What Is a Prolapsed Uterus?
Your uterus (or womb) is normally held in place inside your pelvis with various muscles, ligaments, and tissues. During pregnancy and childbirth, these supports can weaken. Age and the natural loss of the hormone estrogen can weaken these supports, too. As a result, the uterus can drop into the vaginal canal or protrude from the vaginal opening. When that happens, you have a condition known as a prolapsed uterus.
Uterine prolapse belongs to a group of conditions called pelvic organ prolapse. Your bladder, rectum, or the vagina itself can sag out of place. These are common conditions. Nearly half of people assigned female at birth have some degree of uterine prolapse or another form of pelvic organ prolapse by ages 50-79.
Uterine Prolapse Stages
Uterine prolapse can be mild or severe, depending on how weak the pelvic support structures become. Doctors say a prolapse is incomplete if the uterus remains within the vaginal canal and complete if it comes out of the vaginal opening. More precisely, doctors describe uterine prolapse in four stages:
- Stage I: The uterus moves into the upper part of your vagina.
- Stage II: The uterus drops into the lower part of your vagina.
- Stage III: The uterus protrudes from your vagina.
- Stage IV: The entire uterus is outside of your vagina.
Prolapsed Uterus Symptoms
Signs and symptoms of a prolapsed uterus can include:
- Feeling like you are sitting on a small ball
- Feeling that something is coming out of your vagina
- Tissue bulging out of your vagina
- Fullness, heaviness, or pressure in your pelvis
- Pain in your pelvis or lower back
- Pain during sex
- Trouble inserting tampons or vaginal applicators
- Leaking pee
- Trouble emptying your bladder
- Constipation or trouble finishing a bowel movement (You might have to press your fingers in your vagina to get poop out.)
- Discomfort when you walk
What does a prolapsed uterus look like?
If it's a severe prolapse, you might see what looks like a red ball coming out of your vagina.
When to seek medical care
Seek medical care immediately if you:
- Can't pee or poop.
- See your uterus coming out of your vagina.
Notify your doctor if:
- You feel the cervix -- the lower part of your uterus -- near the opening of your vagina.
- You feel pressure in your vagina or feel something coming out of your vagina.
- You have continuing discomfort from leaking pee, trouble pooping, low back pain, or walking difficulties.
Prolapsed Uterus Causes
Uterine prolapse happens when the muscles and tissues that support your uterus get weak. The most common causes of this weakening include:
- Vaginal childbirth, especially if you've had several babies, large babies (over 9 pounds), or difficult labors and deliveries
- Low estrogen after menopause
- Frequent constipation or straining to poop
- Chronic cough or bronchitis
- Repeated heavy lifting
Prolapsed Uterus Risk Factors
You are more likely to get a prolapsed uterus if you:
- Gave birth at an older age
- Are overweight or obese
- Smoke
- Are White or Hispanic
- Have had pelvic surgery
- Have a family history of pelvic organ prolapse
Prolapsed Uterus Diagnosis
If you suspect you might have a prolapsed uterus, your doctor will ask you questions about your symptoms and may have you fill out a questionnaire to get more details about how the symptoms are affecting your life.
To confirm a prolapsed uterus, you'll need a pelvic exam. During the exam, the provider:
- Will insert a device called a speculum to gently open your vaginal walls and look at your vagina and cervix
- Will feel for any bulges caused by your uterus moving into the vagina
- May ask you to bear down as if you are having a bowel movement
- May ask you to tighten your pelvic muscles as if you're trying to stop peeing
If you have severe difficulty emptying your bladder or urinary incontinence (peeing when you don't want to), you might get additional tests to look at how your bladder holds and empties urine. You might get a test called a cystoscopy to look at your bladder and urethra. During this test, a doctor applies a numbing gel and then slides a lubricated, lighted tube up the urethra (the opening for your pee) to see inside the urethra and bladder.
You might also get an MRI exam so your doctor can get a more detailed look at your pelvic organs and kidneys.
Prolapsed Uterus Treatment
If your uterine prolapse isn't bothering you, you might not need treatment at all. If you do have bothersome symptoms, treatment will depend on how severe the symptoms are and your preferences.
Self-care at home
Among things you can try:
Prolapsed uterus exercises. You can strengthen your pelvic muscles with movements called Kegel exercises. To do them, just tighten the muscles you use to hold back pee, hold for a few seconds, and release. You might start by tightening for 3 seconds and work up to 10 seconds. Try to do 10 Kegels in a row; if that's difficult start with five. Repeat the set at least two or three times a day.
Diet changes. Drinking more water and getting more fiber in your diet can help relieve constipation, so you don't strain to poop and put extra pressure on your pelvic muscles.
Managing weight. A healthy weight puts less pressure on your pelvic organs.
Pessary. Your doctor can prescribe a rubber or plastic doughnut-shaped device that's inserted in your vagina to hold your uterus in place. In some cases, you'll be asked to frequently take out and clean the pessary yourself. In other cases, you have to go back to the doctor every few months to have the pessary cleaned and inspected. Proper care is important because pessaries can cause infection and irritation.
Prolapsed uterus medications
Doctors sometimes prescribe estrogen, in the form of pills, patches, vaginal creams, etc., to help with uterine prolapse. You might be offered an estrogen cream for your vagina if you get a pessary. This might help thicken the vaginal walls and prevent drying and irritation from the pessary. Sometimes, estrogen is prescribed before surgery for uterine prolapse to possibly reduce the risk of tearing and infection. However, studies have not clearly shown that estrogen helps.
Prolapsed uterus surgery
If other treatments aren't enough, you might consider surgery to fix or remove your uterus. The surgical options include:
- Hysterectomy, which is surgery to remove your uterus. This might be done through a small cut in your abdomen or your vagina. If you have this surgery, pregnancy is no longer possible.
- Prolapse repair without hysterectomy. In this surgery, your uterus is put back in position. This can also be done through your abdomen or vagina. It's an option for those who might still want to get pregnant.
Sometimes, surgeons perform added procedures if you have prolapse of the vaginal walls, urethra, bladder, or rectum, along with a sagging uterus. The surgeon might:
- Repair the pelvic structures with stitches, in a way that leaves the vagina intact, preserving your ability to have vaginal intercourse.
- Close the opening of the vagina. This is an option for those who don't want to have vaginal intercourse in the future.
- Insert a piece of mesh to support vaginal tissues. Mesh surgeries have been associated with complications, including pain during sex, so talk to your surgeon about all the potential risks and benefits.
Can I push a uterine prolapse back up?
You can't put your uterus back in place yourself. Only a surgeon can do that.
Follow-up
Follow-up depends on how your condition was treated.
- If you had surgery, follow your surgeon's instructions and keep follow-up appointments.
- If you have a pessary inserted in your vagina, follow instructions for cleaning and return visits.
- If you are doing Kegel exercises, expect regular follow-up visits so that your health care provider can check the progress of your muscle strength.
Prolapsed Uterus Complications
If you've had surgery for your uterine prolapse, complications can include:
- Heavy bleeding
- Blood clots in your legs or lungs
- Infection
- A bad reaction to anesthesia
- Damage to your bladder or bowels
- Leaking urine
- A new prolapse
Uterine prolapse itself can lead to:
- Sexual problems
- Poor body image
- Anxiety and depression
- A lower quality of life because of bowel and bladder problems
In addition, the same muscle weakening that leads to uterine prolapse can lead the bladder, bowel, and vaginal wall to sag and move out of place. This can add to symptoms and complications, including increased problems with peeing and pooping. In severe cases, your kidneys or urethra can get blocked, stopping you from peeing. That requires immediate treatment.
Prolapsed Uterus Prevention
You can't change all the factors that lead to uterine prolapse, but you can lower your risk if you:
- Maintain a healthy weight. Talk with your doctor if you need help to avoid weight gain or lose pounds.
- Avoid constipation. Straining to poop can weaken your pelvic muscles. So, eat foods with plenty of fiber, such as fruits, vegetables, beans, and whole grains. And drink plenty of water.
- Do Kegel exercises. If you are not sure you are doing Kegels right, talk to your health care provider.
- Avoid heavy lifting or straining. Lift objects using your leg muscles, not your back.
- Don't smoke.Smokers often develop chronic coughs, which can weaken pelvic muscles. If you want to quit and need help, talk to your doctor.
Prolapsed Uterus Outlook
Treatment for uterine prolapse is usually successful. It is possible, though, to have a repeat prolapse, especially if you have had a severe case. A repeat is more likely if you are over 60 or have obesity. Following prevention advice, like managing your weight, can help prevent a new prolapse.
Takeaways
Uterine prolapse is a common condition after age 50. It doesn't always need treating. But if you have a severe prolapse or bothersome symptoms, you have treatment options.
