Uterine prolapse is a condition in which the muscles and ligaments that hold the uterus in place weaken, allowing the uterus to migrate down into the vagina. At its mildest, it is practically unnoticeable. At its worst, the decline of the uterus can interfere with the bowels and bladder, causing bladder retention and discomfort. In a few cases, the uterus may even protrude enough to be felt outside of the vagina.
This condition is extremely common, estimated to affect half of all women between 50 and 80 years old. When it occurs, it requires regular monitoring by a medical professional. Learn more about why uterine prolapse happens, how to treat it when it does, and how to recognize the symptoms.
Causes and Prevention
Whether or not a woman develops uterine prolapse depends on several factors ranging from genetic differences to lifestyle choices. Women who have given birth vaginally are the most likely to develop this condition, especially if there were difficulties with the birth, if the infant was larger than average, or if there were multiple births. Other common causes of uterine prolapse include chronic cough, obesity, chronic constipation, or estrogen loss related to normal aging. Those with a family history of uterine prolapse may also have an increased chance of developing it.
Smoking cigarettes can increase your chances of developing uterine prolapse in two ways. University studies have revealed cigarette smoking as an independent risk factor for the condition, possibly caused by increases in an enzyme known as macrophage elastase, which degrades the elastin in the body. Smoking also leads to a smoker’s cough, a chronic condition that weakens the pelvic floor due to repetitive strain.
Eliminating habits that lead to uterine prolapses, like smoking and eating a low-fiber diet, may reduce the chances of developing the condition. Performing Kegel exercises can also help strengthen the pelvic floor muscles that help hold your uterus in place. Kegels can not only help to prevent the uterus from slipping further into the vagina after prolapse has occurred, but they may also play a factor in preventing or delaying prolapse in the first place. Because of influences such as family history, childbearing trauma, and normal aging, however, lifestyle changes can’t always prevent prolapse altogether.
Symptoms and Diagnosis
Women in the early stages of uterine prolapse often experience no noticeable symptoms. As the uterus becomes more displaced, symptoms become more apparent. Signs of moderate to severe uterine prolapse can include:
- Constipation
- Frequent bladder infections
- Heaviness or a pulling feeling in the pelvic area
- Lower back pain
- Painful sex
- Pelvic discomfort
- The sensation of sitting on a ball
- Unusual or excessive discharge from the vagina
- Urine leakage
Your doctor will diagnose uterine prolapse with a pelvic exam, where they will be able to feel any bulges caused by the descending uterus. Your physician may also want to do an MRI to assess kidney health or an ultrasound of the pelvic area to better visualize the movement of the uterus.
Untreated Uterine Prolapse
Although this condition can sometimes deteriorate quickly, most changes in uterine position are extremely gradual. If left untreated, however, uterine prolapse will eventually worsen. While this is a common condition, it should not be ignored.
Turning a blind eye to uterine prolapse can lead to serious symptoms such as urinary retention, bladder or urinary tract infection, or possibly even kidney damage. The only caveat to this is women who are diagnosed while still in the early postpartum period. They may sometimes see improvement over the first year, even without treatment.
Treating Uterine Prolapse
While this can be an uncomfortable condition, it is also treatable. There are several methods for treating uterine prolapse. Depending on the severity and positioning of the prolapse, your physician will likely suggest one of four treatments, along with lifestyle changes such as smoking cessation, improvements to diet and exercise, or estrogen replacement therapy.
Kegel exercises
Kegel exercises require no special equipment and can be done anywhere at any time. When executed properly, they are exceptionally helpful in strengthening the pelvic floor to better support the uterus. If you are uncertain how to perform Kegel exercises properly, ask your physician, and they can coach you.
Depending on how bad the prolapse is, by the time you realize you have a problem, it may be too late for kegel exercises to make a difference.
Vaginal pessary
A vaginal pessary is a rubber or plastic ring that helps prop up the uterus and keep it in place. It fits snugly around or under the cervix to improve the strength and stability of the pelvic floor. Pessaries are most often employed when the patient is trying to avoid surgery for personal reasons or when surgery is medically dangerous.
Prolapse repair surgery
Surgery to repair the underlying structure of the pelvic floor is often successful in alleviating symptoms by returning the uterus to its original position. Your surgeon can complete this procedure either through the vagina or through the abdomen.
Prolapse repair surgery with hysterectomy
In some cases, the best treatment is to remove the uterus altogether, a procedure known as a hysterectomy. Your surgeon may choose to perform the surgery through either the vagina or through an incision in the abdomen, depending on which is less invasive in your particular situation.
These treatments have a high rate of initial success, but uterine prolapse often reoccurs over time. Your medical team needs to monitor your pelvic region even after a repair involving a hysterectomy. While the uterine prolapse can no longer reoccur, vaginal vault prolapse, where the upper portion of the vaginal canal sags into the lower portion, may develop in its place.
A Final Word
Individuals with uterine prolapse should also avoid certain activities that may exacerbate their condition. Patients with uterine prolapse should avoid heavy to moderate lifting, if possible. If lifting cannot be avoided, it is crucial to use proper lifting techniques to prevent further displacement of the uterus. It is also crucial to manage any chronic coughing or ongoing constipation as soon as possible, as these conditions trigger or worsen uterine prolapse for many individuals.
If you suspect that you have uterine prolapse, schedule an appointment to talk with your doctor as soon as possible. The sooner you enlist your doctor’s help, the sooner you can assess the situation and formulate a treatment plan that keeps you active, healthy, and pain-free.
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