What Is Uterine Prolapse and How to Treat it?
Uterine prolapse is a type of pelvic organ prolapse. It happens when the uterus is no longer held in place and slips down or herniates into the vagina. It commonly occurs in older women due to the weakening of pelvic floor muscles and ligaments that support the uterus.
What causes uterine prolapse?
Uterine prolapse usually affects post-menopausal women who have had multiple vaginal deliveries. Giving birth, especially to high birth weight babies, is the biggest risk factor for uterine prolapse. Other reasons include:
- loss of muscle strength due to aging
- low estrogen levels after menopause
- constipation or strained bowel movements
- heavy weightlifting
- difficulty or trauma during labor and childbirth
Smoking, menopause, family history, race, chronic cough, prior pelvic surgery, and increased abdominal pressure are some of the other possible risk factors.
There are also some obstetric factors that may increase the risk of uterine prolapse. These include macrosomia (growth of the baby beyond normal), young maternal age (<25 years), prolonged second stage of labor (when you are fully dilated and pushing), and anal sphincter injury (OASIS) during vaginal delivery.
Is there a correlation between uterine prolapse and endometrial pathologies?
A 2016 study that included 111 participants found that 20.2% of the participants had endometrial hyperplasia, 27% had uterine fibroids, 18% had adenomyosis, and 7.2% had endometrial polyps.
How common is it?
The exact prevalence of uterine prolapse is not clear as it varies greatly based on geography.
According to a 2014 study based on the National Health and Nutritional Examination Survey from 2005 to 2010 in 7,924 non-pregnant US women revealed that at least 25% of them had one or more pelvic floor disorders and 2.9% of them had a prolapse. Obesity, a high number of children, and hysterectomy were also risk factors in this study.
A 2013 study found that there is a discrepancy in the prevalence of prolapse based on symptoms from the prevalence identified via a physical examination because pelvic organ prolapse is often asymptomatic.
What are the symptoms?
Mild forms of uterine prolapse are often asymptomatic. More advanced forms can also be associated with additional cystoceles (prolapsed bladder) and rectoceles (prolapsed rectum). Common symptoms include:
- bulge or vaginal pressure
- feeling of something “falling out”
- discomfort during intercourse
- feeling of incomplete bladder emptying
- urinary incontinence or urinary retention
- excessive vaginal discharge
- constipation, fecal urgency or incontinence
Symptoms often start mild and worsen as the day progresses and can be positional.
How do doctors diagnose it?
A pelvic exam using a speculum can confirm uterine prolapse and detail which parts of the vagina are affected. Your doctor will ask you to strain while performing something called a Valsalva maneuver to mimic pushing out a baby. This lets them know how far the uterus has slipped into the vagina. He or she will also ask you to tighten your pelvic muscles as if to stop urinating to gauge their strength.
The extent of uterine prolapse is graded based on five stages:
- Stage 0: no prolapse
- Stage 1: the most distal portion of the prolapse is >1 cm above the level of the hymen
- Stage 2: The most distal portion of the prolapse is ≤1 cm proximal or distal to the hymen
- Stage 3: The most distal portion of the prolapse is >1 cm below the hymen but protrudes no further than 2 cm less than the total length of the vagina
- Stage 4: Complete eversion of the vagina
The doctor may also use other diagnostic tests such as a cystoscopy (camera into the bladder), urodynamic testing to measure your bladder function, and/or an MRI.
How do doctors treat uterine prolapse?
There are non-surgical and surgical options to treat uterine prolapse.
Non-surgical options include performing Kegel exercises to strengthen the pelvic floor muscles and using a vaginal pessary. A pessary is a rubber or plastic device that is inserted into the cervix to support the uterus. The pessary must be removed and cleaned regularly.
Surgical options are dependent on patient age and desire for future sexual function. They are also divided into procedures that spare or remove the uterus (hysterectomy). Hysterectomy alone does not correct the weakness in the ligaments.
Procedures such as uterosacral ligament suspension and sacrocolpopexy are designed to improve and restore support to weakened pelvic ligaments. Consultation with a specialist is warranted.
How to prevent uterine prolapse?
Uterine prolapse may not be fully preventable, but certain lifestyle changes can greatly help minimize the risk. These include performing Kegel exercises, maintaining a healthy body weight, exercising regularly, and avoiding heavy weights. Quitting smoking and switching to a healthy diet rich in fiber is also important.
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