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Uterine prolapse

Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then slips down into or protrudes out of the vagina.

Uterine prolapse can happen to women of any age, but it often affects postmenopausal women who've had one or more vaginal deliveries. Weakening of the pelvic muscles that leads to uterine prolapse can be caused by:

  • Damage to supportive tissues during pregnancy and childbirth
  • Effects of gravity
  • Loss of estrogen
  • Repeated straining over the years

If you have mild uterine prolapse, treatment usually isn't needed. But if uterine prolapse makes you uncomfortable or disrupts your normal life, you might benefit from treatment.

Symptoms Causes Risk factors Complications Prevention

Uterine prolapse varies in severity. You may have mild uterine prolapse and experience no signs or symptoms. If you have moderate to severe uterine prolapse, you may experience:

  • Sensation of heaviness or pulling in your pelvis
  • Tissue protruding from your vagina
  • Urinary problems, such as urine leakage or urine retention
  • Trouble having a bowel movement
  • Low back pain
  • Feeling as if you're sitting on a small ball or as if something is falling out of your vagina
  • Sexual concerns, such as a sensation of looseness in the tone of your vaginal tissue
  • Symptoms that are less bothersome in the morning and worsen as the day goes on

When to see a doctor

Uterine prolapse doesn't require treatment unless it's severe. If your signs and symptoms become bothersome and disrupt your normal activities, make an appointment with your doctor to discuss your options.

Weakening of pelvic muscles and supportive tissues contribute to uterine prolapse. This may happen as a result of:

  • Pregnancy
  • Trauma during childbirth
  • Delivery of a large baby
  • Difficult labor and delivery
  • Loss of muscle tone
  • Less circulating estrogen after menopause

Certain factors may increase your risk of uterine prolapse:

  • One or more pregnancies and vaginal births
  • Giving birth to a large baby
  • Increasing age
  • Frequent heavy lifting
  • Chronic coughing
  • Prior pelvic surgery
  • Frequent straining during bowel movements
  • Genetic predisposition to weakness in connective tissue
  • Being Hispanic or white

Some conditions — such as obesity, chronic constipation and chronic obstructive pulmonary disease (COPD) — can place a strain on the muscles and connective tissue in your pelvis and may play a role in the development of uterine prolapse.

Possible complications of uterine prolapse include:

  • Ulcers. In severe cases of uterine prolapse, part of the vaginal lining may be displaced by the fallen uterus and protrude outside your body, rubbing on underwear. The friction may lead to vaginal sores (ulcers). In rare cases, the sores could become infected.
  • Prolapse of other pelvic organs. If you experience uterine prolapse, you might also have prolapse of other pelvic organs, including your bladder and rectum. A prolapsed bladder (cystocele) bulges into the front part of your vagina, which can lead to difficulty in urinating and increased risk of urinary tract infections. Weakness of connective tissue overlying the rectum may result in a prolapsed rectum (rectocele), which may lead to difficulty having bowel movements.

Although uterine prolapse isn't always preventable, you may be able to decrease your risk if you:

  • Perform Kegel exercises on a regular basis. These exercises can strengthen your pelvic floor muscles — especially important after you have a baby.
  • Treat and prevent constipation. Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans and whole-grain cereals.
  • Avoid heavy lifting and lift correctly. When lifting, use your legs instead of your waist or back.
  • Control coughing. Get treatment for a chronic cough or bronchitis, and don't smoke.
  • Avoid weight gain. Talk with your doctor to determine your ideal weight and get advice on weight-loss strategies, if you need them.
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