Uterine and Vaginal Prolapse

The uterus is held in place by a number of muscles, tissues and ligaments and prolapse takes place when these muscles, ligaments and tendons become too weak to support the uterus and it falls down from its normal place. 

Prolapses happen in different stages, which are referred to as:
  • A first degree prolapse – this is when part of the uterus slips down into the vagina
  • A second degree prolapse – this is when part of the uterus comes out of the vagina
  • A third degree prolapse – this is when the entire uterus comes out of the vagina

Up to 30% of women who have had children are affected by some degree of prolapse. It is more common as women become 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.*

Symptoms

Some women who have a prolapse of the uterus do not suffer from any symptoms and the condition is only identified during an internal examination which is carried out for other reasons.

The majority of women who have a prolapse will experience an uncomfortable feeling of fullness, dragging or heaviness in the vagina and sometimes there may be pain.

There may be the sensation of something coming down or out of the vagina and if the prolapse is a second or third degree prolapse, the uterus can actually be seen.

Other symptoms include:

  • Back pain
  • Cystitis 
  • Difficulty in going to the toilet
  • Difficulty walking
  • Difficulty whilst having sex

Stress incontinence can also be a symptom of uterine prolapse.

Causes

The following are often causes a prolapse of the uterus:

  • Childbirth - especially amongst women who have suffered long and difficult labours, had large babies and/or multiple births
  • Changes that have occurred due to going through the menopause which can cause weakness to the muscle tone and low levels of the hormone
  • Being overweight - creating additional pressure in the pelvic area
  • Pelvic surgery - for example hysterectomy or bladder repair
  • Heavy lifting
  • Persistent coughing
  • Constipation - excessive straining when going to the toilet.

Diagnosis

In order to diagnose a first-degree prolapse, the consultant gynaecologist will need to carry out an internal examination in order to determine whether there are any abnormalities in the pelvic area and the degree of the prolapse.

The consultant gynaecologist is able to diagnose a second or third-degree prolapse without internal examination as the uterus can be seen outside the opening of the vagina. 

Treatment

There are a number of treatments available for uterine prolapse including:

Pelvic floor exercises

Pelvic floor exercises can help strengthen the muscles and aid recovery following pelvic surgery. They can also reduce symptoms such as leaking urine and backache.

Hormone Replacement Therapy

Women who are going through the menopause may benefit from HRT.

HRT will increase the levels of collagen, which is a natural protein that supports skin, bone and tissue and the hormone oestrogen, and may help strengthen the vaginal walls and pelvic floor muscles.

HRT (oestrogen) cream or pessary can be inserted into the vagina and may be recommended by the consultant gynaecologist.

Vaginal pessaries

A vaginal pessary can be inserted into the vagina in order to hold the uterus in place.

Pessaries are recommended for more severe prolapses and the consultant gynaecologist will remove the pessary every three to six months and replace it with a new one. 

Surgery 

Several types of surgical procedures can be carried out in order to treat a severe prolapse including:

Hysterectomy

A hysterectomy is a major procedure carried out to completely remove the uterus and is considered to be one of the most effective treatments for uterine prolapse.

Suspension

Suspension treatment holds the uterus in place and there are several different types of suspension treatment.

During surgery, a synthetic mesh (suspension sling) is inserted into the vagina to either support the uterus or prevent future prolapse of the vagina. The main mesh treatments are:

  • Sacrohysteropexy - one end of the mesh is attached to the cervix and the other to a bone in the spine to hold the uterus in place
  • Sacrocolpopexy - one end of the mesh is attached to the top of the vagina to prevent the vagina collapsing and this can be done at the same time as a hysterectomy
  • Infracoccygeal hysteropexy or colpopexy - these are newer techniques and the same as the 'sacro' methods above however, they are less invasive. Mesh is inserted through the vagina, as opposed to the abdomen, and patient are often able to be discharged from hospital on the same day.

For further information regarding the Uterine and Vaginal Prolapse please contact 0161 428 3656.

*Reference NHS Choices