Uterine Prolapse
Uterine prolapse occurs when the ligaments and muscles that support the pelvic organs become weakened — a treatable condition with effective therapeutic options.
Symptoms of uterine prolapse — when to be concerned
Symptoms depend on the degree and type of prolapse. Many women avoid mentioning them, yet treatment is often straightforward and effective.
- A sensation of heaviness, pressure or "something coming down" in the pelvis or vagina.
- A palpable bulge in the vaginal area, especially after prolonged standing.
- Urinary difficulty: Sensation of incomplete bladder emptying, urinary incontinence or leakage with coughing/sneezing.
- Bowel difficulty: Sensation of obstruction, need for manual splinting.
- Pain or discomfort during sexual intercourse (dyspareunia).
- Low back or pelvic pain that worsens toward the end of the day.
- Recurrent urinary tract infections with no other identifiable cause.
Causes and risk factors of prolapse
Prolapse is not an inevitable consequence of aging — there are clear risk factors that, when known, can be addressed early.
- Vaginal childbirth, especially with large birth weight infants or prolonged second stage of labor.
- Menopause: Estrogen decline weakens connective tissue and the pelvic floor.
- Chronic constipation and prolonged straining during bowel movements.
- Obesity: Increased pressure on pelvic organs.
- Chronic cough (smoking, asthma): Repeated increases in intra-abdominal pressure.
- Heavy physical work or lifting.
- Genetic predisposition: Connective tissue laxity that runs in families.
Types of pelvic organ prolapse
Multiple types of prolapse often occur simultaneously. Accurate assessment determines the treatment plan.
- Uterine prolapse: Descent of the uterus toward or out of the vagina — the most common type.
- Cystocele (bladder prolapse): Descent of the anterior vaginal wall and bladder — causes urinary symptoms.
- Rectocele (rectal prolapse): Descent of the posterior vaginal wall — causes bowel difficulty.
- Vaginal vault prolapse: After hysterectomy, the vaginal apex may descend.
- Enterocele: Prolapse of the upper vagina with displacement of small intestine.
How prolapse is diagnosed
Diagnosis is based primarily on clinical examination. Additional tests are used to evaluate function and plan treatment.
- Clinical gynecologic examination: Assessment of prolapse grade at rest and with Valsalva — POP-Q staging.
- Urodynamic testing: Evaluation of bladder function, storage and voiding pressures — before surgery.
- Pelvic floor ultrasound: Assessment of anatomy, identification of levator ani avulsion.
- Pelvic MRI: Detailed mapping before complex surgeries.
Tests for assessment of functional impairment
Beyond anatomy, the impact on urination, bowel function and sexual function is assessed.
- Urine culture: Exclusion of urinary tract infection that may worsen symptoms.
- Quality of life questionnaires (PFDI, PFIQ): Objective recording of symptoms and their impact.
- Post-void residual (PVR): Measurement of urine remaining in the bladder after voiding.
Surgical repair of prolapse
Surgery is recommended when symptoms significantly affect quality of life and conservative treatment is insufficient. The goal is durable repair with preservation of function.
- Robotic/laparoscopic sacrocolpopexy: Gold standard for vaginal vault and uterine prolapse — suspension with permanent mesh, excellent long-term results.
- Colporrhaphy (anterior/posterior): Repair of the vaginal wall for cystocele and rectocele.
- Sacrospinous colpopexy: Laparoscopic or vaginal suspension of the vaginal vault to the sacrospinous ligament.
- Concurrent incontinence treatment: If stress urinary incontinence coexists, a suburethral sling (TVT/TOT) may be placed simultaneously.
Treatment of prolapse — conservative options
Not all women need surgery. Conservative management is effective for mild to moderate prolapse and is always the first line of treatment.
- Pelvic floor exercises (Kegel): Strengthening of pelvic floor muscles — effective when performed correctly and consistently.
- Pelvic floor physiotherapy: Specialized guidance for correct technique and biofeedback.
- Vaginal pessary: A silicone device placed in the vagina to support the organs — ideal for women who do not wish surgery or for whom surgery is not safe.
- Topical estrogen: Improves tone and elasticity of the vaginal wall in menopause.
Prevention and follow-up after treatment
Even after successful surgery, recurrence is possible if risk factors are not addressed.
- Maintaining a healthy weight — reduces chronic pressure on the pelvic floor.
- Management of chronic constipation through diet and hydration.
- Avoidance of heavy lifting and exercises with high intra-abdominal pressure.
- Long-term continuation of Kegel exercises.
- Regular gynecologic check-up for monitoring after surgery.
Symptoms
Symptoms depend on the degree and type of prolapse. Many women avoid mentioning them, yet treatment is often straightforward and effective.
- A sensation of heaviness, pressure or "something coming down" in the pelvis or vagina.
- A palpable bulge in the vaginal area, especially after prolonged standing.
- Urinary difficulty: Sensation of incomplete bladder emptying, urinary incontinence or leakage with coughing/sneezing.
- Bowel difficulty: Sensation of obstruction, need for manual splinting.
- Pain or discomfort during sexual intercourse (dyspareunia).
- Low back or pelvic pain that worsens toward the end of the day.
- Recurrent urinary tract infections with no other identifiable cause.
Prolapse is not an inevitable consequence of aging — there are clear risk factors that, when known, can be addressed early.
- Vaginal childbirth, especially with large birth weight infants or prolonged second stage of labor.
- Menopause: Estrogen decline weakens connective tissue and the pelvic floor.
- Chronic constipation and prolonged straining during bowel movements.
- Obesity: Increased pressure on pelvic organs.
- Chronic cough (smoking, asthma): Repeated increases in intra-abdominal pressure.
- Heavy physical work or lifting.
- Genetic predisposition: Connective tissue laxity that runs in families.
Multiple types of prolapse often occur simultaneously. Accurate assessment determines the treatment plan.
- Uterine prolapse: Descent of the uterus toward or out of the vagina — the most common type.
- Cystocele (bladder prolapse): Descent of the anterior vaginal wall and bladder — causes urinary symptoms.
- Rectocele (rectal prolapse): Descent of the posterior vaginal wall — causes bowel difficulty.
- Vaginal vault prolapse: After hysterectomy, the vaginal apex may descend.
- Enterocele: Prolapse of the upper vagina with displacement of small intestine.
This information is for educational purposes and does not replace medical advice. For diagnosis and personalized treatment, book an appointment.
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