Uterine prolapse is caused by weakened and stretched ligaments and muscles of the pelvic floor. The poorly supported uterus slips down into the vagina or protrudes out of it. This condition, over time, can heavily impact bladder function and health.
Definition & Facts
While uterine prolapse can happen to women in any age group, it most often occurs among women who have had one or more vaginal deliveries and are post-menopausal. The loss of muscular elasticity caused by hormonal changes during menopause, combined with the wear and tear of pregnancy, and the effects of gravity work together to weaken the muscles of the pelvic floor. A uterine prolapse can be left untreated, but if the condition impacts daily living, the patient may benefit from one of several treatments.
Symptoms & Complaints
- Urinary leakage when lifting, sneezing, laughing or coughing
- Bowel problems
- Lower back pain and back pain more generally
- Sexual discomfort and inability to experience orgasm
- A feeling of weight or drag in the pelvis
- Pain or other symptoms that are mild in the morning but worsen as a person goes about her day and gravity works on the body
- Painful bowel movements
- Actual tissue protrusion from the vagina
Severe prolapse disrupts the function of the bladder and can lead to chronic urinary tract infections. In addition, the displacement of the uterus can change the force that can be applied when having a bowel movement and cause pain. Uterine prolapse may also cause urinary retention or the inability to empty the bladder completely.
The conditions that lead to prolapse include strain and stretching of the muscles and ligaments of the pelvic floor. Pregnancy, vaginal delivery, particularly of a large baby, and delivery trauma can all lead to stretched and strained ligaments and muscles. Over time, the effects of gravity and loss of muscle tone reduce the structure supporting the uterus. Reduced estrogen levels cause muscles throughout the body to lose elasticity and strength.
Smoking impacts the strength of the muscles and ligaments of the pelvic floor as coughing can increase the risk of prolapse. Constipation and the need to strain to pass stool can also increase the risk of prolapse. Inactivity and obesity add to the pressure and strain placed on the pelvic floor as well.
Diagnosis & Tests
A physician should be able to diagnose uterine prolapse with a pelvic examination. This examination may include reviewing the action of the pelvic floor musculature while lying down and standing up. The physician may also require the patient to bear down as though having a bowel movement, to determine if the uterus is slipping down the vagina.
If the prolapse has started to impact the position and function of the bladder, further tests to determine bladder function may be necessary. Urodynamic tests might include checking the pressure inside the bladder by inserting a tube into the urethra and expanding the bladder with dyed liquid that can be studied in an X-ray. This test can confirm if the bladder is being distorted by the weight of the prolapsed uterus. If necessary, uterine prolapse can be confirmed with an MRI.
Treatment & Therapy
A slight prolapse can be treated with Kegel exercises. To become familiar with the muscles involved in Kegel exercises, women should practice cutting off urinary flow while voiding urine or passing gas. The memory of this tightening sensation, once developed, can be practiced during any exercise program by sitting on the floor and placing the soles of the feet together out in front with the knees out wide.
While stretching the hips, inner thighs and lower back, the individual can tighten the muscles that he or she remembers using to stop urinary flow. The exercise involves holding this position for five to ten seconds, then relaxing for five seconds, and ten repetitions may be performed.
This exercise can also be done when sitting in a chair at a desk or watching television, so it's a good idea to do these ten repetitions four or five times a day to build and maintain pelvic health. Many women who struggle with urinary leakage when lifting or doing jumping jacks regain control using this exercise.
For more advanced prolapse, physicians can fit a ring or pessary into the upper section of the vagina. These are used to prop up the vagina and bladder, and can be removed for cleaning. If the prolapse is severe, the pessary will most likely be a short-term fix. The pessary can cause ulcers on vaginal tissue and may interfere with sexual activity.
Should the prolapse be severe, it can be corrected with surgery. Depending on the age and current health of the woman, a hysterectomy may be performed at this time. Surgical correction of uterine prolapse often includes building a sling for the bladder. While recovery may be long, this procedure often offers active women a greatly improved quality of life. If a woman is planning to have more children, a surgical repair of uterine prolapse will most likely be undone during pregnancy and delivery.
Prevention & Prophylaxis
Bladder and bowel health can also impact the health of the pelvic structure. For women who struggle to have bowel movements, a high fiber diet and proper hydration may help. Women who've experienced vaginal delivery, particularly if they've delivered a large baby or had difficult births, need to pay particular attention to rebuilding and strengthening the musculature of the pelvic floor.