Symptoms of prolapsed uterus during pregnancy

Uterine Prolapse | Johns Hopkins Medicine

What You Need to Know

When pelvic muscle, tissue and ligaments weaken, the uterus can drop down into the vaginal canal, causing uterine prolapse.
Nearly one-half of all women between ages 50 and 79 have some degree of uterine or vaginal vault prolapse, or some other form of pelvic organ prolapse.
Factors that increase your risk of uterine prolapse include childbirth, age, obesity, chronic constipation and having a hysterectomy.
Many women with uterine prolapse have no symptoms. If symptoms are present, they may include bulging in the vagina, feeling pressure in the pelvis or vagina, and lower back pain accompanied by bulging in the vagina.
There is no definitive way to prevent uterine prolapse. Losing weight, eating a fiber-rich diet, quitting smoking and performing pelvic floor exercises can help to reduce the risk of this condition.

What is uterine prolapse?

Uterine prolapse occurs when the muscles and tissue in your pelvis weaken. The weakness lets the uterus drop down into your vagina. Sometimes, it comes out through your vaginal opening. Nearly half of all women between ages 50 and 79 have this condition.

What causes uterine prolapse?

Uterine prolapse is caused when the muscles and tissue of the pelvic floor are weakened and can’t support the weight of the uterus. This lets it drop into your vagina.

What are the risk factors for uterine prolapse?

Risk factors include:

What are the symptoms of uterine prolapse?

Many women with this condition have no symptoms. However, if symptoms start, they may include:

Leakage of urine
Inability to completely empty your bladder
Feeling of heaviness or fullness in your pelvis
Bulging in your vagina
Lower-back pain
Aching, or the feeling of pressure, in your lower abdomen or pelvis
Constipation

How is uterine prolapse diagnosed?

If your healthcare provider thinks that you have a prolapsed uterus, he or she will probably do a physical exam to check your pelvis. If you also have urinary incontinence or a feel like you can’t empty your bladder, your doctor may do a procedure called a cystoscopy to examine your bladder and urethra.

Your healthcare provider might also order an MRI (magnetic resonance imaging). This procedure uses a magnet and radio waves to create images. This will allow your healthcare provider to get a good look at your kidneys and other pelvic organs.

The Johns Hopkins Women’s Center for Pelvic Health & Reconstructive Surgery

Our team of compassionate urogynecologists uses the latest research and advanced technologies to treat a range of pelvic floor disorders.

Learn how our urogynecology team can help.

How is uterine prolapse treated?

If your symptoms bother you or you’re not comfortable during everyday activities, talk with your healthcare provider about treatment options. Lifestyle changes, such as losing weight, may help. So can doing Kegel exercises. These strengthen your pelvic floor muscles. To do this exercise, you squeeze the muscles you use to control the flow of urine, and hold for up to 10 seconds then release. Repeat 50 times a day.

A pessary can also relieve symptoms. This is a device your healthcare provider inserts into your vagina to support your pelvic organs.

A hysterectomy is a surgery to remove your uterus. This can be done through your vagina. The healing time is faster than with surgery that requires an abdominal incision. There also are fewer complications.

Can uterine prolapse be prevented?

There is no certain way to prevent uterine prolapse. However, the following can help lower your risk:

Lose weight, if you’re overweight
Follow a diet rich in fiber and fluids to prevent constipation and straining
Avoid heavy lifting
Quit smoking, if you smoke
Seek prompt treatment for a chronic cough, which can place extra pressure on your pelvic organs
Do Kegel exercises to strengthen your pelvic floor muscles

These actions may also help if you already have uterine prolapse.

See your healthcare provider when symptoms first start to bother you. Don’t wait until your discomfort becomes severe. Regular pelvic exams can help detect uterine prolapse in its early stages.

Key points for uterine prolapse

Uterine prolapse occurs when the muscles and tissue in your pelvis weaken.
This allows your uterus to drop down into your vagina.
Common symptoms include leakage of urine, fullness in your pelvis, bulging in your vagina, lower-back pain, and constipation.
Treatment for uterine prolapse includes lifestyle changes, a pessary, or surgery to remove the uterus.
You may be able to prevent this condition with weight loss, a high fiber diet, not smoking, and doing Kegel exercises.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down the questions you want to be answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also, know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.

#TomorrowsDiscoveries: Pelvic Floor and Women’s Health – Dr. Victoria Handa

Dr. Victoria Handa and her team at the Johns Hopkins Women's Center for Pelvic Health and Reconstructive Surgery study how childbirth leads to long-term physical and functional changes in a woman’s body. Watch to learn more.

Stages, Causes, Symptoms, Treatment, and Surgery

Written by WebMD Editorial Contributors

What Is a Prolapsed Uterus?

Your uterus (or womb) is normally held in place inside your pelvis with various muscles, tissue, and ligaments. Because of pregnancy, childbirth or difficult labor and delivery, in some women these muscles weaken. Also, as a woman ages and with a natural loss of the hormone estrogen, their uterus can drop into the vaginal canal, causing the condition known as a prolapsed uterus.

Muscle weakness or relaxation may allow your uterus to sag or come completely out of your body in various stages:
- First degree: The cervix drops into the vagina.
- Second degree: The cervix drops to the level just inside the opening of the vagina.
- Third degree: The cervix is outside the vagina.
- Fourth degree: The entire uterus is outside the vagina. This condition is also called procidentia. This is caused by weakness in all of the supporting muscles.

Other conditions are usually associated with prolapsed uterus. They weaken the muscles that hold the uterus in place:
- Cystocele: A herniation (or bulging) of the upper front vaginal wall where a part of the bladder bulges into the vagina. It’s also called a prolapsed bladder. This may lead to urinary frequency, urgency, retention, and incontinence (loss of urine).
- Enterocele: The herniation of the upper rear vaginal wall where a small bowel portion bulges into the vagina. Standing leads to a pulling sensation and backache that is relieved when you lie down.
- Rectocele: The herniation of the lower rear vaginal wall where the rectum bulges into the vagina. This makes bowel movements difficult, to the point that you may need to push on the inside of your vagina to empty your bowel.

Prolapsed Uterus Symptoms

Symptoms of a prolapsed uterus include:

A feeling of fullness or pressure in your pelvis (it may feel like sitting on a small ball)
Low back pain
Feeling that something is coming out of your vagina
Uterine tissue that bulges out of your vagina
Painful sexual intercourse
Difficulty with urination or moving your bowels
Discomfort walking

When to seek medical care

Seek medical care immediately if you have any of the following:

Obstruction or difficulty in urination and/or bowel movement
Complete uterine prolapse (your uterus comes out of your vagina)

Notify your doctor if you have any of the following symptoms:

You feel the cervix near the opening of the vaginal canal or you feel pressure in your vaginal canal and the feeling of something coming out of your vagina.
You have persistent discomfort from urinary dribbling or the urge to have a bowel movement (rectal urgency).
You have continuing low back pain with difficulty in walking, urinating, and moving your bowels.

Prolapsed Uterus Causes and Risk Factors

Uterine prolapse happens when vaginal childbirth or other conditions weaken the muscles and tissues of the pelvic floor so they can no longer support the weight of the uterus. It can happen as a result of:

Pregnancy/childbirths with normal or complicated delivery through the vagina
Weakness in the pelvic muscles with advancing age
Weakening and loss of tissue tone after menopause and loss of natural estrogen
Conditions leading to increased pressure in the abdomen such as chronic cough (with bronchitis and asthma), straining (with constipation), pelvic tumors (rare), or an accumulation of fluid in the abdomen
Being overweight or obese with its additional strain on pelvic muscles
Major surgery in the pelvic area leading to loss of external support
Smoking

Other risk factors include:

Excess weight lifting
Being white
Family history

Prolapsed Uterus Diagnosis

Your health care provider can diagnose uterine prolapse with a medical history and physical examination of the pelvis.

The doctor may need to examine you in standing position and while you are lying down and ask you to cough or strain to increase the pressure in your abdomen.
Specific conditions, such as ureteral obstruction due to complete prolapse, may need an intravenous pyelogram (IVP) or renal sonography. Dye is injected into your vein, and a series of X-rays are taken to view its progress through your bladder.
Ultrasound may be used to rule out other pelvic problems. In this test, a wand is passed over your abdomen or inserted into your vagina to create images with sound waves.
Pelvic magnetic resonance imaging (MRI) is sometimes done if you have more than one prolapsed organ or to help plan surgery.

Prolapsed Uterus Treatment

Treatment depends on how weak the supporting structures around your uterus have become.

Self-care at home

You can strengthen your pelvic muscles by performing Kegel exercises. You do these by tightening your pelvic muscles, as if trying to stop the flow of urine. This exercise strengthens the pelvic diaphragm and provides some support. Have your health care provider instruct you on the proper ways to isolate and exercise the muscles.

Medications

Estrogen (a hormone) cream or suppository ovules or rings inserted into the vagina help in restoring the strength and vitality of tissues in the vagina. But estrogen is only for use in select postmenopausal women.

Surgery

Depending on your age and whether you wish to become pregnant, surgery can repair the uterus or remove it. When indicated, and in severe cases, your uterus can be removed with a hysterectomy. During the surgery, the surgeon can also correct the sagging of the vaginal walls, urethra, bladder, or rectum. The surgery may be performed by an open abdominal procedure, through the vagina, or through small incisions in the abdomen or vagina with specialized instruments.

Other therapy

If you do not want surgery or are a poor candidate for surgery, you may decide to wear a supportive device, called a pessary, in your vaginal canal to support the falling uterus. You can use this temporarily or permanently. They come in various shapes and sizes and must be fitted to you. If your prolapse is severe, a pessary may not work. Also, pessaries can be irritating inside your vagina and may cause a foul-smelling discharge.

If you are not a good candidate for a hysterectomy or a pessary and are not going to have intercourse again, there is an option for a surgery called colpocleisis. During this procedure, the walls of the vagina are sewn shut.

Follow-up

Follow-up depends on how your condition was treated.

If you had surgery, you need to follow up according to your surgeon's advice.
If you have a pessary inserted in your vagina, it needs to be cleaned and checked by your health care provider for the correct position and fit at regular intervals unless you are instructed on how to remove it and clean it yourself at home.
If you have been told to do Kegel exercises, you should have a regular follow-up visit so that your health care provider can check the progress of your muscle strength.

Prolapsed Uterus Symptoms Prevention

Reduce your weight.
Avoid constipation by eating a high-fiber diet.
Do Kegel exercises to strengthen your pelvic muscles.
Avoid heavy lifting or straining.

Prolapsed Uterus Symptoms Outlook

Pessaries can be effective temporarily or permanently if they are checked and cleaned as often as necessary. Surgery can support a prolapsed uterus or remove it.

Women's Health Guide

Screening & Tests
Diet & Exercise
Rest & Relaxation
Reproductive Health
Head to Toe

Fixation of the uterus in case of prolapse or prolapse in Rostov-on-Don

Omission or prolapse of the uterus and other internal genital organs is observed today in 50% of women giving birth. During pregnancy, the fetus puts constant pressure on the pelvic muscles, relaxing them. With a gradual weakening of the muscles and ligaments, the walls of the vagina are lowered. In this case, a diagnosis of genital prolapse is made.

After 30 years, the perineal tissue becomes less elastic.

If the first birth occurs at this age, then the risk of tissue injury and, consequently, prolapse of the internal genital organs increases.

Main causes of genital prolapse:
- chronic constipation,
- diabetes mellitus, obesity, hormonal disorders,
- constant lifting of weights,
- frequent bouts of violent coughing,
- congenital weakness of the connective tissue.

Prolapse of the internal genital organs occurs gradually.

There are 5 degrees of this process:
First degree - there is a slight prolapse of the posterior and anterior walls of the vagina, while the genital gap gapes.
Second degree - the pelvic floor muscles weaken more significantly, the prolapse of the vaginal walls gradually continues. This also lowers the bladder and rectum (its front wall).
Third degree - the uterus is already lowered, and its neck is at the level of the entrance to the vagina.
Fourth degree - incomplete uterine prolapse occurs. At the same time, the cervix is already outside the entrance to the vagina
Fifth degree - the woman has a complete prolapse of the uterus, during which the walls of the vagina are everted. Prolapse of organs occurs, as a rule, in old age.

The process of prolapse of the internal genital organs by violations of the reproductive function, it is also possible:
- urination disorder,
- difficulty in emptying the bowels,
- occurrence of frequent pains, inflammations,
- a feeling of discomfort when walking, moving, sexual relations.
All of the above phenomena significantly reduce the quality of life.

The danger of the problem is that at first it may not declare itself in any way. Therefore, for its prevention, it is necessary to undergo an examination by a gynecologist at least once every 6 months.

Seek immediate medical attention if the following symptoms occur:
- sensation of a foreign body in the vagina, urinary incontinence, constipation,
- feeling of heaviness in the lower abdomen,
- Unusual vaginal discharge.

In the clinic "Genome-Don" the problem of prolapse/prolapse of the internal genital organs is solved comprehensively, efficiently and reliably with the help of surgical technologies.

The list of reconstructive plastic gynecological operations includes:
- surgical fixation of the uterus and other internal organs of the reproductive system in the normal position when they are displaced / omitted / prolapsed;
- surgical treatment to narrow the vagina;
- correction of injured areas of the perineum;
- Improving the shape of the labia.

Uterine prolapse: symptoms and treatment

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Prolapse of the uterus: symptoms and treatment

08/01/2018

Uterus prolapse is a gynecological problem that can affect not so few women as it might seem at first glance. This disease is characterized by a constant increasing displacement of the pelvic organs downward. The prolapse of the uterus brings a lot of inconvenience and discomfort to a woman’s life, so this problem needs to be solved as soon as possible. In this article, we will try to figure out what this disease is and what methods it is customary to treat.

Symptoms of prolapse of the uterus

Prolapse of the walls of the uterus is characterized by the following symptoms:

Changes in the normal pattern of menstruation. The menstrual cycle begins to move away, or vice versa, it comes much faster than expected.
Sensation of a foreign body in the vagina. The woman will feel as if her vagina is filled with something. The sensations themselves can be both constant and periodically disappear.
Painful intercourse. Having sex during prolapse of the uterus can cause both sharp and not the most severe pain. In any case, discomfort will be present.
Drawing pains in the lower abdomen. The stomach will hurt: not too sharply, but the attacks of pain themselves will be relatively protracted.
Drawing pains in the loin and sacrum. The back will also suffer from uterine prolapse, so if such a symptom occurs, uterine prolapse should also be suspected.
Problems with urination. They can appear in completely different ways. Someone begins too frequent urge to go to the toilet, and someone begins to feel pain when urinating.
Congestion in the urinary organs. This symptom leads to more serious complications, which are characterized by infection of the lower and upper urinary tract.
Urinary incontinence. Due to problems with urination, uncontrolled urination may begin. At the same time, it can be either spontaneous, without any urge to urinate, or with a preliminary desire to immediately visit the restroom.
Proctological problems. With prolapse of the uterus, they occur in almost a third of patients. It can be both incontinence of gas and fecal masses, and constipation and colitis.
Uterine prolapse. If a woman does not turn to doctors in time to cure the prolapse of the uterus, her prolapse may begin. The uterus begins to protrude from the vagina. Its external can be both matte and shiny, and the surface will be matte and covered with abrasions. Actually, a woman will be able to detect such an education on her own, which most often serves as the reason for contacting a doctor.

Causes of uterine prolapse

There are many reasons why uterine prolapse can begin. So, the most common is the slowdown in collagen production in connective tissues. Because of this, the ligaments begin to stretch, which leads to the prolapse of the pelvic organs - both the uterus and the vagina.

Another common cause of uterine prolapse problems is decreased muscle tone. This process is most often observed in pregnant women or in women who have recently given birth. The fact is that during childbirth, a rather serious load is placed on the body, and it is especially strong on the pelvic organs. If optimal tone is lost, the muscles will not be able to prevent the uterus from moving towards the vagina.

Quite often, such problems arise as a result of birth trauma. Cases when a woman receives injuries to the perineum during childbirth are not at all uncommon. If the birth was especially difficult, the abdominal organs can suffer quite a lot, from which uterine prolapse begins.

Changes with age are another reason for prolapse and even prolapse of the uterus. With age, women begin to reduce the production of estrogen, due to which a gradual loss of muscle tone begins. Especially often the prolapse of the uterus manifests itself during menopause.

Uterine prolapse is a common syndrome in overweight women. So, excess body weight creates an additional load on the internal organs. Moreover, chronic disorders of the digestive system (especially constipation) can cause changes in the normal position of the uterus.

Diagnosis of uterine prolapse

If a problem of this nature is detected at an early stage, there is every chance of avoiding surgery and the appearance of more serious and painful symptoms.

Diagnosis of uterine prolapse is combined from several stages:

Complete examination of the patient on the gynecological chair,
Diagnosis with special equipment,
Delivery of laboratory tests.

If the case has caused a lot of additional symptoms, the gynecologist can prescribe additional consultations of the proctologist and urologist.

Treatment of uterine prolapse

Treatment of uterine prolapse is a lengthy and complex procedure. So, if the symptoms themselves are relatively frivolous, it is quite possible to get by with Kegel exercises. They will be individually prescribed by the doctor to each patient with similar problems.

If the problem turned out to be sufficiently neglected, surgical intervention is mandatory.