Prolapsed Uterus Diagnosis and Treatment

Causes of uterine prolapse

A prolapsed uterus occurs when the pelvic tissues and muscles are weakened.

Common causes include:

• Repeated heavy lifting
• Vaginal deliveries, especially of large babies or following difficult labours
• Chronic coughing or straining due to constipation
• Low oestrogen levels after menopause

Stages of a prolapsed uterus

The severity of uterine prolapse is classified into four stages based on how far the uterus has shifted:

First stage: The womb moves into the upper fraction of the vagina.

Second stage: The uterus descends further into the lower vaginal canal.

Third stage: Part of the womb (uterus) shows from the vaginal opening.

Fourth stage: The entire womb extends out of the vagina.

Symptoms of uterine prolapse

Signs of a prolapsed uterus are:

• Difficulty using tampons or vaginal applicators
• Discomfort while walking
• A sensation of sitting on a small object
• In advanced cases, the uterus may appear as a red, ball-like structure emerging from the vagina
• A feeling of pressure or something descending from the vagina
• Constipation or needing to press on the vagina to complete bowel movements
• Visible tissue bulges from the vaginal opening
• Painful intercourse
• Urinary incontinence or trouble emptying the bladder
• Pelvic heaviness, discomfort, or lower back pain

When to seek medical attention

Immediate medical attention is required if:

• The uterus is visibly protruding from the vaginal opening
• You cannot have a bowel movement or urinate

Notify a healthcare provider if:

• You have persistent back pain, urinary issues, walking difficulties, or vaginal pressure occur
• You feel the cervix near the vaginal opening

Diagnosing a uterine prolapse

A diagnosis typically involves:

• A pelvic examination, during which a speculum is used to view the cervix and vaginal walls
• Assessing for any bulging caused by the uterus
• Asking the patient to contract or bear down pelvic muscles
• Additional tests, such as a cystoscopy or MRI, may be performed to assess bladder and urinary function or to obtain detailed images of pelvic organs

Risk factors associated with uterine prolapse

Several factors can increase the risk of uterine prolapse, including:

• A family history of pelvic organ prolapses
• Previous pelvic surgeries
• Giving birth later in life
• Hispanic or White European ethnicity
• Smoking, which can contribute to chronic coughing
• Excess weight or obesity

Treatment options for uterine prolapse

If symptoms are mild and not troubling, treatment may not be necessary. For more severe cases, options include:

• Pessary devices: A pessary, typically a rubber or silicone ring, can be inserted into the vagina to support the uterus. Regular cleaning and maintenance are essential to avoid irritation or infection.
• Pelvic floor exercises: Strengthening muscles of the pelvic region through Kegel exercise can provide support. These exercises involve tightening the muscles used to stop urination, holding for a few seconds, and releasing. Aim to do this 10 times per session, at least twice daily.
• Weight management: Maintaining a healthy weight can lessen the strain on the muscles of the pelvic region.
• Dietary adjustments: Increasing fibre and water intake can prevent constipation and reduce pelvic pressure.

Medications recommended for uterine prolapse

Topical oestrogen creams may be prescribed to thicken vaginal walls and reduce irritation, especially for pessary users. Oestrogen may also be recommended prior to surgery to strengthen tissues and minimise infection risks, though its efficacy is not conclusively proven.

Surgical treatments for uterine prolapse

If non-surgical approaches are insufficient, surgical options include:

• Uterine suspension: Repositioning the uterus without removal is suitable for those who wish to maintain fertility
• Hysterectomy: Removing the uterus via vaginal or abdominal surgery. However, this option eliminates the possibility of future pregnancies
• Other procedures may address related prolapse issues, such as repairing vaginal walls or supporting tissues with mesh. However, mesh implants carry risks such as pain during intercourse and should be thoroughly discussed with a medical professional

Can you push a prolapse back yourself?

No, a prolapsed uterus cannot be repositioned manually by the patient. Surgical intervention is required.

Follow-Up care

Post-treatment follow-up is essential to ensure recovery and prevent recurrence:

• Continue pelvic floor exercises and monitor progress with a healthcare provider
• Adhere to post-surgical care instructions
• Regularly clean and maintain a pessary if one is used

Complications of uterine prolapse

Surgical complications or untreated prolapse can lead to:

• Prolapse can also impact sexual health, self-esteem, and overall quality of life
• Infections or heavy bleeding
• Bladder or bowel damage
• Recurrence of prolapse

How to prevent prolapsed uterus

While not all risk factors can be avoided, the following measures may reduce your chances:

• Carry out regular pelvic floor exercises
• Steer clear of heavy lifting or straining
• Maintain a healthy weight
• Give up smoking to reduce coughing-related strain
• Keep away from constipation by eating fibre-rich foods and staying hydrated

Prognosis

With appropriate treatment, most people achieve symptom relief and improved quality of life. However, older age and obesity increase the likelihood of recurrence.

If you are experiencing symptoms of uterine prolapse, don't wait to seek help. Contact us for personalised advice, a thorough evaluation, and effective treatment. Schedule an appointment today to take control of your pelvic health.