The uterus is held in position by pelvic muscles, ligaments and other tissues. If the uterus drops out of its normal position, this is called prolapse. Prolapse is defined as a body part falling or slipping out of position. Prolapse happens when the pelvic muscles and connective tissues weaken. The uterus can slip to the extent that it drops partially into the vagina and creates a noticeable lump or bulge. This is called incomplete prolapse. Complete prolapse occurs when the uterus slips to such a degree that some uterine tissue is outside the vagina.
Pelvic prolapse is usually accompanied by some degree of vaginal vault prolapse. Vaginal vault prolapse occurs when the upper part of the vagina loses its shape and sags into the vaginal canal or outside the vagina. Pelvic prolapse may also involve sagging or slipping of other pelvic organs, including the bladder, the urethra which is the tube next to the vagina that allows urine to leave your body, and rectum.
Causes of Pelvic prolapse
Pelvic prolapse results from the weakening of pelvic muscles and supportive tissues. Causes of weakened pelvic muscles and tissues include:
- Difficult labor and delivery or trauma during childbirth
- Delivery of a large baby
- Being overweight or obese
- Lower estrogen level after menopause
- Chronic constipation or straining with bowel movements
- Chronic cough or bronchitis
- Repeated heavy lifting
Symptoms of Pelvic prolapse
Women with mild cases of pelvic prolapse may have no noticeable symptoms. However, as the uterus falls further out of position, it can place pressure on other pelvic organs—such as the bladder or bowel — causing a variety of symptoms, including:
- Sensation of sitting on a small ball
- Heaviness or pulling in the pelvis
- Pelvic or abdominal pain
- Pain during intercourse
- Protrusion of tissue from the opening of the vagina
- Repeated bladder infections
- Vaginal bleeding or an unusual or excessive discharge
- Frequent urination or an urgent need to empty your bladder
Diagnoses of Pelvic prolapse
A diagnosis of Pelvic prolapse generally occurs during a pelvic exam.
During the pelvic exam your doctor is likely to ask you:
- To bear down as if having a bowel movement. Bearing down can help your doctor assess how far the uterus has slipped into the vagina.
- To tighten your pelvic muscles as if you're stopping a stream of urine. This test checks the strength of your pelvic muscles.
Treatment of Pelvic prolapse
If Pelvic prolapse is severe, your doctor might recommend surgery. Minimally invasive (laparoscopic) or vaginal surgery might be an option.
- Repair of weakened pelvic floor tissues. This surgery is generally approached through the vagina but sometimes through the abdomen. The surgeon might graft your own tissue, donor tissue or a synthetic material onto weakened pelvic floor structures to support your pelvic organs.
- Removal of your uterus (hysterectomy). Hysterectomy might be recommended if uterine prolapse is severe.