Uterine Prolapse
Treatment for the uterus descending into the vaginal canal due to weakened pelvic support
What is uterine prolapse?
The pelvic organs are held up by a hammock of muscle, ligament and fascia. Childbirth stretches it, and age and the fall in oestrogen after the menopause weaken it further, so what was suspended begins to descend into the vagina.
It is graded by how far down it has come, from a small descent found on examination through to tissue that stays outside the body. The front wall, the back wall and the uterus itself can each come down alone or together, and which of them has descended decides which repair is appropriate.
Anything that raises pressure in the abdomen day after day drives it: chronic constipation, a long-standing cough, heavy lifting and carrying extra weight. Those are also the things that undo a repair, so they get dealt with alongside it and not afterwards.
What you might notice
- A feeling of something coming down in the vagina
- Leaking urine on coughing or on the way to the toilet
- Pelvic pain
How it is diagnosed
This diagnosis is made by examination. A doctor looks at each wall separately, with you resting and then bearing down, and grades what descends and how far, sometimes with you standing since gravity changes what is found.
They will also check the bladder, because a descent can mask leakage that only appears once the anatomy is put back, and a woman who was dry beforehand can be surprised afterwards. Measuring what is left in the bladder after passing urine is part of the same assessment.
Scans are not usually needed. An ultrasound is added where there is a suspicion of something else in the pelvis contributing to the pressure from above.
Recovery
Pelvic floor training needs three to six months of daily work before it is judged, and it is most effective in the earlier grades. Done properly with a physiotherapist it can be enough on its own.
After a repair done through the vagina expect two nights in hospital and four to six weeks off work, with a catheter for the first day or two and some discharge for a few weeks as the stitches dissolve. Where the repair was done through the abdominal wall with small cuts, the stay is similar and the outside heals faster than the inside does.
What protects the result is the twelve weeks afterwards. No lifting, no straining, constipation treated actively, and the pelvic floor work restarted once you are told to. Repairs fail where the pressure that caused the problem goes straight back on.
If it is left untreated
A mild descent that you are not aware of does not need treating, and watching it with pelvic floor work is entirely reasonable. It does not always progress.
Where it does progress, tissue that sits outside rubs against clothing and can ulcerate, and the bladder may stop emptying completely, which brings repeated infections and, uncommonly, backs pressure up towards the kidneys. Difficulty emptying the bowel is common at the later grades.
The part that goes unmentioned in clinic is the effect on intimacy and on confidence, and it is a legitimate reason to treat something that is not dangerous. Being unable to pass urine at all is the one situation that needs seeing the same day.
Questions about uterine prolapse
Can pelvic floor exercises fix it without surgery?
In the earlier grades they genuinely can, and they are the first thing to try in almost everyone. What matters is doing them properly, since most people contract the wrong muscles at first, and a session or two with a pelvic floor physiotherapist changes the results substantially. Give it three to six months of daily work before judging it. Where the descent already reaches or passes the vaginal opening, exercises will not lift it back, though they still help the symptoms and are worth continuing alongside whatever else is planned.
Is a pessary a permanent solution?
It can be. A pessary is a soft silicone device fitted into the vagina to hold the prolapse up, and many women use one for years perfectly happily. It suits a woman who wants to avoid an operation, one who is not fit for anaesthesia, one who has not finished having children, and one who wants relief while waiting for surgery. It needs the right size fitted, a check every few months, and often a little local oestrogen to keep the vaginal tissue healthy. It supports the prolapse without correcting it, so if it is removed the descent is as it was.
Can I have a repair and still have children?
It is possible but rarely advised in that order. A pregnancy and a vaginal delivery put exactly the load on the repair that caused the original problem, and the descent commonly returns afterwards, so where a woman has not completed her family the usual advice is a pessary and pelvic floor work until she has. Where surgery cannot wait, uterus-preserving repairs exist and a caesarean delivery is generally planned for any later pregnancy. It is worth being explicit about your plans at the first consultation, because it changes which operation is offered.
Other obstetrics & gynaecology treatments
Delivery of a baby through surgery when vaginal delivery is not advisable or safe
InpatientManagement of non-cancerous growths in the uterus, based on symptoms, size, location and reproductive plans
Day CareTalk to a care coordinator about uterine prolapse
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one