Definition
Uterine prolapse is falling or sliding of the uterus from its normal position in the pelvic cavity into the vaginal canal.
Alternative Names
Pelvic relaxation; Pelvic floor hernia
Causes, incidence, and risk factors
The uterus is normally supported by pelvic connective tissue and the pubococcygeus muscle, and held in position by special ligaments. Weakening of these tissues allows the uterus to descend into the vaginal canal. Tissue trauma sustained during childbirth, especially with large babies or difficult labor and delivery, is typically the cause of muscle weakness.
The loss of muscle tone and the relaxation of muscles, which are both associated with normal aging and a reduction in the female hormone estrogen, are also thought to play an important role in the development of uterine prolapse. Descent can also be caused by a pelvic tumor, however, this is fairly rare.
Uterine prolapse occurs most commonly in women who have had one or more vaginal births, and in Caucasian women.
Other conditions associated with an increased risk of developing problems with the supportive tissues of the uterus include obesity and chronic coughing or straining. Obesity places additional strain on the supportive muscles of the pelvis, as does excessive coughing caused by lung conditions such as chronic bronchitis and asthma. Chronic constipation and the pushing associated with it causes weakness in these muscles.
Symptoms
- Sensation of heaviness or pulling in the pelvis
- A feeling as if "sitting on a small ball"
- Low backache
- Protrusion from the vaginal opening (in moderate to severe cases)
- Difficult or painful sexual intercourse
Signs and tests
A pelvic examination (with the woman bearing down) reveals protrusion of the cervix into the lower part of the vagina (mild prolapse), past the vaginal introitus/opening (moderate prolapse), or protrusion of the entire uterus past the vaginal introitus/opening (severe prolapse).
These signs are often accompanied by protrusion of the bladder and front wall of the vagina (cystocele) or rectum and back wall of the vagina (rectocele) into the vaginal space. The ovaries and bladder may also be positioned lower in the pelvis than usual.
A mass may be noted on pelvic exam if a tumor is the cause of the prolapse (rare).
Treatment
Uterine prolapse can be treated with a vaginal pessary or surgery.
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