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Alternative namesPelvic relaxation; Pelvic floor hernia
DefinitionFalling or sliding of the uterus from its normal position in the pelvic cavity into the vaginal canal.
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.
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).
TreatmentA vaginal pessary (an object inserted into the vagina to hold the uterus in place) may be used as a temporary or permanent form of treatment. Vaginal pessaries come in many shapes and sizes, and they must be fitted for each woman individually.
Vaginal pessaries are effective for many women with uterine prolapse, however, depending on the extent of the prolapse and vaginal wall relaxation, pessaries may be of little or no use. In addition to the limits of their use in treatment there are other drawbacks.
Pessaries may cause an irritating and abnormal smelling discharge, and they require periodic cleaning, usually done by the physician. In some women they rub on and irritate the vaginal mucosa , and in some cases may erode and cause ulcerations. Some types of pessaries may interfere with normal sexual intercourse by limiting the depth of penetration.
There are some surgical procedures that can be done without removing the uterus, such as a sacral colpopexy. This procedure involves the use of surgical mesh for supporting the uterus.
When indicated, a vaginal hysterectomy is performed. Any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time.
With proper precautions (periodic check-ups and cleaning) vaginal pessaries can be effective for many women with uterine prolapse. Surgery, if done, usually provides excellent results, however, some women may require treatment again in the future for recurrent prolapse of the vaginal walls.
Urinary tract infections and other urinary symptoms may occur due to the frequently associated cystocele . Constipation and hemorrhoids may also occur as a result of the associated rectocele. Ulceration and infection may occur in more severe cases of prolapse.
Calling your health care providerCall for an appointment with your health care provider if symptoms of uterine prolapse occur.
Prenatal and postpartum Kegel exercises (tightening of the pelvic floor musculature as if trying to interrupt urine flow) helps to strengthen the muscles and reduces the risk.
The affect of episiotomy and other obstetric interventions on the later development of uterine prolapse is unclear. Estrogen replacement therapy in postmenopausal women tends to help maintain muscle tone.
Update Date: 5/9/2002Catherine S. Bradley, M.D., Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network (6/16/2001).
Last updated: Tue, 06 Jan 2009 00:20:03 GMT