Understanding Uterine Prolapse

Uterine Prolapse Stages

Uterine prolapse occurs when the uterus slips down or protrudes out of the vagina due to weakened or overstretched pelvic floor muscles and ligaments.

The severity of uterine prolapse is categorised into four stages, based on how far the organs, such as the bladder, womb, or bowel, have descended:

Uterine Prolapse Symptoms

Many women with uterine prolapse experience no symptoms. However, when symptoms do appear, they may include a feeling of pressure or heaviness in the pelvis or vagina, leaking urine or a sudden urge to empty the bladder, and a bulging of the uterus and cervix into the vaginal opening. Other symptoms can include lower back pain, vaginal bleeding, constipation, and increased vaginal discharge.

Uterine prolapse can also increase the risk of urinary tract infections (UTIs). When the uterus descends, it may press on the bladder, making it difficult to fully empty. This residual urine can promote bacterial growth, leading to infections. Additionally, urinary symptoms such as urgency and incontinence further elevate the risk of infection.

Although uterine prolapse is not life-threatening, symptoms can worsen over time, leading to increased pelvic pressure, discomfort, and urinary or bowel issues. Living with prolapse can affect mental health, leading to anxiety, depression, and reduced quality of life due to pain, sexual function concerns, or body image issues. In severe cases, untreated prolapse may complicate future surgical options if intervention becomes necessary.

Uterine Prolapse Risk Factors

Childbirth, especially vaginal deliveries, poses the highest risk for uterine prolapse, particularly in cases of multiple or complicated births. The strain of delivery can weaken the pelvic floor muscles, making it harder for them to support the uterus.

Ageing and menopause also contribute to this condition, as the natural decline in oestrogen levels after menopause reduces the strength and elasticity of the pelvic tissues that support the uterus. This increases the likelihood of prolapse. Additionally, genetics play a role, as a family history of uterine prolapse or weakened connective tissue can make someone more susceptible.

Chronic straining from constipation, frequent coughing, or heavy lifting places extra pressure on the pelvic floor muscles, which can lead to prolapse over time. Being overweight or obese further compounds this, as excess weight increases pressure on the pelvic organs.

Previous pelvic surgeries, such as a hysterectomy, can weaken the structural support of the uterus and surrounding organs, making prolapse more likely. Smoking, with its associated chronic coughing, adds to this strain on the pelvic floor muscles.

Lastly, occupations or activities involving repetitive heavy lifting or prolonged standing can also elevate the risk of developing uterine prolapse

Uterine Prolapse Diagnosis

Typically, a combination of a patient’s medical history, symptoms, and a physical examination is needed to diagnose uterine prolapse.

During a pelvic examination, you may be asked to lie down while the doctor visually and physically assesses the position of your uterus and other pelvic organs. You may also be asked to bear down or cough during the exam to see if this causes the uterus to descend further.

In some cases, an ultrasound scan may be performed to assess the uterus and other pelvic structures.

Uterine Prolapse Treatment and Prevention

Pelvic floor exercises (Kegel exercises) are an effective way to strengthen the core and pelvic floor muscles. These exercises can be done at any time—while sitting, lying down, eating, at your desk, driving, or even relaxing at home.

A vaginal pessary, a device made of latex or silicone, can be inserted into the vagina to help manage prolapse symptoms by supporting the pelvic organs.

Losing excess weight can relieve pressure on the pelvic organs and help reduce the symptoms of uterine prolapse. Additionally, reducing activities that strain the pelvic floor, such as heavy lifting, can help prevent the prolapse from worsening. It is important to use proper lifting techniques when handling heavy objects.

Eating a fibre-rich diet and drinking plenty of fluids can help avoid constipation and reduce straining, which can exacerbate prolapse symptoms.

Quitting smoking is crucial, as smoking-related chronic coughing can strain the pelvic floor muscles, increasing the risk of prolapse.

In mild cases of uterine prolapse, surgery can often be avoided. In some cases, the organs may naturally shift back into position, or at the very least, they may not fall any further. Many women find that performing pelvic floor exercises and/or using a vaginal pessary is effective in managing their symptoms.

In cases of severe uterine prolapse, a hysterectomy (removal of the uterus) may be recommended. After a hysterectomy, additional procedures may be performed to support the remaining pelvic organs and prevent further prolapse.

Alternatively, uterine suspension may be done to reposition the uterus and secure it to the pelvic ligaments or surrounding tissues. This procedure can help restore the uterus to its proper position while maintaining the pelvic structure.

Book an Appointment at Gleneagles Hospitals

If you are experiencing symptoms of uterine prolapse that are worsening, do get in touch with us to book an appointment today for a consultation with the experienced team of O&G specialists at  your nearest Gleneagles Hospital to receive the best possible care.