Uterine Prolapse
(Pelvic Floor Hernia; Pudendal Hernia; Pelvic Relaxation)
Definition
Uterine prolapse occurs when the uterus slips out of place and 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
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Causes
The uterus is normally supported by pelvic connective tissue. It is held in position by special ligaments. Weakening of the tissue causes the uterus to descend into the vaginal canal.
Risk Factors
Increasing age and white race increase your chances of having uterine prolapse. Other factors include:
- Multiple vaginal deliveries
- Post-menopause
- Obesity
- Straining caused by chronic cough, constipation, or heavy lifting
Symptoms
Symptoms may include:
- Pelvic pressure
- 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
- Protrusion of pink tissue from the vagina that may be irritated or itchy
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will also be done. Uterine prolapse that has no symptoms may be diagnosed during routine examinations. Your doctor may refer you to a gynecologist, who will do a pelvic exam.
Treatment
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.
Medication
Your doctor may recommend estrogen therapy. This may help prevent further weakness of the pelvic floor.
Pessary Insertion
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
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.
If you are diagnosed with uterine prolapse, follow your doctor's instructions.
Prevention
To help prevent 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, quit. Smoking may cause chronic coughing and weakening of connective tissues.
- Limit heavy lifting.
RESOURCES:
American Congress of Obstetricians and Gynecologists
http://www.acog.org
US Department of Health and Human Services Women's Health
http://www.womenshealth.gov
CANADIAN RESOURCES:
Canadian Women's Health Network
http://www.cwhn.ca
Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org
REFERENCES:
Colpocleisis (LeFort procedure). International Center for Laparoscopic Urogynecology website. Available at: http://www.miklosandmoore.com/lap_proc11.php. Accessed April 22, 2013.
Pelvic organ prolapse. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated January 22, 2013. Accessed April 22, 2013.
Pelvic organ prolapse. International Urogynecological Association website. Available at: http://www.iuga.org/resource/resmgr/Brochures/eng_pop.pdf. Published 2011. Accessed April 22, 2013.
Pelvic relaxation syndromes. Merck Manual for Health Care Professionals. Available at: http://www.merckma.... Updated February 2012. Accessed April 22, 2013.
Vaginal pessary. American Academy of Family Physicians Family Doctor website. Available at: http://familydocto.... Updated August 2010. Accessed April 22, 2013.
10/21/2008 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Shariati A, Maceda JS, Hale DS. High-fiber diet for treatment of constipation in women with pelvic floor disorders. Obstet Gynecol. 2008;111:908-913.
Last reviewed April 2013 by Andrea Chisholm; Brian Randall, MD
Last Updated: 4/22/2013