Lifting the Lid on Uterine Prolapse: What You Need to Know

A woman’s body can stretch, organs can shift, and it can all adapt through the years. Thanks to hormonal changes, ageing, and the wild ride of childbirth. These changes can sometimes affect the pelvic floor, resulting in a uterine prolapse. A uterine prolapse is a condition where the uterus slips down from its normal position and into the vagina. It is especially common in women who’ve given birth or are navigating menopause. In fact, for women under 45, the odds of experiencing uterine prolapse range from 2% to 20%. So while your uterus may not send you a formal eviction notice, it’s definitely something to keep an eye on. 

What is uterine prolapse?

Uterine prolapse occurs when the uterus, a muscular organ typically held in place by the pelvic floor muscles and ligaments, descends into the vagina. The pelvic floor is an intricate arrangement of muscles and connective tissues that provides support to the pelvic organs. When these muscles weaken or the ligaments stretch, the uterus loses its normal support and can prolapse. 

What are the stages of uterine prolapse?

This fall can be categorised into four stages based on the degree of uterine protrusion.

1. First-degree prolapse: It occurs when the cervix, or lower section of the uterus, remains within the vagina but has dropped below its typical position. This is the mildest  form of prolapse.

2. Second-degree prolapse: The cervix has reached the vaginal opening. This shows a more considerable uterine descent.

3. Third-degree prolapse: It occurs when the cervix protrudes beyond the vaginal opening. This is a severe case of prolapse, and the uterus may expand outside the body.

4. Fourth-degree prolapse: It occurs when the entire uterus, including the cervix, protrudes outside of the vaginal opening. This is the most severe type of prolapse, which can cause major discomfort and functional impairment.

Look out for these symptoms of uterine prolapse

Uterine prolapse presents a variety of symptoms:

1. Pelvic discomfort and pressure

• Pelvic pressure or fullness: A sensation of heaviness or pulling in the pelvic region, particularly when standing or exerting oneself.

• Vaginal bulge: A noticeable bulge or lump protruding from the vagina, especially when standing or straining.

• Backache or pelvic pain: Discomfort in the lower back or pelvic area may worsen with activity.

2. Urinary symptoms

• Difficulty urinating: Trouble initiating or stopping the urine stream.

• Frequent urination: Increased urinary frequency, often associated with a feeling of incomplete bladder emptying.

• Urinary incontinence: It’s the involuntary leakage of urine due to anything causing increased abdominal pressure, such as coughing, sneezing, or laughing. It can range from mild dribbling to severe incontinence.

3. Bowel symptoms

• Constipation: Difficulty passing stool

• Faecal incontinence: Accidental leakage of stool, especially with straining or coughing (not common unless the sphincter is damaged)
  

4. Sexual dysfunction

• Painful intercourse: Painful intercourse may be a symptom of uterine prolapse, causing discomfort or pain during sexual activity.

• Difficulty achieving orgasm: Impaired sexual satisfaction

What causes uterine prolapse?

Uterine prolapse may be caused by a variety of circumstances, including childbearing, ageing, hormonal changes, persistent constipation, obesity, or chronic coughing. Childbirth, particularly vaginal deliveries, may impair pelvic floor muscles.

As we age, our body's tissues, especially those on the pelvic floor, naturally lose suppleness. Hormonal changes, particularly a drop in oestrogen levels following menopause, might affect tissue strength. Ongoing constipation or frequent heavy lifting can impose excessive strain on the pelvic floor muscles. Excess weight might also put more pressure on the pelvic floor. Persistent coughing, such as from chronic bronchitis or smoking, may also strain the pelvic floor muscles.

Keep your uterus happy: Tips to prevent prolapse

Want to keep your uterus in tip-top shape? Here are a few easy tips:

• Pelvic floor power-ups: Do Kegel exercises regularly to strengthen those muscles that support your uterus.

• Watch your weight: Shedding those extra kilos may take pressure off your pelvic floor.

• Smooth sailing: Avoid constipation. A fibre-rich diet and plenty of water may help keep things moving smoothly.

• Kick the habit: Smoking may weaken tissues, so quitting is a great way to protect your body.

• Talk to your doc: If you're concerned about your risk, consult your healthcare provider for personalised advice.

How is a uterine prolapse diagnosed?

A uterine prolapse can be extremely uncomfortable, but that is not a tell-tale sign for the condition, as discomfort down there has plenty of possible culprits. That’s why your healthcare provider will run a few tests to get to the bottom of it (quite literally). 

The most common test to diagnose a uterine prolapse is a pelvic examination. Your healthcare provider may perform a pelvic examination to see if your uterus has moved from its normal position. For this, they may insert a speculum (an instrument that allows them to see inside your vagina) and conduct a thorough examination. 

Apart from this, an ultrasound, a urine test, and urodynamic studies to check bladder function may also be done. 

How is a uterine prolapse treated?

Uterine prolapse can be easily treated with surgical and non-surgical measures. Your healthcare provider, depending on the stage and the intensity of the condition, will recommend the most effective treatment. Some of the most common treatment options are listed below.

1. Surgical Options 

• Uterus removal: In this procedure, the uterus is surgically removed. However, removing the uterus means you can no longer get pregnant. 

• Repair without uterus removal: In this procedure, the uterus is surgically put back to its normal location.

2. Non-surgical options 

• Kegel exercises: These are special exercises that strengthen the pelvic floor muscles and are only beneficial in cases with minimal prolapse. 

• Vaginal Pessary: A small, rubber or plastic, donut-shaped device that supports the uterus by sitting around or under the cervix. A healthcare provider fits and inserts it to put the uterus back in its place. It needs regular cleaning and must be removed before sex. 

Don't let prolapse get you down

One of the most pressing issues when it comes to uterine prolapse is an increased risk of urinary tract infections (UTIs). A prolapsed uterus may prevent complete bladder emptying, allowing germs to stay and grow, resulting in infection. 

Severe occurrences of prolapse might impair renal function. Furthermore, the projecting tissue can become irritated and uncomfortable, particularly when exposed to friction or moisture, resulting in skin ulcers. 

In terms of sexual health, prolapse may cause discomfort during intercourse, affecting intimacy and general well-being. To avoid these consequences, get medical assistance at once and investigate treatment alternatives, including pelvic floor therapy.

Don’t ignore your body’s signals

Uterine prolapse can be a challenging condition, but it's important to remember that you're not alone. By recognising the factors, signs, and treatment alternatives, you can take charge of your health and improve your overall well-being. If you're experiencing any symptoms of uterine prolapse, don't hesitate to seek medical advice. Timely identification and intervention can ease discomfort and avoid complications. Remember, you deserve to feel your best, so don't ignore your body's signals.  

Frequently Asked Questions:

1. What does a prolapsed uterus feel like?

A prolapsed uterus may cause several uncomfortable sensations. Many women describe feeling heaviness or pressure in their pelvis as if something is pulling down. You might also notice a bulge or lump in your vagina, especially when standing or straining. Additionally, prolapse can lead to urinary and bowel issues, such as difficulty urinating, frequent urination, constipation, or incontinence.

2. Who gets uterine prolapse?

While anyone can develop uterine prolapse, certain factors increase your risk. Women who have given birth vaginally, especially those who have had multiple deliveries, are more prone to prolapse. Ageing, hormonal changes, and weakened pelvic floor muscles due to menopause can also add to the condition. Obesity and chronic conditions like chronic cough or constipation can further exacerbate the issue.

3. Are there changes in lifestyle that can assist in managing uterine prolapse?

Yes, several lifestyle modifications can help one manage uterine prolapse. Exercises for the pelvic floor, often referred to as Kegel exercises, are strongly advised to enhance the muscles that support the pelvic organs. Keeping a healthy weight can help alleviate pressure on the pelvic floor. Consuming a diet rich in fibre and ensuring sufficient hydration can help avoid constipation, which may exacerbate prolapse. It's also advisable to avoid heavy lifting and straining to minimise stress on the pelvic floor.

4. How is uterine prolapse different from other pelvic organ prolapses?

Uterine prolapse specifically refers to the descent of the uterus into the vagina. Other pelvic organ prolapses involve the descent of the bladder (cystocele), rectum (rectocele), or small intestine (enterocele). While these conditions often occur together, uterine prolapse is distinct in that it involves the displacement of the uterus. The signs and treatment methods for these conditions vary, so consulting a doctor is essential for an accurate diagnosis and suitable management.

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