Uterine Prolapse

(Pelvic Floor Hernia; Pudendal Hernia; Pelvic Relaxation)

Definition

Uterine prolapse is when the uterus slips into or extends past the vagina.

Uterine Prolapse
uterine prolapse

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Causes

This problem happens when the muscles and ligaments that support the uterus become weak.

Risk Factors

This problem is more common in women over 70 years of age. It is also more common after menopause. Other things that may raise the risk are:

Symptoms

Some women may not have symptoms. Others may have:

  • Pelvic pressure, heaviness, or pain
  • Pain during sex
  • Tissue that slips or extends past the vagina
  • Vaginal discharge
  • Problems passing stool
  • Problems passing urine, such as urgency and frequency

Diagnosis

You will be asked about your symptoms and health history. A physical exam will be done. A pelvic exam will also be done. This is often enough to make the diagnosis.

Treatment

The goal of treatment is to ease symptoms. This can stop the problem from getting worse and needing surgery. This can be done with:

  • Kegel exercises to strengthen the pelvic floor muscles
  • Estrogen therapy to prevent further weakness of the pelvic floor
  • A device placed in the vagina to prop up the uterus and bladder

Surgery

Surgery may be needed for severe prolapse. It is usually not done until a woman has finished having children. Options are:

  • Hysterectomy to remove the uterus
  • Vaginal repair using sutures, mesh, or slings (sometimes done with a hysterectomy)
  • Colpocleisis to close the vagina in older women who are not sexually active

Prevention

The risk of uterine prolapse may be lowered by:

  • Staying at a healthy weight
  • Limiting heavy lifting
  • Avoiding constipation
  • Doing exercises to strengthen the pelvic floor
RESOURCES:

The American Congress of Obstetricians and Gynecologists
https://www.acog.org

Office on Women's Health
https://www.womenshealth.gov

CANADIAN RESOURCES:

Canadian Women's Health Network
http://www.cwhn.ca

Society of Obstetricians and Gynaecologists of Canada
https://sogc.org

REFERENCES:

American College of Obstetrics and Gynecology (ACOG) and American Urogynecologic Society (AUGS). ACOG Practice Bulletin No. 185: Pelvic Organ Prolapse. Obstet Gynecol. 2017 Nov;130(5):e234-e250.

Pelvic organ prolapse. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/pelvic-organ-prolapse. Updated April 22, 2019. Accessed July 22, 2020.

Uterine and apical prolapse. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gynecology-and-obstetrics/pelvic-organ-prolapse-pop/uterine-and-apical-prolapse. Updated April 2019. Accessed July 22, 2020.

Vaginal pessary. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/vaginal-pessary. Updated February 8, 2020. Accessed July 22, 2020.

Last reviewed March 2020 by EBSCO Medical Review Board Elliot M. Levine, MD, FACOG  Last Updated: 7/22/2020