Uterine prolapse

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Descensus uteri

Overview

Uterine prolapse is falling or sliding of the uterus from its normal position in the pelvic cavity into the vaginal canal.

The uterus is held in position in the pelvis by muscles, special ligaments, and other tissue. The uterus drops into the vaginal canal (prolapses) when these muscles and connective tissues weaken.

Risk Factors

Uterine prolapse usually happens in women who have had one or more vaginal births. Normal aging and lack of estrogen hormone after menopause may also cause uterine prolapse. Chronic cough and obesity increase the pressure on the pelvic floor and may contribute to the prolapse. Uterine prolapse can also be caused by a pelvic tumor, although this is rare.

Chronic constipation and the pushing associated with it can worsen uterine prolapse.

Diagnosis

History and Symptoms

• A feeling as if sitting on a small ball
• Difficult or painful sexual intercourse
• Frequent urination or a sudden, urgent need to empty the bladder
• Low backache
• Pain during intercourse
• Protruding of the uterus and cervix through the vaginal opening
• Repeated bladder infections
• Sensation of heaviness or pulling in the pelvis
• Vaginal bleeding or increased vaginal discharge

Many of the symptoms are worse when standing or sitting for long periods of time.

Physical Examination

Genitals

A pelvic examination performed while the woman is bearing down (as if trying to push out a baby) will show how far the uterus comes down.

• Uterine prolapse is mild when the cervix drops into the lower part of the vagina.
• Uterine prolapse is moderate when the cervix drops out of the vaginal opening.

The pelvic exam may reveal that the bladder, front wall of the vagina (cystocele), or rectum and back wall of the vagina (rectocele) are entering the vaginal area. The urethra and bladder may also be positioned lower in the pelvis than usual.

A mass may be noted on pelvic exam if a tumor is causing the prolapse (this is rare).