Uterine Prolapse

Overview

Uterine prolapse occurs when weakened pelvic floor muscles cause the uterus to descend into or protrude out of the vaginal canal. Common symptoms include pelvic pressure, discomfort during intercourse, urinary issues, bowel difficulties, and a visible bulge at the vaginal opening. It is most common after menopause in women who have had multiple childbirths. Factors contributing to prolapse include pregnancy, aging, obesity, chronic coughing, and previous pelvic surgeries. Diagnosis involves a pelvic examination and may include imaging tests. Preventive measures include pelvic floor exercises, maintaining a healthy weight, and proper prenatal and post-surgical care. Treatment options vary from pelvic floor exercises and pessaries to surgical interventions.

What is Uterine Prolapse?

Uterine Prolapse tends to occur when an individual’s pelvic floor muscles have been weakened, usually as a result of childbirth, and it leads to the uterus slipping down or protruding out of the vagina Although a uterine collapse can happen to anyone assigned female at birth, it’s most common after menopause amongst people who have had more than one childbirth.

Stages of Uterine Prolapse

Uterine prolapse is often classified into stages based on the degree of descent of the uterus and other pelvic organs. The staging system most commonly used is the Pelvic Organ Prolapse Quantification (POP-Q) system, which evaluates the position of specific pelvic landmarks relative to the hymen.

Stage 1, the mildest form of uterine prolapse, the uterus descends minimally and remains within the vagina. This stage may not cause significant symptoms and might be asymptomatic in some cases.

Stage 2 involves moderate descent of the uterus, where it descends to the level of the vaginal opening but does not protrude outside the body. Symptoms may become more noticeable at this stage, including pelvic pressure and discomfort.

Stage 3, the uterus descends further and protrudes outside the vaginal opening during certain activities, such as standing or straining. This stage often causes more pronounced symptoms, including urinary and bowel issues, as well as discomfort during sexual intercourse.

Stage 4 represents the most severe form of uterine prolapse, where the uterus protrudes significantly outside the vaginal opening and may even protrude completely out of the body. This stage typically causes significant discomfort and functional impairment, affecting urinary, bowel, and sexual function.

Symptoms of Uterine Prolapse

Uterine prolapse, a condition where the uterus descends into or protrudes out of the vaginal canal due to weakened pelvic floor muscles and ligaments, manifests through various symptoms. One of the primary indications is a sensation of pressure or fullness in the pelvic region, often likened to the feeling of something descending or falling out of the vagina. Women with uterine prolapse may experience discomfort or pain during sexual intercourse, as well as difficulty inserting tampons or maintaining them in place.

Another prominent symptom is urinary issues, such as frequent urination, urgency, or leakage (incontinence). This occurs due to the proximity of the bladder to the descending uterus, leading to interference with its normal function. Bowel movement difficulties, including constipation or the sensation of incomplete evacuation, can also arise as the prolapsed uterus exerts pressure on the rectum.

Physical changes in the pelvic area are observable in some cases, with a visible or palpable bulge at the vaginal opening being a notable sign of advanced prolapse. Women may also notice a dragging sensation or discomfort in the lower back or pelvis, particularly after prolonged standing or physical exertion.

Causes behind Uterine Prolapse

Uterine prolapse is primarily caused by weakened pelvic floor muscles and ligaments, which support the uterus and other pelvic organs. These muscles and ligaments can become weakened due to various factors, including pregnancy and childbirth. The strain placed on the pelvic floor during pregnancy, especially if multiple pregnancies occur or if labour is prolonged and difficult, can stretch and weaken these supportive structures. Additionally, the hormonal changes associated with pregnancy and childbirth can contribute to the weakening of connective tissues in the pelvic region.

Other factors that can increase the risk of uterine prolapse include ageing, as the natural ageing process can lead to a loss of muscle tone and elasticity in the pelvic floor. Women who have undergone pelvic surgery, such as a hysterectomy, may also be at a higher risk due to the disruption of the normal pelvic anatomy.

Chronic conditions that increase abdominal pressure, such as obesity, chronic coughing, or constipation, can further strain the pelvic floor and contribute to uterine prolapse. Additionally, genetic factors may play a role, as some women may inherit a predisposition to weakened pelvic floor muscles.

Tests and Treatments of Uterine Prolapse

Diagnosing uterine prolapse typically involves a comprehensive evaluation by a healthcare provider, often a gynaecologist or urogynecologist, and may include both a medical history assessment and a physical examination. During the medical history assessment, the healthcare provider will inquire about symptoms such as pelvic pressure, urinary and bowel irregularities, discomfort during intercourse, and any relevant medical conditions or surgical history.

The physical examination is a crucial component of the diagnostic process and usually includes a pelvic examination. During this examination, the healthcare provider will visually inspect the pelvic region and may perform a pelvic organ prolapse quantification (POP-Q) assessment to assess the degree of prolapse and determine its severity. This involves measuring the descent of various pelvic organs, including the uterus, in relation to specific landmarks within the vagina.

In some cases, additional diagnostic tests may be recommended to further evaluate the pelvic floor and rule out other conditions. These tests may include pelvic ultrasound, magnetic resonance imaging (MRI), or urodynamic studies to assess bladder function and urinary symptoms associated with uterine prolapse.

Prevention of Uterine Prolapse

Preventing uterine prolapse involves adopting measures to maintain pelvic floor health and minimize risk factors associated with the condition. One of the primary preventive strategies is engaging in regular pelvic floor exercises, also known as Kegel exercises, to strengthen the muscles that support the uterus and other pelvic organs. These exercises involve contracting and relaxing the pelvic floor muscles and can be performed discreetly at any time.

Maintaining a healthy weight through a balanced diet and regular exercise is another important aspect of prevention, as excess weight can increase abdominal pressure and strain the pelvic floor muscles. Additionally, avoiding activities that place excessive strain on the pelvic floor, such as heavy lifting or high-impact exercises, can help reduce the risk of uterine prolapse.

During pregnancy and childbirth, practising proper prenatal care and following guidelines for labor and delivery can help minimize the risk of pelvic floor damage. This includes attending regular prenatal check-ups, practising good posture, and considering pelvic floor physical therapy to prepare for childbirth and promote postpartum recovery.

For women who have undergone pelvic surgery, such as a hysterectomy, it's essential to follow postoperative care instructions and engage in rehabilitation exercises as recommended by healthcare providers to support pelvic floor recovery.