Uterine Prolapse

Uterine prolapse, is a condition in which the uterus (womb) descends from its normal place into the vaginal canal. In this condition, pelvic floor muscles and ligaments stretch and weaken until they cannot provide enough support for the uterus, resulting in uterine prolapse. It can develop due to numerous factors, including weakened pelvic floor muscles, multiple childbirths, complications during labour, and ageing. While uterine prolapse is not a life-threatening condition, it can significantly impact a female's quality of life, leading to discomfort, urinary incontinence, and sexual dysfunction. Let's understand the causes, symptoms, types, risk factors, diagnosis, and treatment options for uterine prolapse.

Causes of Uterine Prolapse

Numerous factors can contribute to the development of uterine prolapse, including:

• Pregnancy and Childbirth: The physical strain of repeated deliveries, difficult labour, multiple births can weaken the pelvic floor muscles and supporting ligaments and tissues, increasing the risk of uterine prolapse. Complications of labour, delayed pushing phase of labour, large baby or rapid delivery are other labour related causes
• Ageing: As women age, the natural decline in estrogen hormone can weaken the pelvic floor muscles and supportive tissues, making them more susceptible to uterine prolapse.
• Chronic Straining: Conditions that cause chronic straining, such as chronic constipation, severe cough, or heavy lifting, can put additional pressure on the pelvic floor muscles, increasing the risk of uterine prolapse.
• Obesity: Excess weight can put undue strain on the pelvic floor muscles, increasing the likelihood of uterine prolapse.
• Previous Pelvic Surgery: Certain surgical procedures, such as hysterectomy or pelvic organ surgery, can weaken the pelvic floor muscles and supporting tissues, leading to uterine prolapse.

Symptoms of Uterine Prolapse

The symptoms of uterine prolapse can vary and depend on the severity of the condition. Here are some common symptoms:

• A feeling of pressure or heaviness in the pelvic area or vagina
• Noticing a bulge or protrusion from the vaginal opening
• Increased vaginal discharge
• Difficulty urinating or the need to strain to empty the bladder
• Leakage of urine (urinary incontinence)
• Recurrent bladder infection
• Difficulty having bowel movements or the need to manually assist in evacuating the rectum
• Discomfort or pain during sexual intercourse
• Lower back pain or abdominal discomfort
• Symptoms may worsen with prolonged standing, lifting, or physical activity

Types and Stages of Uterine Prolapse

Uterine prolapse is classified into different types and stages based on the severity of the situation:

Types of Pelvic Organ Prolapse:

• Cystocele: Bladder descends into the vagina
•  Rectocele: Rectum descends into the vagina
•  Enterocele: Prolapse of the part of the small intestine into the vaginal area
•  Uterine Prolapse: Prolapse of the uterine cavity into the vagina
•  Incomplete Prolapse: Uterus descends into the upper vagina but does not protrude beyond
•  Complete Prolapse: The uterus plummets to the level of the vaginal opening or outside the vaginal opening.

Stages of Uterine Prolapse:

• Stage 1 (Mild): The uterus has descended into the upper portion of the vagina.
• Stage 2 (Moderate): The uterus has descended to the opening of the vagina.
• Stage 3 (Severe): The uterus has descended through the vaginal opening.
• Stage 4 (Complete): The entire uterus has protruded outside the vaginal opening.

Risk Factors for Uterine Prolapse

Several factors can enhance a woman's risk of developing uterine prolapse, including:

• Multiple pregnancies and childbirths
• Vaginal deliveries, especially those involving prolonged labour or the use of forceps or vacuum extraction
• Obesity and excess weight around the waistline
• Chronic conditions that cause increased abdominal pressure, such as chronic coughing or constipation
• Aging and decreased estrogen levels after menopause
• Previous pelvic surgery, such as hysterectomy or pelvic organ surgery
• Connective tissue disorders, like Marfan syndrome or Ehlers-Danlos syndrome 
• Family history of uterine prolapse or other pelvic floor disorders

Diagnosis of Uterine Prolapse

Diagnosing uterine prolapse involves a combination of the following methods:

• Physical Examination: A doctor will perform a pelvic examination to assess the position and mobility of the uterus and other pelvic organs.
• Pelvic Ultrasound: Doctors may perform an ultrasound to visualise the position of the uterus and other pelvic organs, as well as to rule out other potential causes of pelvic discomfort.
• Pelvic MRI: In some cases, a pelvic MRI (magnetic resonance imaging) provides comprehensive images of the pelvic organs and surrounding structures.
• Cystoscopy or Proctoscopy: These procedures involve inserting a small camera into the bladder or rectum to examine the pelvic organs and assess the extent of prolapse.
• Urodynamic Testing: This test evaluates the function of the bladder and urethra, which can help determine the appropriate treatment for uterine prolapse and associated urinary incontinence.

Treatment for Uterine Prolapse

The uterine prolapse treatment depends on several factors, including the severity of the condition, the woman's age, overall health, and future pregnancy plans. Treatment options may include:

• Pelvic Floor Muscle Exercises (Kegel Exercises): These exercises can strengthen the pelvic floor muscles and support the pelvic organs. They are often recommended as the first line of treatment approach for mild to moderate cases of uterine prolapse.
• Pessary: Considered a preferred uterine prolapse treatment for older adults, doctors insert this removable apparatus into the vagina to support the pelvic organs and help relieve symptoms. Pessaries are often used as a non-surgical treatment option for women who are not candidates for surgery or who prefer a more conservative approach.
• Estrogen Therapy: In some cases, doctors may prescribe topical or systemic estrogen therapy to help enhance the strength and tone of the pelvic floor muscles and supporting tissues.
• Surgery: For more severe cases of uterine prolapse or when non-surgical treatments are ineffective, doctors may recommend surgical intervention. Surgical options include:
  • Sacrocolpopexy: A minimally invasive procedure that involves attaching the vagina to the sacrum (a bone in the lower back) using mesh or synthetic material to provide additional support.
  • Uterine Suspension: A procedure that involves repositioning and securing the uterus in its proper position using stitches or mesh.

Complications

If left untreated, uterine prolapse can lead to several complications, including:

• Urinary incontinence or difficulty urinating
• Constipation or difficulty having bowel movements
• Recurrent urinary tract infections
• Ulceration or erosion of the protruding tissue
• Sexual dysfunction or discomfort during intercourse
• Psychological distress or decreased quality of life

Prevention

While some risk factors for uterine prolapses, such as ageing and pregnancy, cannot be avoided, there are several steps women can take to help prevent or reduce the possibility of developing this condition:

• Achieve and maintain a healthy weight and exercise regularly to strengthen the pelvic floor muscles.
• Practice Kegel exercises regularly to improve pelvic floor muscle strength.
• Avoid chronic straining during bowel movements by maintaining a high-fibre diet and staying hydrated.
• Quit smoking, as smoking can contribute to chronic coughing and increased abdominal pressure.
• Use proper lifting methods and avoid heavy lifting whenever possible.
• Seek prompt treatment for chronic cough or constipation to reduce abdominal strain.

When to See a Doctor

If you experience any symptoms of uterine prolapse, such as a bulge or pressure in the vaginal area, difficulty urinating or having bowel movements, or discomfort during sexual intercourse, consult with a doctor. Early diagnosis of prolapsed uterus and treatment can prevent further condition progression and alleviate symptoms.

Conclusion

Uterine prolapse is a common gynaecological condition that can significantly affect a woman's daily life. By understanding the causes, symptoms, risk factors, and treatment modalities, women can take proactive steps to manage this condition effectively. If you suspect you may be experiencing uterine prolapse, it is crucial to consult with a doctor for proper diagnosis and personalised treatment recommendations.

FAQs

1. What are the leading causes of uterine prolapse?

The leading causes of uterine prolapse include pregnancy and childbirth, ageing and decreased estrogen levels, chronic straining (due to conditions like constipation or chronic coughing), obesity, and previous pelvic surgery.

2. Is uterine prolapse a serious condition?

While uterine prolapse is not a life-threatening condition, it can significantly affect a woman's quality of life and result in complications if left untreated. Seeking prompt medical intervention and appropriate treatment is essential to managing the condition and preventing further progression.

CARE Medical Team

2