There are several treatment options available for prolapse of the uterus (womb). Which treatment is used depends on:
- the degree of the prolapse (for more information about degrees of prolapse (see Prolapse of the uterus - introduction)
- how severe your symptoms are
- your age and health
- whether you are planning to have children in the future
Self care advice
You will not need to have treatment if your prolapse is mild to moderate and not causing any pain or discomfort. There are ways to improve the condition, prevent it worsening and make you more comfortable.
You should avoid standing for long periods of time. Eat a high-fibre diet with plenty of fresh fruit, vegetables and wholegrain bread and cereal. This will prevent constipation and reduce straining when going to the toilet.
If you are overweight, losing weight may resolve or reduce your symptoms. .
Pelvic floor exercises
Your pelvic floor muscles are the muscles that you use to control the flow of urine from your bladder. They surround the bladder and the tube that carries urine from the bladder to outside the body (urethra).
Having weak or damaged pelvic floor muscles can make a prolapse more likely. If you have a mild prolapse, doing pelvic floor exercises may help to support your prolapse.
Pelvic floor exercises are also used to treat urinary incontinence (when you leak urine), so they can be useful if this is one of your symptoms. Read more about treating urinary incontinence.
Your doctor may refer you to a physiotherapist who will be able to teach you how to do pelvic floor exercises. It may take a few months before you notice any improvement.
Hormone replacement therapy (HRT)
If you are going through the menopause, you may benefit from hormone replacement therapy (HRT). The menopause is where a woman's monthly periods stop, which usually occurs at around 52 years of age.
After the menopause, your levels of the hormones oestrogen and progesterone will start to fall. It is possible that the lack of oestrogen weakens the tissues in your pelvis, which leads to the prolapse.
Taking HRT will increase your levels of oestrogen, which may help to strengthen the vaginal walls and pelvic floor muscles and tissues. Read more about HRT, including who can use it and how it is taken.
Oestrogen is available as:
- a cream that you apply to your vagina
- a tablet that you insert into your vagina
- a patch that you stick on your skin
- an implant that is inserted under your skin
If you are having HRT, the oestrogen may be combined with another hormone called progesterone.
The evidence for the effectiveness of taking oestrogen for a prolapse is mixed. If you are planning on having surgery for your prolapse, taking oestrogen for three weeks before your operation may reduce the risk of a bladder infection (cystitis) afterwards. One trial found that taking oestrogen reduced the need for prolapse surgery in women over 60 years of age, but further research is needed to confirm this.
Despite the lack of evidence, oestrogen is widely used for women who have symptoms of a prolapse after the menopause. It may also be combined with pelvic floor muscle exercises or vaginal pessaries (see below).
A vaginal pessary is a device that is similar to a diaphragm or cap. It is inserted into your vagina to hold your uterus in place. Pessaries are usually made of latex (rubber) or silicone and come in different shapes and sizes.
Pessaries may be an option if your prolapse is more severe but you would prefer not to have surgery. A gynaecologist (a specialist in treating conditions of the female reproductive system) or a specialist nurse usually fits a pessary. The pessary will be removed every three to six months and replaced with a new one.
Pessaries can occasionally cause vaginal discharge. They may also cause some irritation and possibly bleeding and sores inside your vagina. Other common side effects include:
These side effects can usually be treated.
Several different types of surgery can be used to treat a severe prolapse of the uterus, including hysterectomy and suspending the uterus. These procedures are described below.
A hysterectomy is a major operation that involves removing the uterus. It is considered to be the most effective treatment, although it can put women at increased risk of other types of prolapse, such as vaginal vault prolapse (where the top of the vagina falls in). You cannot get pregnant after having a hysterectomy.
Suspending the uterus
Suspension treatment holds the uterus in place and is recommended if you want to have children in the future. There are several types of suspension treatment, which are outlined below. These may be carried out under general anaesthetic, where you are put to sleep, or a spinal anaesthetic, where you are numb from the waist down.
For many types of suspension treatment, a synthetic mesh (suspension sling) is inserted into the vagina either to support the sagging uterus or to prevent future prolapse of the vagina. The main mesh treatments are:
- Sacrohysteropexy, where one end of the mesh is attached to the cervix (entrance to the uterus) and the other to a bone in the spine to hold the uterus in place.
- Sacrocolpopexy, where one end of the mesh is attached to the top of the vagina to prevent the vagina collapsing. This is done at the same time as a hysterectomy.
- Infracoccygeal sacropexy, where the mesh is inserted through the buttocks and into the back of the vagina.
A suspension treatment that does not use mesh is called sacrospinous fixation. This is where the uterus is stitched directly to one of the pelvic ligaments. Ligaments are bands of tissue that connect two bones. The procedure is performed through the vagina so it is less invasive than some other methods, but it has a lower success rate.
Complications from surgery
All types of surgery carry some risks. Your surgeon will be able to explain these in more detail, but possible complications could include:
- the mesh wearing away - further surgery may be required to remove and replace the mesh
- damage to the surrounding organs, such as your bladder
- an infection - you may be given antibiotics to take during and after surgery to reduce the risk of infection
- pain during sex
- vaginal discharge
- vaginal bleeding
- experiencing more prolapse symptoms - which may require further surgery
- a blood clot forming in one of your veins (for example, in your leg) - you may be given medication to help reduce this risk after surgery
Recovering from surgery
Most repair operations take about an hour and you may need to stay in hospital for three to five days, depending on the type of procedure that you have. With some newer techniques you may be able to go home on the same day as the procedure or on the following day.
While you are in hospital, you may have a drip in your arm to provide fluids and a thin plastic tube called a catheter to drain urine from your bladder. Some gauze will be placed inside your vagina to act as a bandage for the first 24 hours. This may be slightly uncomfortable. Your stitches will usually dissolve on their own after a few weeks.
For the first few days after your operation you may have some vaginal bleeding which is similar to a period. You may also have some vaginal discharge. This may last three or four weeks. During this time you should use sanitary towels rather than tampons.
Recovering at home
The recovery time after surgery for prolapse of the uterus can vary. It can take up to three months to recover fully. If you find that activities make you tired, you may need to rest.
You should rest for around two weeks. For the first 8-12 weeks you should:
- Avoid heavy lifting. You should not be carrying anything heavier than a two-litre bottle of water.
- Avoid doing any strenuous exercise. You may have been shown some exercises in hospital to help reduce your risk of blood clots and strengthen your pelvic floor muscles. You can carry on with these and go for gentle walks.
- Avoid standing up for long periods of time. Only do light housework, such as dusting. Do not do the vacuuming or carry heavy shopping.
- Avoid becoming constipated. Drink plenty of water, eat a high-fibre diet and use laxatives (medication) if necessary. Read more about treating constipation .
You can go swimming after three or four weeks if your vaginal discharge has stopped.
You should be able to start having sex again after around six weeks if your vaginal discharge has stopped.
You doctor will advise you about when you can return to work. It may be between six and twelve weeks after your operation. However, this will depend on the speed of your recovery and the type of work that you do.
You can start to drive again when you can comfortably wear a seatbelt and you are able to perform an emergency stop. However, you may need to check with your insurance company in case they have their own restrictions regarding this.
Problems with recovery
Vaginal discharge is perfectly normal. However, if the amount of discharge increases over time or becomes smelly, you should contact your GP because you may have an infection. You should also contact your GP if you:
- have a high temperature (fever) of 38°C (104°F) or over
- experience severe pain low in your tummy
- have heavy vaginal bleeding
- experience a stinging or burning sensation when you pass urine