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Article on "Prolapse of the Uterus (Uterine Prolapse)"  

Prolapse of the Uterus (Uterine Prolapse)

Summary

Prolapse of the Uterus (Uterine Prolapse) is a condition of the women, in which the uterus (womb) descends down into the vagina (birth canal). Prolapse of the Uterus occurs when the muscles that support the uterus become weak or are damaged.

It usually affects the old aged women, but it may also be seen in young women during and after pregnancy. The common symptoms of Uterine Prolapse are feeling of something coming out of the vagina, lower back pain and difficulty in urination. 

Depending upon the degree of the descent, Uterine Prolapse can be categorized into following stages:

  • First degree: When the cervix (the lowermost part of the uterus) slides into the vagina, but not up to the opening of vagina.

  • Second degree: When the cervix drops down to the opening of the vagina but not out of it.

  • Third degree: The cervix is out of the vagina but some part of the uterus is still inside the vagina.

  • Fourth degree: When the entire uterus comes out of the vagina. This condition is also known as Complete Prolapse or Procidentia.

It is not an emergency condition but negligence may lead to certain complications.

Quick Points About the Disease/Condition

Old age related condition, may be life style induced or rarely genetic also.

Your Body Part or System That it Affects

Uterus is the main organ affected but other organs, such as vagina, urinary bladder, and rectum, may also be affected.

Causes of Prolapse of the Uterus (Uterine Prolapse)

The uterus is normally held in its place by the support of various muscles that are called as the pelvic floor muscles. The following are certain factors that can lead to weakness or damage to these muscles, which may  result in Uterine Prolapse:

  • Age: Most of the women having this condition are beyond fifty years of age.  

  • Pregnancy: The normal delivery increases the chances of Uterine Prolapse. Women, who had multiple child births, may develop Uterine Prolapse during a pregnancy due to the increasing weight of the uterus.    

  • Obesity: Obese women have additional strain on their pelvic floor muscles. 

  • Weakening and loss of tissue tone after menopause and loss of natural estrogen may be causing factors. 

  • Certain conditions that leads to increased abdominal pressure may also be responsible, such as: 

        o   Persistent cough due to Asthma, Bronchitis, or Tuberculosis.  

        o   Constipation

        o   Accumulation of fluid inside the abdomen due to some liver or kidney diseases.

        o   Large tumors of the pelvis (lower abdomen)

  • Surgeries of the lower abdomen may damage to the pelvic floor muscles.

  • Heavy weight lifting.

  • Sometimes, the prolapse is due to the tumors of the uterus, which may pull the uterus downward due to the extra weight.

  • Some genetic conditions such as Marfan Syndrome and Ehler-danlos Syndrome also increase the chances of Uterine Prolapse.

Symptoms of Prolapse of the Uterus (Uterine Prolapse)

The first degree Uterine Prolapse usually does not produce any symptom. But women with higher degrees of Uterine Prolapse may experience the following Symptoms. The discomfort due to these symptoms is less in the morning but it worsens as the day passes. 

The common symptoms are:

  • A feeling of heaviness or pressure in the lower abdomen. 

  • Feeling of something coming into your vagina. 

  • Women with third and fourth degree of prolapse may actually see the some mass coming out of their vagina. 

  • Pain in the lower back.

  • Some of these women may feel pain during sexual intercourse.

  • The prolapsed uterus may compress over the urinary tract leading to difficulty in urination.

  • Sometimes it may also compress the rectum (a part of the large bowel) causing difficulty in defecation. 

  • The women with complete prolapse may have difficulty in walking. 

  • Unusual vaginal discharge

Tests and Diagnosis of Prolapse of the Uterus (Uterine Prolapse)

Most of the times, Prolapse of the Uterus can be diagnosed on the basis of the symptoms and the physical examination.

Usually, there is no laboratory tests are required. But sometimes, the following lab tests may be required to find out other associated conditions:

  • Ultrasonography (USG): It is an imaging technique that may help in finding out any tumor or fluid accumulation inside the abdomen. It may also show any obstruction to the urinary flow.

  • Culture of the Vaginal Discharge: Uterine Prolapse may lead to an infection of the vagina or the cervix. Therefore, vaginal discharge may be checked in the lab for the presence of any bacteria.

  • Pap Smear: The cells present over the cervix are taken with the help of a spatula and examined under a microscope to rule out any cancer which may be associated with Uterine Prolapse.

Treatments for Prolapse of the Uterus (Uterine Prolapse)

Various treatment options are available depending upon the degree of the Uterine Prolapse and the other associated conditions.

  • Estrogen Theraoy: Estrogen is a hormone that strengthens the pelvic muscles. With advancing age, the production of this hormone decreases and the chances of prolapse increases. This hormone can be given to the old women in the form of tablets or vaginal creams (to be applied in the vagina). It can also be given preventively to the post-menopausal women, whose monthly cycle has stopped.

  • Vaginal Pessary: It is a ring shaped device that can be placed inside the vagina so as to hold the uterus in its place. It is particularly useful for the lower (1st and 2nd) degrees of Uterine Prolapse. Estrogen containing pessaries are also available.

  • Pain reliever drugs can be given to reduce the pain.

  • Stool softeners may help women with Constipation.

  • Surgery: Depending upon the condition, the type of surgery varies. 

        o    In young women, who may plan pregnancy in their future, the uterus may be repaired and fixed in its normal place.

        o    In older women with higher degrees of prolapse, usually Hysterectomy, which is removing the uterus, is considered.

        o Laparoscopic Surgery: It is a modern type of surgery that leaves minimum scars on the skin. It involves insertion of surgical instruments along with a laparoscope, which is a thin tube that has a light and a camera at its tip, into the abdomen through small skin incisions. The surgery is done by looking at the monitor on which the picture inside the body is displayed.

Side-effects and Complications

The common complications associated with Uterine Prolapse are:

  • Ulcers:  These are non-healing wounds that may occur on the exposed part of the uterus or in the walls of the vagina. 

  • The ulcer on the exposed part of the uterus may bleed leading to loss of blood.

  • The exposed part of the uterus may also become infected that can sometimes result in the death of the exposed tissue.

  • Prolapse of other pelvic organs: Uterine Prolapse may be associated with prolapse of other pelvic organs such as:

        o   Cystocele: Prolapse of the urinary bladder into the vagina leading to retention of the urine or loss of control over urination.

        o   Rectocele: It is prolapse of the rectum into the vagina causing difficulty in defection. 

The treatments of Uterine Prolapse may also have following side effects such as:

  • Estrogen may increase the risk of Breast Cancer and Gall Bladder Disease.

  • The pessaries are relatively free of side effects, but in some cases they cause discomfort, impaction, infection or bleeding inside the vagina.

Self-care and Important Considerations

The following measures may help in preventing Prolapse of the Uterus:

  • Regular light exercises to maintain the normal weight and to strengthen the muscles.

  • One should take balanced diet with sufficient amount of dietary fibers so as to avoid constipation.

  • One should avoid heavy weight lifting without proper guidance.

  • Smoking should be avoided, as it is associated with various conditions that cause chronic (long lasting) cough.

  • One should not neglect any chronic cough.

  • Pelvis strengthening exercise reduces the chances of Uterine Prolapse. This exercise can be done by tightening the pelvic muscle as if trying to stop the flow of urine.

This article is developed by our team of Doctors/Experts. Last updated in 20th December,2010. Please see our Editorial board for details.
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