Uterine prolapse is an abnormal position of the uterus in which the uterus descent downwards and protrudes into or out of the vagina due to weakened pelvic muscles.
During pregnancy, uterine prolapse occurs in about 1 in 250 cases. It can occur at any age but most commonly occurs in postmenopausal women who had undergone multiple vaginal deliveries.
The uterine prolapse occurs most commonly due to the weakness of muscles and ligaments that support the uterus in position. Below are some factors that lead to the weakening of the muscles of the pelvis.
- Vaginal delivery with injury to the supporting structures of the vagina
- Overstretching of the vaginal wall
- Two or three vaginal deliveries
- Due to aging
- Providing downward pressure on uterine fundus in an attempt to deliver the placenta
- Difficult labor and childbirth
- Delivery of a big baby
- Premature bearing down efforts during delivery
- Operative delivery
- Chronic constipation
- Chronic cough
- Trauma during childbirth
- Getting involved in strenuous activities after a few weeks of childbirth
Degrees of Uterine Prolapse
First degree- The uterus and cervix descend from their normal position but remain inside the vagina.
Second degree- In this degree, the uterus remains inside the vagina but the cervix protrudes outside the vaginal opening.
Third degree- The uterine body protrudes outside the vagina. In this degree, complete prolapse of the uterus occurs.
Mild cases of uterine prolapse don’t cause any symptoms but in case of severe uterine prolapse, the women may experience the following symptoms-
- The feeling of something coming down the vagina
- A feeling of heaviness or mass in the vagina while sitting
- Protruded part can be felt in the vagina
- Abdominal pain or backache
- Dragging pain in the pelvis
- Difficulty in passing stool and urine
- Difficulty or pain while having sexual intercourse
- Incomplete emptying of the bladder and bowel
- Vaginal bleeding and discharge
- Infection may be present
Some measures help you to prevent uterine prolapse-
- If you are overweight, try to lose weight by modifying your diet and exercises.
- Avoid constipation by taking plenty of fluids and including fibers in your diet.
- Perform Kegel’s exercises a few days after childbirth to strengthen your stretched muscles.
- Avoid heavy lifting of objects and adopt proper lifting techniques if you are at risk of uterine prolapse
- Avoid strenuous activities, few days after delivery of the baby
- Get your chronic cough treated
- Quit smoking
Your healthcare provider may perform a pelvic examination to diagnose the condition. Ultrasonography can also be done to rule out pelvic pathology.
You may be asked to cough so that the level of uterine prolapse can be checked. To check the strength of your muscles, your health care provider may ask you to do Kegel’s exercise in which you may have to contract your muscles as you do while withholding the flow of urine. According to the problem, your doctor may discuss and institute treatment to help to overcome it.
Treatment of uterine prolapse depends on age, general health, degree of prolapse, and desire to have children in the future. It includes-
Muscle-strengthening exercises– You can do pelvic floor exercises or Kegel’s exercises to strengthen your pelvic floor muscles. Mild cases of uterine prolapse don’t require any treatment but you can do this exercise to strengthen your muscles and prevent further prolapse. You can do kegel’s exercise by tightening your pelvic muscles as you’re trying to hold back the flow of urine for 10 seconds and then release. You can do this exercise 4 times a day with 10 repetitions.
Nutrition- You should take a well-balanced diet with high fiber and protein content. Take more water to prevent constipation.
Pessary treatment- In pessary treatment, mostly ring pessary is used in selective cases like early pregnancy, puerperium, women’s unwillingness for operation, or if the woman is unfit for surgery. A vaginal pessary is a rubber or plastic ring inserted into your vagina and placed under the lower part of the cervix to support the protruding part. It must be removed regularly for cleaning.
Surgical options may include hysterectomy with pelvic floor repair usually done in uterovaginal prolapse. Hysterectomy can be done either by vagina or abdomen. Once your uterus is removed, you will never get pregnant again.
If you would like to have future pregnancies then discuss different treatment options with your healthcare provider.
In the above post, we have discussed uterine prolapse. It is an abnormal condition of the uterus in which the uterus descent downwards into or out of the vagina. It is usually caused by weakness of the pelvic floor muscles which support the uterus. It can be treated by inserting pessary or by surgical procedures.