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Uterine prolapse is generally defined as the descent of the uterus into the vagina. The uterus is located within the pelvis along with the bladder, both of which are held in place atop the inside end of the vagina by a web of supportive muscles and ligaments.
These supportive structures can become loose and weak over time due to gradual wear and tear as well as stretching during pregnancy. The muscles and ligaments give way, and consequently the uterus sags and bulges out of the vaginal canal, which is referred to as uterine prolapse.
In mild cases, the downward shift of the uterus only creates a protrusion inside the vaginal canal with minimal symptoms that largely go unnoticed.
In fact, it is estimated that nearly half of all women experience some degree of uterine or bladder prolapse in the aftermath of childbirth. However, most of them remain oblivious to it since it does not cause any noticeable discomfort.
More serious cases of uterine prolapse involve a drastic sinking of the uterus such that it becomes visible from the vagina’s opening or even sticks out of it. Treatment is warranted in such cases.
What are the different stages of a prolapsed uterus?
Stage 0 through 4 are the general stages of prolapse. However, there are other staging methods that may be compartment specific that some surgeons utilize.
The severity of uterine prolapse is gauged based on how far the bladder, uterus, or bowel has sunk. The four general stages of severity are:
- First degree: There is only a slight downward shift in the position of the concerned organs.
- Second degree: The organs descend far enough to reach the level of the vaginal opening.
- Third degree: The vagina or uterus slips so far that 1 cm of it bulges out of the vaginal opening.
- Fourth degree: The organs drop down even further such that more than 1 cm of the vagina or uterus protrudes out of the vaginal opening.
What are the major causes of uterine prolapse?
The cause of uterine prolapse is multifactorial. The most common is pregnancy, but other causes include heavy lifting for prolonged periods. Patients who smoke are also at risk as smoking affects collagen production and can weaken connective tissue over time.
What are the common symptoms of uterine prolapse?
Many women will report pelvic or vaginal pressure. Sometimes, they will experience pelvic or low back pain.
When the uterus sinks into the vagina, the bladder and rectum may also drop down (bladder and rectal prolapse). Bladder prolapse can cause urinary symptoms such as frequency or urgency of urination and incomplete emptying of the bladder.
Rectal symptoms include constipation or feeling of incomplete emptying of the bowels.
Can a prolapsed uterus cause bleeding?
Bleeding directly from the uterus in a post-menopausal woman could be cancer and will need to be evaluated.
However, if a woman has bleeding and a prolapse, her doctor will need to rule other causes and sites of bleeding. Ulceration of the prolapsed walls could be a common reason, or the bleeding may be from her bladder or rectum.
How is uterine prolapse diagnosed?
Your doctor will stage the prolapse during a pelvic exam with the use of a speculum. They may ask you to bear down during the exam to elicit the prolapse and determine its stage. They may ask you to stand and bear down as well to fully evaluate the prolapse.
What is the best treatment option for uterine prolapse?
I like to base “best treatment” on what makes the most sense to the patient. In other words, not all treatments are good for everyone.
The treatment can be pelvic floor physical therapy to help some of the pelvic floor weakness.
The use of a pessary can also be helpful. A pessary is a silicone ring or other shaped device that is placed into the vagina by the doctor after being properly sized. This device can help elevate the prolapse and thereby alleviate the symptoms.
If these nonsurgical options do not help, then surgery can be done. Depending on the stage of prolapse, procedures such as laparoscopic uterosacral colpopexy, sacrocolpopexy, and sacrospinous fixation are all commonly done to repair a prolapse.
Your surgeon should tailor the surgical management to your specific stage of prolapse and desired outcomes.
Is a prolapsed uterus dangerous?
A prolapse is rarely a dangerous diagnosis. However, stage 4 prolapse that cannot be reduced may lead to obstruction of urination and renal failure. Along that line, prolapse that cannot be reduced also may lead to decubitus ulceration, which could become infected and cause sepsis.
What are the complications of a prolapsed uterus?
The complications of uterine prolapse broadly depend on the stage of prolapse. In most cases, women who have stage 1 or 2 prolapse will not experience any significant symptoms.
However, stages 3 and 4 could have complications as the surrounding organs may be affected.
Is it normal for a prolapsed uterus to be accompanied by pain?
Pain can be normal, but also many women can have a prolapse for years with little impact on their lives. But pelvic pressure, pain, and generalized discomfort are common reasons women will seek medical attention.
Is it advisable to push a prolapsed uterus back up?
If a woman sees a prolapse, her instinct would be to try to reduce it. However, she should seek specialized care and consultation as soon as possible to be sure it is not something more concerning such as a mass related to cancer.
Can exercising worsen a prolapsed uterus?
If a woman has a prolapse already, vigorous weight-bearing exercising could worsen the prolapse. However, light cardio workouts, yoga, etc., can be continued safely.
Can a woman suffering from uterine prolapse get pregnant?
The simple answer is yes.
Is uterine prolapse dangerous during pregnancy?
The pregnancy itself is not likely to be at any risk due to the prolapse.
Also, it is important to know that a woman with a known prolapse who is pregnant may notice a worsening of her prolapse up to a year after her delivery, and any surgical intervention should be delayed until then.
What important points should be kept in mind while dealing with a prolapsed uterus?
If you feel you have a prolapse, see a doctor who specializes in female pelvic floor disorders and also performs surgeries for these conditions.
There may not be a one-size-fits-all correction of prolapse, and it may take many months or years to get the results you are comfortable with.
Many women feel embarrassed by the prolapse and may not talk to anyone about it. Women should know that they are not alone and that many women experience this.
There may be nonsurgical methods to help address the symptoms of prolapse, and women should not be afraid to ask their doctor about all their options.