpocleisis—This involves closing the vagina. It is done only in women who are elderly and who are no longer sexually active.

Prevention    TOP

To help reduce your chances of uterine prolapse:

  • Do Kegel exercises.
  • Maintain a healthy weight.
  • To avoid constipation, eat plenty of fruits, vegetables, and whole grains. Drink plenty of fluids throughout the day.
  • If you smoke, talk to your doctor about ways to quit. Smoking may cause chronic coughing and weakening of connective tissues.
  • Limit heavy lifting.

RESOURCES:

Office on Women's Health
https://www.womenshealth.gov
The American Congress of Obstetricians and Gynecologists
https://www.acog.org

CANADIAN RESOURCES:

Canadian Women's Health Network
http://www.cwhn.ca
Society of Obstetricians and Gynaecologists of Canada
https://sogc.org

References:

Pelvic organ prolapse. EBSCO DynaMed website. Available at: http://www.dynamed.... Updated March 23, 2015. Accessed April 17, 2018.
Pelvic organ prolapse. International Urogynecological Association website. Available at:
...(Click grey area to select URL)
Accessed April 17, 2018.
Uterine and vaginal prolapse. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gynecology-and-obstetrics/pelvic-relaxation-syndromes/uterine-and-vaginal-prolapse. Updated February 2017. Accessed April 17, 2018.
Vaginal pessary. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/vaginal-pessary. Updated October 24, 2017. Accessed April 17, 2018.
10/21/2008 DynaMed's Systematic Literature Surveillance https://www.dyname...: Shariati A, Maceda JS, Hale DS. High-fiber diet for treatment of constipation in women with pelvic floor disorders. Obstet Gynecol. 2008;111(4):908-913.
5/11/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Fritel X, Varnoux N, Zins M, Breart G, Ringa V. Symptomatic pelvic organ prolapse at midlife, quality of life, and risk factors. Obstet Gynecol. 2009;113(3):609-616.
Last reviewed March 2018 by EBSCO Medical Review Board Marcie L. Sidman, MD
Last Updated: 4/17/2018

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