Uterine Prolapse: Causes, Symptoms & Treatment

Uterine prolapse is a prolapse of the uterus. When this happens, the uterus slips through the birth canal.

What is uterine prolapse?

Uterine prolapse (uterine prolapse) is classified as the worst form of uterine prolapse (descensus uteri). This causes the uterus (womb) to push through the birth canal. This in turn causes the vagina to bulge out and leak outside the body. The reason for this is the giving way of the retaining ligaments. The uterus of the woman represents a muscular organ. It is held in place by ligaments and muscles within the pelvis. If these ligaments and muscles weaken and stretch, they are no longer able to ensure the fixation of the uterus. The result of this is prolapse. This is seen when the uterus descends or slips from its normal position. Uterine prolapse occurs either partially or completely. In complete prolapse, the uterus slips so that part of it can be seen outside the vagina.

Causes

Prolapse of the uterus is caused by the same reasons that cause uterine prolapse. This is a congenital or acquired weakness of the connective tissue during childbirth. Certain risk factors further increase the risk of uterine prolapse occurring. Increasing age is considered a high risk factor, which leads to a decrease in estrogen levels in the body. Estrogen is important for strong muscles of the pelvic floor. Also high is the risk of uterine prolapse in women who have had multiple vaginal births. Thus, pelvic tissues and muscles can be negatively affected by the birth process. The risk of prolapse is particularly pronounced after menopause. In addition, activities that create pressure on the pelvic floor muscles have a favorable effect on uterine prolapse. Other risk factors are considered to be injuries during the birth process, chronic constipation, persistent coughing, and obesity (being overweight).

Symptoms, complaints, and signs

The symptoms of uterine prolapse depend on its extent. If there is only a small prolapse, sometimes there are no symptoms at all. If, on the other hand, the prolapse is moderate or severe, vaginal bleeding, heavy discharge, constipation, repeated inflammation of the urinary bladder or a pulling sensation in the pelvic region may occur. In addition, affected women feel as if they are sitting on a ball. Furthermore, they have difficulty during sexual intercourse. It is not uncommon for the cervix to protrude from the vagina. In rare cases, there is also the threat of total prolapse. In this case, the entire uterus protrudes from the entrance to the vagina, and the vagina becomes inverted. In the event of such symptoms, the affected person should contact a doctor as soon as possible.

Diagnosis and course of the disease

If there is suspicion of a descent of the uterus or uterine prolapse, the attending gynecologist first reviews the patient’s medical history (anamnesis). It is not uncommon for the suspicion of a prolapse to be substantiated by the patient’s statements. Following the interview, the gynecologist performs a gynecological examination, during which he inserts a speculum into the vagina, among other things. With the help of this instrument he checks the uterus as well as the birth canal. As a rule, the examination takes place while the patient is lying down. If necessary, the patient must also stand up during the procedure. In order to determine the severity of the uterine prolapse, the patient performs pressure movements as during bowel evacuation. It depends on the severity of the finding whether further examinations are necessary. This may involve sonography (ultrasound examination) of the kidneys. It is used to rule out urinary retention. Medical treatment of uterine prolapse is not always necessary. However, in severe cases, uterine prolapse can negatively affect bladder and bowel functions. Likewise, disruption of sexual functions is possible.

Complications

In most cases, the complications and symptoms of uterine prolapse depend very much on the exact manifestation of the disease. For this reason, a general prediction is usually not possible. In this case, those affected suffer from severe vaginal bleeding and thus also from pain.Constipation or various inflammations and infections can also occur and have a very negative impact on everyday life. Above all, the urinary bladder can be damaged, so that patients also suffer from pain when urinating. Uterine prolapse can also cause discomfort or pain during sexual intercourse. This has a negative effect on the relationship with one’s partner and can lead to complications. The earlier the disease is diagnosed, the higher the probability of a positive course of the disease. Treatment is usually not associated with further complications. The symptoms can be alleviated with the help of medication and pelvic floor training. In some cases, the uterus is removed by surgery. Because this removal can also lead to psychological discomfort, many affected individuals and their partners rely on psychological treatment.

When should you see a doctor?

A doctor is needed insofar as women or sexually mature girls experience problems with the female reproductive organs. If there is discomfort in the lower abdomen, if there is interference during the sexual act, or if there is a feeling of tightness in the vagina, the irregularities should be investigated. Sexual apathy or discomfort during sexual intercourse are signs of a health disorder. If there are no accompanying circumstances that can be explained, a visit to the doctor should be made to establish a diagnosis. Discrepancies in the menstrual cycle, a foreign body sensation in the lower abdomen or sudden discomfort must be clarified by a doctor. Uterine prolapse is characterized by unexpected abnormalities in the genital area. The discomfort can be noticed without any significant prolapse during locomotion, change of clothes or going to the toilet. Since spontaneous healing is not expected, medical consultation should be sought. Sudden bleeding, an unusual vaginal discharge, or sensory disturbances in the uterine area are other indications that should be investigated. Patients often complain of a pulling sensation in the lower abdomen that does not correspond to the timing of a menstrual period. A physician is needed to clarify the cause and develop a treatment plan. If tissue at the exit of the vagina can be felt with the fingers, action is needed. A doctor’s visit should be made immediately to avoid complications.

Treatment and therapy

Treatment of uterine prolapse is available by both conservative and surgical means. Conservative measures include estrogen replacement therapy, relieving pressure on the pelvic structures by reducing body weight, and special training of the pelvic floor. This includes, for example, Kegel exercises designed to strengthen the muscles of the vagina. Another therapeutic option is the insertion of a pessary into the vagina. This prevents the organs from descending further. The cube-shell or ring-shaped instruments are made of silicone or soft rubber. However, they are used less often nowadays because they can cause pressure points in the vagina. They also need to be replaced regularly. If there is severe uterine prolapse or if there are pronounced concomitant symptoms such as urinary incontinence, surgical intervention is usually required. This serves to restore the holding apparatus of the genital organs and the pelvic floor. The surgeon tightens the organs and returns them to their original position. Which surgical procedure is used depends on the extent of the prolapse and the patient’s age. In addition, possible wishes to have children play a role. In some cases, complete removal of the uterus may be appropriate, which is performed as part of a hysterectomy. The procedure takes place either through the abdomen or through the vagina. If the patient still wants to have children, doctors do not recommend surgery. Thus, childbirth often renders the results of surgery ineffective again.

Prevention

To prevent uterine prolapse, it is recommended to maintain a healthy body weight. Furthermore, regular Kegel exercises should be done to strengthen the pelvic floor muscles.

Aftercare

Follow-up care is important if uterine prolapse is treated surgically. Normally, the patient must stay in the hospital for three to five days.However, the duration of the hospital stay also depends on her general state of health. If there are no difficulties with urination and no other problems, the patient is discharged and can continue to recover at home. However, for uncomplicated healing of the operated body region, consistent rest is required for the first two weeks after the operation. If there is still pain after the operation, this is usually treated with mild pain medication. Aftercare also includes refraining from bending over, lifting heavy objects or standing for long periods of time. The same applies to strenuous shopping. It is therefore advisable to accept appropriate help from relatives or friends. Sporting activities must also be avoided for the first two weeks after the operation. However, regular walks that stimulate digestion are useful. A diet that promotes digestion is also recommended. This can counteract heavy pressing when visiting the toilet. In some cases, bowel movement regulation must be stimulated by taking appropriate medications. After the operation, the patient must not have sexual intercourse for about six weeks. Fourteen days after the operation, however, she can start light sporting activities again. These include gymnastics or yoga.

What you can do yourself

If signs of uterine prolapse are noticed, a doctor should be consulted. Uterine prolapse is not necessarily a medical emergency, but it does need to be medically evaluated. If the symptoms cause problems, medical advice is needed. Accompanying medical diagnosis and therapy, pelvic floor training is a good idea. Regular workouts with an exercise ball or other aids strengthen the pelvic floor and prevent further slipping of the uterus. If the uterus has already descended, this cannot be reversed by training. However, pelvic floor training prevents secondary problems such as incontinence. Women who have been diagnosed with uterine prolapse often feel unattractive and uncomfortable in their bodies. Targeted pelvic floor training helps to improve self-esteem. Accompanying this, conversations with other affected women help. It is even more important to talk to your partner about the problem. The gynecologist can provide information about alternative options. For example, it is possible to insert a so-called pessary, which supports the vagina or uterus and prevents further descent. Lastly, it is important to accept the physical changes as a natural part of childbirth and growing older.