Uterine Prolapse: Symptoms and Treatments

Uterine prolapse happens when the uterus leaves its usual place in the pelvic region and drops down into the vagina when supporting vaginal walls and ligaments gets disrupted during childbirth. Often this happens with the bladder descending and rectum bulging in the vagina.

While it is alarming to discover, uterine prolapse is fairly common – happening in 40 percent of women ages 50-79 in the U.S., according to JAMA.

Muhammed Qureshi, MD, FACOG, URPS, is an OB/GYN provider at our Clinton Crossings office and sees many patients who are dealing with uterine prolapse. He explains what causes a prolapse, how to recognize the signs of it, and the treatments available to help repair a prolapse and get patients to regular life.

How to recognize signs of uterine prolapse

For most patients, the first sign of a uterine prolapse is usually when they notice a bulge in their vagina while they are in the shower or while sitting down.

“This is typically tissue that they have never seen before, which prompts them to schedule a visit with their primary care provider or OB/GYN,” Dr. Qureshi said.

Other signs of a prolapse may happen just before feeling a bulge or around the same time a patient notices it. These include:

• chronic constipation
• inability to completely empty the bladder
• incontinence (stress or urge)
• increased pelvic pressure
• pain during/after sex
• UTIs

The point when someone discovers a pelvic organ prolapse varies from person to person. Some notice it happening gradually, while others suddenly discover a bulge or pressure where there wasn’t before.

Risk factors for uterine prolapse

Women who have been pregnant and given birth to a child are the most likely to have uterine prolapse.

Research suggests about 40 percent of women over the age of 40 are likely to have at least one pelvic organ prolapse.

Genetics also play a strong role.

“If a patient’s mother or grandmother may have had a uterine prolapse, they may be more likely to have a prolapse as well,” Dr. Qureshi said.

What causes uterine prolapse?

Uterine prolapse most often stems from a weak pelvic floor, which means the tissue and ligaments that hold the pelvic organs in place are contracted and/or have lost their strength.

Your pelvic floor muscles sit like a hammock in the bottom of your pelvis, helping to support and control bowel movements and keep the uterus in place. When they are too weak, it can lead to prolapse – along with many other symptoms previously mentioned.

Treatments for uterine prolapse

If someone notices a bulge or increased pelvic pressure in their vagina, they should visit their primary care provider or OB/GYN to determine if it is a pelvic organ prolapse.

Providers will examine the patient and determine what stage the prolapse is in.

Stage 0: No prolapse

Stage 1: Minimal prolapse

Stage 2: Moderate prolapse

Stage 3: Advanced prolapse

Stage 4: Organ has completely prolapsed

Available treatments range from conservative to surgical – each dependent on the individual patient’s stage and physical health, as well as their personal goals and desires.

“Some patients don't want to wait, and they would rather have it taken care of with a procedure,” Dr. Qureshi said. “Others are willing to spend more time doing the pelvic floor therapy before considering surgery.”

Non-surgical treatments

OB/GYN providers and urogynecologists – physicians who have experience in both urology and gynecology – generally recommend pelvic floor exercises.

“Pelvic floor exercises with a certified pelvic physical therapist can help a lot,” Dr. Qureshi said. “There is a good success rate.”

Silicone devices like pessaries can be inserted into the vagina to support the prolapsed uterus. Surveys suggest most women who use them are satisfied with them.

Surgical treatments

If non-surgical options are not successful, urogynecologic surgeons offer a variety of procedures – including minimally invasive options.

These surgeries include:

• Conservative uterine-sparing surgeries
• Surgical removal of uterus with or without removal of ovaries

Some surgeries may involve lifting up the prolapsed bladder or reinforcing the back wall of the vagina – a procedure called rectocele repair. These surgeries help to correct incontinence.

• Hysterectomy (removal of uterus)
• Rectocele repair (reinforces wall between rectum and vagina)
• Sling surgery (hammock-like support created for pelvic organs)

Most surgeries have just a few days of post-operative recovery, with some lasting up to a 6-week recovery period. The time of recovery depends on several factors – including the type of surgery, patient age and personal health history, and more.

“If a patient does nothing at all, there is a 30-40 percent risk that the prolapse can advance,” Dr. Qureshi said.