Uterine prolapse is a condition that occurs when the uterus descends or slips from its normal position into the vaginal canal or protrudes outside the body. It occurs when the ligaments, muscles, and tissues that support the uterus become weak or damaged, leading to the descent of the uterus from its normal position.It is a common condition that primarily affects women, especially those who have given birth or experienced significant changes in their pelvic floor muscles and supporting structures.

Uterine prolapse can be classified into several types based on the extent of the descent of the uterus and the structures involved. These types include:

• First-Degree Prolapse (Mild Prolapse): In this type, the cervix descends into the vaginal canal but remains within the vagina.
• Second-Degree Prolapse (Moderate Prolapse): The cervix descends further into the vaginal opening, protruding outside the body during activities like standing, coughing, or straining, but it returns to a higher position when lying down.
• Third-Degree Prolapse (Severe Prolapse): The cervix protrudes outside the vaginal opening and remains there, even when lying down. The uterus may be partially or completely outside the body, and other pelvic organs like the bladder or rectum may also prolapse.
• Complete Prolapse (Procidentia): In this severe form of uterine prolapse, the uterus protrudes completely outside the vaginal opening, often appearing as a bulge or mass. This condition can significantly impact a woman's daily activities and requires prompt medical attention.

The severity of uterine prolapse may change over time, and it can be influenced by factors such as hormonal changes, childbirth, age, obesity, and the strength of the pelvic floor muscles and connective tissues. Understanding the specific type and degree of uterine prolapse is crucial for determining the most appropriate treatment approach and management strategies

Symptoms of Uterine Prolapse 

Uterine prolapse can manifest with various symptoms, which may vary depending on the severity of the condition. Common symptoms of uterine prolapse include:

• Sensation of Pelvic Pressure or Heaviness: Women with uterine prolapse often experience a feeling of pressure or heaviness in the pelvic area. This sensation may worsen when standing for long periods, lifting heavy objects, or engaging in physical activities.
• Vaginal Discomfort or Pain: Some women with uterine prolapse may experience discomfort or pain in the vagina, which can range from a dull ache to a more pronounced pain. This discomfort may be exacerbated during sexual intercourse.
• Vaginal Bulging or Protrusion: In more advanced cases of uterine prolapse, the uterus may descend into the vaginal canal or even protrude outside the body. This can create a visible bulge or lump that can be felt or seen by the woman or her healthcare provider.
• Urinary Symptoms: Uterine prolapse can affect bladder function and lead to various urinary symptoms, including increased frequency of urination, urgency (sudden strong urge to urinate), incomplete emptying of the bladder, and stress urinary incontinence (leakage of urine during coughing, sneezing, or physical exertion).
• Bowel Symptoms: Some women with uterine prolapse may experience bowel-related symptoms, such as difficulty emptying the bowels completely (incomplete evacuation), constipation, or a sensation of rectal fullness.
• Backache or Lower Back Pain: Uterine prolapse can cause discomfort in the lower back or a persistent dull ache in the pelvic region, which may radiate to the lower back.
• Problems with Sexual Function: Uterine prolapse can interfere with sexual intercourse, leading to discomfort or pain during penetration. The visible bulge or vaginal discomfort associated with prolapse can also contribute to a decreased sexual desire or satisfaction.

Not all women with uterine prolapse will experience the same set of symptoms. The severity and combination of symptoms can vary, and some women may be asymptomatic, especially in cases of mild prolapse. 

Causes of Uterine Prolapse

Uterine prolapse can occur due to various factors that weaken or damage the pelvic floor muscles and supportive structures. The main causes of uterine prolapse include:

• Pregnancy and Childbirth: The process of pregnancy and childbirth puts significant strain on the pelvic floor muscles and tissues that support the uterus. Vaginal delivery, especially if it is prolonged or involves complications such as a large baby or the use of forceps, increases the risk of uterine prolapse. Multiple pregnancies and deliveries further contribute to the weakening of the pelvic floor.
• Weakening of Pelvic Floor Muscles: The pelvic floor muscles play a crucial role in supporting the uterus and other pelvic organs. Factors that can weaken these muscles over time include aging, hormonal changes (such as a decrease in estrogen levels during menopause), and a sedentary lifestyle that leads to muscle deconditioning. Chronic coughing, obesity, and repeated heavy lifting can also strain the pelvic floor muscles.
• Connective Tissue Disorders: Certain connective tissue disorders, such as Ehlers-Danlos syndrome and Marfan syndrome, can affect the strength and integrity of the pelvic floor tissues, making them more prone to prolapse.
• Genetic Predisposition: There may be a genetic component to uterine prolapse, as some women have a higher inherent risk due to inherited characteristics of the pelvic anatomy or connective tissue structure.
• Chronic Conditions and Lifestyle Factors: Chronic conditions that cause chronic coughing, such as chronic obstructive pulmonary disease (COPD), can contribute to the development of uterine prolapse. Additionally, factors such as obesity, smoking, and ongoing heavy lifting can strain the pelvic floor and increase the risk of prolapse.
• Hormonal Imbalances: Fluctuations or imbalances in hormone levels, particularly estrogen, can affect the strength and elasticity of the pelvic floor tissues. Estrogen helps maintain the integrity of connective tissues and muscles in the pelvic region. Therefore, a decrease in estrogen, such as during menopause, can contribute to the development of uterine prolapse.

Uterine prolapse is a multifactorial condition, and often multiple factors contribute to its development. The weakening of the pelvic floor muscles and supporting structures over time, combined with the presence of one or more risk factors, increases the likelihood of uterine prolapse. Understanding the underlying causes can help in prevention strategies and appropriate management of the condition.

If you suspect you may be experiencing symptoms of uterine prolapse or have concerns about your pelvic health, it's important to seek medical advice. A healthcare professional can provide a proper diagnosis, evaluate the severity of the prolapse, and discuss appropriate treatment options. Remember, early detection and intervention can greatly improve outcomes and quality of life. Contact MASSH to schedule an appointment and receive personalized care and guidance for your pelvic health needs. Don't hesitate to take the first step towards better pelvic health and overall well-being.