Definition

Uterine prolapse, often referred to as "dropped uterus," is a condition where the uterus descends into the vagina due to weakened muscles and tissues. This condition is part of Pelvic Organ Prolapse (POP). Uterine prolapse generally occurs in women after menopause, women who have given birth more than once, those with a family history of uterine prolapse, or those who have had surgery on pelvic organs.

The pelvic floor muscles that support the uterus, anus, vagina, bladder, and other pelvic organs can weaken or become damaged, making it difficult to support these organs. This causes the pelvic organs to descend or fall into the vagina. The uterus can slip out of its position and descend into the vagina.

Uterine prolapse may appear as anything from a bulge to visible uterine tissue protruding from the vagina.

There are several degrees of uterine prolapse classification, including:

• Grade 1: The uterus falls into the upper part of the vagina
• Grade 2: The uterus falls into the lower part of the vagina
• Grade 3: The uterus protrudes from the vagina
• Grade 4: The entire uterus is visible outside the vagina

Causes

The main cause of uterine prolapse is the weakening of the pelvic floor muscles. However, there are several other causes, including:

• A history of vaginal childbirth, especially when giving birth to twins or babies weighing more than 4 kg
• Conditions that increase abdominal pressure, such as chronic coughing (in bronchitis and asthma), straining (in constipation), pelvic organ tumors, or fluid accumulation in the abdomen
• A history of major surgery in the pelvic area that causes loss of muscle support function
• Smoking, as it can lead to chronic coughing

Risk Factor

Several risk factors increase the likelihood of uterine prolapse, such as:

• A history of childbirth or surgery through the vagina
• Increasing age (aging), which is associated with decreasing estrogen levels
• Excessive exercise, especially those requiring significant straining
• A family history of uterine prolapse
• Lifestyle factors like smoking and being overweight (obesity)

Symptoms

Uterine prolapse may be asymptomatic, especially in moderate cases. However, as the uterus shifts from its position, it can put pressure on other pelvic organs (such as the bladder). If the degree of uterine prolapse worsens, the following symptoms may occur:

• A feeling of heaviness, fullness, or pressure in the pelvis
• Pelvic or lower abdominal pain
• Pain during sexual intercourse
• Uterine tissue protruding through the vaginal opening
• Difficulty inserting a tampon or other applicator into the vagina
• Constipation
• A frequent or sudden urge to urinate. Often, patients cannot control the urge to urinate or experience urinary incontinence

These symptoms may worsen when standing or walking for long periods, coughing, or sneezing. This is due to gravity putting additional pressure on the pelvic floor muscles.

Diagnosis

A doctor will examine the pelvis to determine the position of the uterus. During a pelvic exam, the doctor will insert a tool called a speculum to view the condition of the vagina and uterus.

The doctor will check for any bulge that causes the uterus to descend into the vagina. In addition, the doctor may ask the patient to cough, strain, or try to hold in urine. This helps assess the weakness of the pelvic floor muscles.

The doctor may also recommend imaging examinations, such as MRI (Magnetic Resonance Imaging). This test provides images of the pelvic organs and surrounding structures.

In addition to MRI, the doctor may suggest other tests, such as urinary tract X-rays, pelvic and urinary tract ultrasound, and muscle and nerve function tests.

Management

Uterine prolapse treatment can be done through non-surgical and surgical methods. Here is an explanation of uterine prolapse management:

Non-surgical Management

• Lifestyle changes, such as reducing or quitting smoking and losing weight.
• Increase intake of water and fiber to prevent constipation.
• Exercise to strengthen pelvic floor muscles. Kegel exercises can be done by tightening the muscles that control urine flow and holding for up to 10 seconds before releasing. Do this up to 50 times a day.
• Use of a vaginal pessary, a donut-shaped device made of plastic that fits around the lower part of your uterus. This device helps support the uterus in place. A doctor will help adjust and explain the use of this device. The device must be cleaned frequently and removed during sexual intercourse.

Surgical Management

• Surgery to repair the position of the uterus. This procedure can involve replacing the uterine support tissue
• Hysterectomy, or surgical removal of the uterus

Complications

Complications that arise from uterine prolapse include:

• Anterior vaginal prolapse or cystocele: This occurs due to weakened connective tissue separating the bladder and vagina, causing the bladder to bulge into the vagina.
• Posterior vaginal prolapse or rectocele: This occurs due to weakened connective tissue separating the large intestine and vagina, causing the intestine to bulge into the vagina. This can lead to difficulty with bowel movements.
• Uterine protrusion.
• Infection: This is caused by friction between clothing, which can lead to sores on the vagina. If left untreated, the infection can increase the risk of pelvic injury and cause cervical sores.

Prevention

The following measures can reduce the risk of uterine prolapse:

• Drink enough water and eat high-fiber foods like fruits, vegetables, seeds, and legumes to prevent constipation
• Avoid lifting heavy objects or do so with proper posture. If lifting heavy objects, use your legs rather than pulling with your waist or back
• Treat chronic coughs caused by conditions like bronchitis
• Avoid and quit smoking to reduce the risk of chronic cough
• Exercise regularly to maintain a healthy weight
• Practice Kegel exercises to strengthen the pelvic floor muscles

When to See a Doctor?

Contact a doctor if you experience symptoms of uterine prolapse, such as:

• Feeling something bulging or protruding from the vagina
• Pain during urination or bowel movements
• Lower back pain or pelvic pressure not caused by other conditions

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