Uterine Prolapse: Causes, Symptoms, Treatment and When to See a Gynaecologist

Uterine prolapse is a common gynaecological condition in which the uterus moves downward from its normal position into the vagina because the muscles and supporting tissues of the pelvic floor become weak.

It can occur at any age, but it is more common after childbirth, particularly following multiple vaginal deliveries, and after menopause. The good news is that uterine prolapse can be assessed and treated, and women do not need to live with discomfort or embarrassment.

What is Uterine Prolapse?

The uterus is normally held in position by pelvic-floor muscles, ligaments and connective tissues. When these supporting structures become weakened or stretched, the uterus may gradually descend toward the vaginal opening.

Prolapse can range from mild, where there are few or no symptoms, to more advanced stages where the uterus or vaginal walls may protrude outside the vagina.

Symptoms of Uterine Prolapse

Symptoms vary depending on the severity of the prolapse. Common symptoms include:

• A feeling of heaviness or pressure in the pelvis

• A sensation that something is coming down from the vagina

• A visible or palpable bulge at the vaginal opening

• Lower abdominal or pelvic discomfort

• Backache or a feeling of pelvic pressure

• Difficulty passing urine or incomplete emptying of the bladder

• Urinary leakage

• Difficulty with bowel movements

• Vaginal discomfort during sexual intercourse

• Vaginal irritation or discharge, particularly when the prolapse is advanced

Some women may have significant prolapse with surprisingly few symptoms, while others may experience considerable discomfort even with a less advanced prolapse.

Why Does Uterine Prolapse Occur?

Several factors can weaken the pelvic support system.

1. Pregnancy and Childbirth

Pregnancy and vaginal delivery can stretch and weaken the muscles and tissues supporting the uterus. The risk may increase with multiple pregnancies or difficult deliveries.

2. Menopause and Ageing

After menopause, reduced oestrogen levels can contribute to weakening and thinning of pelvic tissues.

3. Chronic Constipation

Repeated straining during bowel movements can place additional pressure on the pelvic floor.

4. Chronic Cough

Long-term coughing can repeatedly increase pressure inside the abdomen and contribute to pelvic-floor weakness.

5. Heavy Physical Work

Repeated heavy lifting and activities that increase abdominal pressure may contribute to symptoms in women who already have weakened pelvic support.

6. Genetic or Connective-Tissue Factors

Some women may naturally have weaker connective tissues and may therefore be more susceptible to pelvic-organ prolapse.

How is Uterine Prolapse Diagnosed?

A gynaecologist usually diagnoses prolapse through a medical history and pelvic examination.

The examination helps determine:

• Whether the uterus has descended

• The severity of the prolapse

• Whether the bladder or rectum is also involved

• Whether there are associated vaginal or cervical problems

Additional investigations may sometimes be recommended depending on the woman's symptoms and examination findings.

Treatment of Uterine Prolapse

Treatment depends on the severity of prolapse, symptoms, age, general health, future pregnancy plans and personal preferences.

Pelvic-Floor Exercises

For mild prolapse or pelvic-floor weakness, pelvic-floor muscle exercises may help strengthen the supporting muscles and improve symptoms.

A healthcare professional can guide women on performing these exercises correctly.

Lifestyle Measures

Depending on the individual situation, treatment may include:

• Avoiding unnecessary heavy lifting

• Treating chronic constipation

• Managing persistent cough

• Maintaining a healthy body weight

• Avoiding prolonged straining

Vaginal Pessary

A vaginal pessary is a medical device placed inside the vagina to provide support to the pelvic organs. It can be useful for some women who prefer a non-surgical approach or who are not suitable for surgery.

Regular follow-up is important when using a pessary.

Surgery

When prolapse is advanced or symptoms significantly affect daily life, surgical treatment may be considered.

The type of surgery depends on the woman's anatomy, the organs involved, symptoms, overall health and whether she wishes to preserve fertility or the uterus.

Surgical procedures may include vaginal or abdominal approaches and reconstructive procedures designed to restore pelvic support.

Can Uterine Prolapse Be Prevented?

Not every case can be prevented, but maintaining good pelvic-floor health may reduce the risk or severity of symptoms.

Helpful measures include:

• Performing appropriate pelvic-floor exercises

• Avoiding chronic constipation and excessive straining

• Treating persistent cough

• Maintaining a healthy weight

• Using proper techniques when lifting

• Seeking medical advice when pelvic symptoms first appear

When Should You See a Gynaecologist?

You should consider a gynaecological assessment if you notice:

“Something coming down” from the vagina, pelvic pressure, a vaginal bulge, difficulty passing urine, urinary leakage, or discomfort associated with prolapse.

Early assessment can help determine the severity of the condition and discuss appropriate treatment options before symptoms become more troublesome.

Frequently Asked Questions

Is uterine prolapse dangerous?

Uterine prolapse is usually not a life-threatening condition, but advanced prolapse can cause significant discomfort and may be associated with urinary, bowel or vaginal problems. A proper examination is important.

Can uterine prolapse be treated without surgery?

Yes. Depending on the severity, options may include pelvic-floor exercises, lifestyle measures and a vaginal pessary. Treatment should be individualized.

Does uterine prolapse always require removal of the uterus?

No. Hysterectomy is not automatically required for every woman with uterine prolapse. The appropriate procedure depends on individual circumstances, including symptoms, anatomy and reproductive plans.

Can a woman become pregnant after treatment for prolapse?

This depends on the type of treatment and the individual circumstances. Women who wish to have future pregnancies should discuss this with their gynaecologist before choosing treatment.

Can uterine prolapse come back after treatment?

Recurrence can occur after treatment. The risk depends on several factors, including the type and severity of prolapse and the treatment performed.

Take-Home Message

Uterine prolapse is common, treatable and should not be a source of shame. If you are experiencing pelvic pressure, a vaginal bulge, difficulty passing urine, or a sensation that something is coming down, a gynaecological examination can help identify the cause and appropriate treatment.

Consultation

Dr. Bushra
Consultant Gynaecologist

For evaluation and treatment of uterine prolapse and other gynaecological conditions, consult a qualified gynaecologist for an individualized assessment.

This article is intended for general health education and does not replace a medical examination or individualized medical advice.