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Prolapse of the uterus

 

The uterus (womb) is usually held in place by muscles, tissue and ligaments. Prolapse happens when the tissues that support the uterus become so weak that the uterus cannot stay in place and it slips down from its normal position. This can cause:

  • a sensation of something coming down or out of the vagina
  • an uncomfortable feeling of fullness
  • difficulty having sex
  • leaking a small amount of urine when you cough, sneeze or exercise (stress incontinence)

Read more about the symptoms of prolapse of the uterus.

Up to half of all women who have had children are affected by some degree of prolapse. It is more common as women get older, particularly in those who have gone through the menopause. It is rare in women who have not had children.

Prolapse is also associated with being overweight and with having a persistent cough. Read more about the causes of prolapse of the uterus.

Stages of prolapse

Prolapse of the uterus can happen in stages.

  • In first-degree prolapse the uterus moves down into the vagina, but the lower section of the uterus (the cervix) still remains inside the vagina.
  • In second-degree prolapse the cervix now passes out of the opening of the vagina.
  • In third-degree prolapse the whole of the uterus is outside the vagina (called procidentia).

How is prolapse of the uterus treated?

Mild cases of prolapse may not need treatment. Lifestyle changes such as weight loss and pelvic floor exercises may be recommended instead.

More severe cases of prolapse may be treated effectively using a device that is inserted into the vagina called a vaginal pessary. This helps to hold the uterus in place. There are also several different surgical techniques that can be used. For example, a mesh can be inserted to support the uterus. Read more about treating prolapse of the uterus.

Some women who have had surgery may need further surgery for prolapse of the vaginal walls.

Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Uterus
The uterus or womb is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Some women with a prolapse of the uterus (womb) do not have any symptoms and the condition is only discovered during an internal examination for another reason.

Most women with a prolapse will experience an uncomfortable feeling of fullness, dragging or heaviness in the vagina, which is sometimes accompanied by pain.

There may be a sensation of something coming down or out of the vagina. If the prolapse is more advanced, it may be possible to see the uterus.

Other common symptoms

Other common symptoms include:

  • lower back pain
  • difficulty going to the toilet
  • cystitis, which is a bladder infection that causes a frequent and urgent need to urinate
  • difficulty walking
  • difficulty having sex

Women with prolapse of the uterus often have stress incontinence , where a small amount of urine is passed if they cough, sneeze or exercise. 

A prolapse can sometimes have a significant impact on a woman's quality of life and on her own body image.

Incontinence
Incontinence is when you pass urine (urinal incontinence) or stools or gas (faecal incontinence) because you cannot control your bladder or bowels.
Uterus
The uterus or womb is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Useful Links

There are several factors that can increase your risk of a prolapse of the uterus (womb). These include:

  • your age, as prolapse is more common as you get older
  • childbirth, particularly if you had a long or difficult labour or gave birth to multiple babies or to a large baby
  • changes caused by the menopause, such as weakening of tissue and low levels of the hormone oestrogen
  • being overweight or obese, which creates extra pressure in the pelvic area
  • previous pelvic surgery, such as hysterectomy or bladder repair
  • heavy lifting and manual work
  • long-term coughing, for example, if you smoke
  • long-term constipation due to the excessive straining when going to the toilet

Conditions

There are some conditions where the tissues in your body are naturally weak and this can make a prolapse more likely. These include:joint

  • hypermobility syndrome, where your joints are very loose, which can be painful and cause a number of other symptoms, such as fatigue and digestion problems
  • Marfan syndrome, which is a condition that affects the blood vessels, eyes and skeleton  
  • Ehlers-Danlos syndrome, which is a condition that causes the skin to stretch and bruise easily  
Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.
Constipation
Constipation is when you pass stools less often than usual or when you have difficulty going to the toilet because your stools are hard and small.
Hysterectomy
A hysterectomy is surgery to remove the uterus, cervix and sometimes fallopian tubes and ovaries.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Uterus
The uterus or womb is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

See your GP if you have any of the symptoms of a prolapse, especially if you can see or feel something near or at the vaginal opening.  

First-degree prolapse

To find out if you have first-degree prolapse, you will need an internal examination. Your doctor will ask you to undress from the waist down and lie back on the examination table while they feel for any lumps or bumps in your pelvic area.

When being examined, you may be asked to lie on your side so the doctor can assess the degree and type of prolapse better.

Second- and third-degree prolapse

Second- and third-degree prolapse can be diagnosed without internal examination as the uterus can be seen outside the vaginal opening. 

Uterus
The uterus or womb is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Booking an appointment

Some women may put off going to their GP if they are embarrassed or worried about what the doctor may find. The examination only takes a few minutes and prolapse is very common, so there is no need to be embarrassed.

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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

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). 

Vaginal pessaries

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.

Side effects

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.

Surgery

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.

Hysterectomy

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 
Constipation
Constipation is when you pass stools less often than usual or when you have difficulty going to the toilet because your stools are hard and small.
HRT
Hormone replacement therapy (HRT) involves giving hormones to women when the menopause starts to replace those that the body no longer produces.
Hysterectomy
A hysterectomy is surgery to remove the uterus, cervix and sometimes the fallopian tubes and ovaries.
Spine
The spine supports the skeleton and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called vertebrae.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.
Uterus
The uterus or womb is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Useful Links

There are several things that you can do to reduce your risk of a prolapsed uterus (womb) or prevent a mild prolapse from getting worse. These include:

  • doing regular pelvic floor exercises
  • losing weight if you are overweight and maintaining a healthy weight for your build.
  • eating a high-fibre diet to avoid constipation and straining when going to the toilet
  • avoiding heavy lifting

If you smoke, you should give up because the persistent cough that most smokers have can lead to a prolapse. See the Health A-Z topic about Stopping smoking for more information and advice about quitting.

Constipation
Constipation is when you pass stools less often than usual or when you have difficulty going to the toilet because your stools are hard and small.
Uterus
The uterus or womb is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.