Uterine Prolapse: Causes, Symptoms, Treatment

What is uterine prolapse?

Uterine prolapse occurs when the uterus slips down into or protrudes out of the vagina due to weakened or stretched pelvic floor muscles and ligaments.

There are four general stages of severity, determined by how far the bladder, womb, or bowel has fallen:

1. First-degree prolapse: The organs have dropped slightly.
2. Second-degree prolapse: The organs have fallen to the level of the vaginal opening.
3. Third-degree prolapse: The vagina or womb has fallen so much that up to 1 cm of it is protruding from the vaginal opening.
4. Fourth-degree prolapse: More than 1 cm of the vagina or womb is protruding from the vaginal opening. 

What are the symptoms of uterine prolapse?

Many women with uterine prolapse have no symptoms. However, if the symptoms start showing, they may include:

• Pressure or heaviness in the pelvis or vagina
• Leaking urine or sudden urge to empty the bladder
• Repeated bladder infections
• Uterus and cervix bulging into the vaginal opening
• Lower back pain
• Vaginal bleeding
• Constipation
• Increased vaginal discharge

Uterine prolapse can cause urinary tract infection (UTIs). When the uterus descends, it can press on the bladder, making it difficult to fully empty, leading to residual urine that fosters bacterial growth. Additionally, urinary symptoms like urgency and incontinence can raise infection risk.

What are the risk factors of uterine prolapse?

The risk factors of uterine prolapse include:

• Childbirth: Vaginal deliveries, particularly multiple or complicated births, pose the highest risk.
• Ageing and menopause: The natural decline in oestrogen levels after menopause can weaken the strength and elasticity of the pelvic tissues supporting the uterus, increasing the risk of prolapse.
• Genetics: A family history of uterine prolapse or weakened connective tissue may increase susceptibility.
• Chronic straining: Chronic constipation, coughing, or heavy lifting can place extra strain on the pelvic floor muscles.
• Obesity: Being overweight increases the pressure on the pelvic organs, raising the likelihood of prolapse.
• Previous pelvic surgery: Surgeries like a hysterectomy or other pelvic procedures can weaken the structural support of the uterus and nearby organs.
• Smoking: Chronic coughing due to smoking can strain the pelvic floor muscles over time.
• Occupational or physical stress: Jobs or activities that involve repetitive heavy lifting or prolonged standing can increase the risk of uterine prolapse.

How is uterine prolapse diagnosed?

Uterine prolapse is typically diagnosed through a combination of a patient’s medical history, symptoms, and a physical examination.

During the physical exam, the doctor will conduct a pelvic examination. You may be asked to:

• Lie down while the doctor visually and physically assesses the position of your uterus and other pelvic organs.
• Bear down or cough during the exam to see if this causes the uterus to descend further.

In some cases, imaging tests may be ordered to get a clearer view of the pelvic organs:

• Ultrasound: To assess the uterus and other pelvic structures.
• MRI: Rarely, a pelvic MRI may be used for a more detailed look at the pelvic anatomy.

How is uterine prolapse treated and prevented?

Lifestyle changes and conservative management

• Pelvic floor exercises (Kegel) can strengthen core and pelvic floor muscles. You can do these exercises when sitting, lying down, eating, sitting at your desk, driving, or even while resting or watching television.
• A vaginal pessary, a device made of latex or silicone can be inserted into the vagina to help manage a prolapse.
• Losing excess weight can reduce pressure on the pelvic organs and alleviate symptoms.
• Reducing activities that strain the pelvic floor can help prevent the worsening of the prolapse. Use correct techniques when lifting heavy objects.
• Consuming a fibre-rich diet and fluids to avoid constipation and straining.
• Quit smoking if you smoke because smoking-related chronic coughs can stress the pelvic floor muscles.

Surgical treatment for uterine prolapse

Surgery can usually be avoided if it is a mild prolapse. Occasionally, the organs shift back into the correct position by themselves, or at least they do not fall any further. Many women discover that engaging in pelvic floor exercises and/or using a vaginal pessary is effective in alleviating the symptoms.

The decision for surgical management of uterine prolapse should be made after a thorough discussion with the patient, considering various personal factors.

• In severe cases of uterine prolapse, a hysterectomy (removal of the uterus) may be recommended. After a hysterectomy, additional procedures might be done to support the remaining pelvic organs to prevent further prolapse.
• Uterine suspension may be performed to reposition the uterus and secure it to the pelvic ligaments or surrounding tissues.

What happens if prolapse is left untreated?

While uterine prolapses are not inherently life-threatening, the severity of symptoms may increase over time, leading to greater pelvic pressure, discomfort, and urinary or bowel problems.

Living with prolapse can lead to anxiety, depression, and reduced quality of life due to pain and concerns about sexual function or body image. In severe cases, leaving prolapse untreated may complicate future surgical options if surgical intervention becomes necessary later.

Make an appointment at Pantai Hospitals

Consult our doctors if you have any of the symptoms of uterine prolapse. A dedicated and expert team of gynaecologists at Pantai Hospitals is available for consultation to provide the best care and assistance.

Get in touch with us to book an appointment today if you have concerns or questions regarding uterine prolapse. We assure you the best possible care tailored to your specific needs.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.