Prolapse

A Prolapsed Uterus is an uncomfortable condition that typically affects women after childbirth or menopause. It occurs when weakened pelvic muscles allow the bladder, uterus or rectum to “drop’’ or sink into the vagina. Anything that puts constant or additional pressure on the abdomen can cause pelvic floor prolapse. Some causes include:

• A vaginal birth delivery versus a cesarean delivery
• History of four or more vaginal births
• Giving birth to babies heavier than nine pounds
• Family history
• Hysterectomy or other prior pelvic surgery
• Menopause/Aging
• Intense physical activity
• Being overweight or obese
• Constipation
• Chronic coughing
• Smoking

Prolapse Symptoms

Many women have no, or minimal, symptoms and are not bothered by their prolapsed uterus.  Prolapse symptoms can, however, progress gradually over time as the muscles of the pelvic floor continue to weaken. Oftentimes, the condition goes un-diagnosed unless a health care provider discovers it during a routine physical exam or a woman detects a slight bulge of tissue in her vagina. The symptoms can range from mild to severe, with severe cases involving the uterus dropping so low as to be seen protruding outside of the vagina. Symptoms of a Prolapsed Uterus can include the following:

• Feeling bloated in the lower belly
• Achy, painful sensation in the lower abdomen or pelvis
• Lower backache
• Releasing urine accidently or difficulty urinating
• Pain during sexual intercourse
• Spotting or bleeding
• Recurring urinary tract infections
• Problems inserting tampons or applicators
• Pelvic pressure that worsens upon prolonged standing, lifting heavy objects or coughing.

Types of Prolapse

Uterine Prolapse

This condition occurs when the ligaments that support the uterus weaken, or tear, allowing the uterus to drop down into the vagina.  A mild degree of uterine prolapse is very common, and there is usually no presentation of symptoms and no need for surgery. 

If, however, the prolapse worsens and a woman experiences vaginal pressure or discomfort, pelvic pressure, difficulty moving the bowels or painful intercourse, then treatment options will need to be considered. 

Vaginal Vault Prolapse

When the upper 1/3 of the vagina (the “vaginal vault”) loses its ligamentous support and drops, it is called a vaginal vault prolapse. This issue is common in women who have had a hysterectomy. Women with this type of prolapse can have issues such as urinary urgency, frequency, and difficulty emptying the bladder as well as pelvic pain and painful intercourse. Corrective vault-suspension surgery may be indicated to correct this condition.

Cystocele

A cystocele occurs when the fascia, or connective tissue, that supports the bladder weakens or tears, and the bladder drops into the vagina. This can result in urine leakage whenever there is increased abdominal pressure from walking, laughing, coughing, lifting or sneezing. It could be a small amount of urine or enough to require a woman to change her clothes or wear pads. A cystocele can also cause pelvic/vaginal pressure, painful intercourse, and a pulling sensation in the vagina. 

Urethrocele

Urethrocele is a condition in which the urethra bulges into the vagina. This usually occurs when there is a cystocele also present and results in similar symptoms.

Rectocele

Rectocele can result from a breakdown in the connective tissue that supports and separates the vagina from the rectum. A weakness, or tear, allows the rectum to push directly against the vagina, thus creating a bulge. A large rectocele could make it difficult to have a bowel movement, especially if constipation is already present. Some women must manually push down on the bulge in the vagina to enable a bowel movement. 

Enterocele

Enterocele typically occurs as a result of a hysterectomy, although it can also occur together with a rectocele and/or other prolapse condition. An enterocele is a bulge of a portion of the small intestine that pushes directly into the top of the vagina. Symptoms are similar to those associated with other pelvic floor conditions.

It is imperative to talk with one's doctor. Proper diagnosis is key to treating pelvic support problems. The exact cause of the issue must be discovered before the best treatment can be recommended. Being open and honest with one’s healthcare practitioner will be helpful in determining the exact cause as well as viable treatment options. 

Prolapsed Uterus Treatment

Prolapsed uterus treatment will be based on the following factors:

• Age
• Desire to have children
• Sexual activity
• Severity of symptoms
• Degree of prolapse
• Other health issues

No form of prolapsed uterus treatment is guaranteed to resolve the entire problem, but there are steps one can take to help prevent or assist with specific symptoms.

Lifestyle Changes for Prolapsed Uterus

• Limit fluid intake, particularly those drinks that contain caffeine (caffeine is a diuretic) if incontinence is an issue. 
• Engage in bladder training (emptying the bladder at scheduled times).
• Gradually increase fiber intake to ward off constipation. Consider a natural laxative or medication to soften stools.
• Lose weight to improve overall health and possibly improve prolapse symptoms.
• Do Kegel exercises(pelvic floor exercises) to strengthen the sphincter muscles that surround the openings of the urethra, vagina, and rectum. Perform these exercises regularly to help improve incontinence. 
• Talk to your doctor about using a pessary. This is a rubber ring inserted into the vagina, to support the organs. Pessaries need to be cleaned regularly and removed prior to sexual intercourse. Some pessaries can be removed, cleaned, and reinserted by the user while others need to be removed by a health care provider.
• Talk to your doctor about using low-dose, bio-identical estrogen cream to strengthen pelvic connective tissue and slow the movement of prolapsed organs.
• Research and talk to your doctor about surgery that helps restore normal depth and function of the vagina. Such surgery can be done through the vagina or laparoscopically through the abdomen depending on the nature and severity of the issue. 

Related:

Amazing graphic from the Washington Post on Prolapse