Uterine Conditions: Uterine Prolapse

Uterine Conditions: Uterine Prolapse²⁴
Uterine prolapse, or "dropped womb," refers to a uterus that has fallen below its natural position in the pelvis. Composed of numerous muscles and connective tissue, the pelvic floor is attached to the pelvic bones in such a way as to support the uterus. In the most serious cases when these ligaments and muscles weaken, the uterus drops from its normal position and sometimes falls out of the vagina.

Causes. Uterine prolapse usually results when the pelvic floor is damaged during a vaginal delivery, particularly if it was a long labor or involved the use of forceps or vacuum extraction. Prolapse can also stem from an inherited weakness of the pelvic floor as well as from aging and menopause. Additionally, anything that puts significant pressure on the abdomen over a long period of time can weaken the muscles-heavy lifting, wearing a tight abdominal girdle, chronic coughing or chronic straining during bowel movements, for example. Race is also a factor, with Latinas having the highest risk for uterine prolapse.

Symptoms. Symptoms generally depend on the severity of prolapse. You may have no symptoms, or you may feel pelvic pain or pressure, a sensation of something "falling" in your vagina, or low back pain. Other symptoms might include urinary incontinence, painful bowel movements and pain during intercourse.

Diagnosis. Many women are embarrassed about seeking treatment for uterine prolapse. Still others have such mild symptoms that they may not feel the need to consult their health care professional.

To diagnose this condition, your health care professional will perform a pelvic exam and take a detailed medical history. Then, he or she will measure the position of your uterus to determine how severely it has dropped or "prolapsed."

There are several treatment options for uterine prolapse. Be sure to discuss any unusual symptoms you have with your health care professional.

Treatment. Nonsurgical options include:

Kegel exercises to strengthen the pelvic muscles. To perform the exercise, squeeze your pelvic muscles as though trying to stop the flow of urine. Hold for a few seconds, then release. Do up to 10 repetitions up to four times daily.
Estrogen supplements may prevent any further weakening of the pelvic floor.
Pessary, a plastic, diaphragm-like device, which fits into the vagina and helps prop up the uterus.
Lifestyle changes. If you avoid lifting heavy objects, wearing a tight girdle and successfully treat your chronic cough or constipation, you can slow or halt the progression of uterine prolapse.

If your prolapse is severe enough to cause significant symptoms, surgery may be recommended to strengthen stretched ligaments or to repair and reconstruct the entire pelvic floor. Even after surgery, however, the ligaments may fail again. That's why hysterectomy is the treatment of choice and why uterine prolapse is the third most common reason for hysterectomy in women over age 55. Unfortunately, removing the uterus doesn't resolve the initial problem-a weakened pelvic floor and the potential for incontinence.

Prevention. Beginning Kegel exercises early in life can help maintain a strong pelvic floor and may help prevent uterine prolapse later in life.