Prolapsed uterus

What is a prolapsed uterus?

Your pelvic organs (uterus, bladder and rectum) can prolapse when the tissues that hold them in place are stretched or weakened. This is called ‘pelvic organ prolapse’.

A prolapsed uterus is when your uterus (womb) gradually comes out of place and drops down towards the opening of your vagina. A prolapsed uterus is also called ‘uterine prolapse’.

Prolapse usually worsens without treatment.

What are the symptoms of a prolapsed uterus?

If you have a prolapsed uterus, you may:

• feel a sensation of fullness or pressure inside your vagina
• feel a lump or bulge in, or out of, your vagina
• have a sensation of heaviness or dragging in your pelvis or vagina

You may also:

• not be able to completely empty your bladder (wee) or bowel (poo) when going to the toilet
• need to strain to get urine (wee) flow started, or to empty your bowel (do a poo)
• have bowel or bladder urgency (needing to go to the toilet very suddenly)
• have incontinence
• have urinary tract infections that keep coming back
• have pain during sex or less sensation during sex
• have lower back pain

Your symptoms may feel worse at the end of the day and feel better after lying down.

What causes a prolapsed uterus?

Your pelvic organs (uterus, bladder and rectum) are usually held in place by your pelvic floor — made up of muscles, ligaments and connective tissue. These organs can prolapse when your pelvic floor is stretched or weakened.

A prolapsed uterus can happen when something puts pressure on your pelvic floor, such as:

• pregnancy and childbirth
• prolonged constipation, or regularly straining on the toilet
• repeated heavy lifting (for example, of children, grandchildren or weights)
• being overweight
• having a chronic (ongoing) cough

You are more likely to have a prolapse after menopause or as you get older.

When should I see my doctor?

See your doctor if you have any symptoms of a prolapsed uterus.

How is a prolapsed uterus diagnosed?

Your doctor will ask about your symptoms and your health in general. They will examine you and may ask if they can do an internal vaginal examination.

You may also be asked to have some tests, like:

• an ultrasound scan
• a urine test
• urodynamic studies (to check your bladder function)

Stages of uterine prolapse

Doctors use a grading system to describe how much of the uterus is pushed down into your vagina.

• Stage 1 — the uterus drops into the upper part of the vagina.
• Stage 2 — the uterus drops into the lower part of the vagina.
• Stage 3 — the uterus protrudes outside of the opening of the vagina.
• Stage 4 — the uterus slips completely outside the vagina.

In some people, the bladder and bowel can also prolapse.

• A cystocoele is when your bladder bulges into the front wall of your vagina.
• A rectocele is when your rectum (lower part of your large bowel) bulges into the back wall of your vagina.

How is a prolapsed uterus treated?

Your treatment will depend on the type and extent of the prolapse, and how much it affects your daily life.

Treatment options can include:

• lifestyle measures
• pelvic floor muscle exercises
• vaginal pessaries
• oestrogen replacement (if appropriate)
• surgery

Some of these treatments can be used in combination.

Talk with your doctor about the different treatment options. It’s important to discuss their benefits and risks, so that you can make an informed decision. Your doctor should also understand what’s important to you as part of shared decision making.

Without treatment, your symptoms are likely to get worse. But if your symptoms are not affecting your usual activities, you can choose to not have any treatment. You can always change your mind if your symptoms start to bother you.

Lifestyle measures

There are lifestyle measures that can help with a prolapsed uterus. These include:

• doing regular physical activity, including core strengthening exercises
• avoiding heavy lifting
• avoiding high impact exercise
• eating high fibre foods and drinking plenty of fluids to prevent constipation
• achieving and maintaining a healthy weight
• not smoking

It can take time for these measures to work.

Pelvic floor muscle exercises

Strengthening your pelvic floor muscles and changing your daily activities may be all that is needed for a mild prolapse.

Your doctor may refer you to a pelvic floor physiotherapist or a continence nurse to help with pelvic floor muscle exercises.

Your physiotherapist may also show you how to avoid straining and support your prolapse when going to the toilet.

Vaginal pessaries

You may be offered a removable device called a pessary. You put the pessary in your vagina as a support for your pelvic organs.

Oestrogen replacement

Menopausal hormone therapy increases your oestrogen levels and may help to strengthen your vaginal walls and pelvic floor muscles.

Surgery

Surgery may be recommended for a severe prolapse or when your symptoms do not improve with other treatments.

Your doctor will talk with you about different procedures to repair the prolapse. There are various options, and it’s important to talk through all the options so that you understand their risks and benefits.

Can a prolapsed uterus be prevented?

The best thing you can do to prevent a prolapsed uterus is to keep your pelvic floor muscles strong. You can do this with pelvic floor exercises and the lifestyle measures that help with treating prolapsed uterus.

Visit the Pelvic Floor First website from the Continence Foundation of Australia for more information about your pelvic floor and how to keep it strong.