Uterine prolapse is a bulging of the uterus (womb) into the vagina.
Normally, the uterus is held just above the vagina by muscles and ligaments. With uterine prolapse, these muscles and ligaments stretch and get too weak to hold the uterus. The uterus slowly sags and moves out of its normal position, so that it bulges into the vagina. In severe cases, the uterus bulges so much that it protrudes outside the vagina, in between the legs. The bladder (which stores urine), urethra (which carries urine to outside the body), and rectum (muscle that controls bowel movements) may bulge out with the uterus.
An untreated prolapse can cause sores on the cervix (opening to the uterus) and increase chances of infection or injury to other pelvic organs.
The cause is often pregnancy and childbirth. The more pregnancies, the more likely it will happen. Large babies, long labors, and use of forceps during delivery can make it even more likely.
Other causes include older age, being overweight or not physically fit, and heavy lifting. It can also happen if a condition puts extra pressure in the belly. Such conditions include a growth, a lot of coughing (such as from smoking), and constipation.
Symptoms include feelings of pressure, fullness, or heaviness; pelvic pain (low in the belly); a backache that worsens during heavy lifting; and pain with sex. Other symptoms are a lump in the front or back of the vagina; bulging outside of the vagina, between the legs; pain when urinating; leaking urine during laughing, sneezing, or coughing; and problems with bowel movements.
The health care provider makes a diagnosis by a physical examination (including a pelvic examination and Pap smear). The health care provider may do other tests, including pelvic ultrasonography, computed tomography (CT), and biopsy (to check for growths inside the uterus).
Treatment depends on how bad the prolapse is, age, sexual activity, if other pelvic problems exist, and if pregnancy is desired.
Mild symptoms may mean using exercises (Kegel), hormone therapy, or a device called a pessary. Kegel exercises strengthen muscles and ligaments holding the uterus and vagina in place. Hormone creams also make these muscles and ligaments stronger. A pessary is a small ring-shaped device put into the vagina to hold the uterus in place.
More severe prolapse may mean surgery. Sometimes the uterus must be removed (hysterectomy).
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