About Uterine Prolapse

Uterine prolapse occurs when the uterus shifts downward into or outside of the vaginal canal due to weakened pelvic muscles and supportive tissues. It’s especially prevalent among women who’ve had children, with the risk increasing with age and multiple vaginal deliveries. Global data indicates that up to 50% of women who give birth vaginally may experience some form of pelvic organ prolapse, though not all cases cause symptoms.

Symptomatic prolapse is seen in 3–6% of the general female population and is more common in:

• Women above 50 years of age
• Those with multiple vaginal births
• Rural and underserved regions in South Asia, including India, where estimates range from 7% to 20%

What is Uterine Prolapse?

Uterine prolapse is a condition where the uterus descends into the vaginal canal due to weakness or injury in the pelvic floor. Most often affecting postmenopausal women, the condition can also result from childbirth-related trauma. The uterus may bulge partially or fully through the vaginal opening, depending on the severity.

Stages of Uterine Prolapse

• Stage I: Uterus remains mostly within the upper vaginal region
• Stage II: Uterus descends lower into the vaginal canal
• Stage III: Uterus partially protrudes outside the vaginal opening
• Stage IV: Entire uterus is outside the vaginal canal

Other associated prolapses include bladder (cystocele), rectum (rectocele), and intestines (enterocele).

Signs and Symptoms of Uterine Prolapse

In Early stages, signs may be subtle. As prolapse worsens, common symptoms include:

• Sensation of pressure in the pelvis
• Pain in the lower back, abdomen, or during intercourse
• Vaginal bulge or protruding tissue
• Constipation or difficult bowel movements
• Urinary leakage or frequent urination

Causes of Uterine Prolapse

 Uterine prolapse arises when pelvic support structures weaken. Contributing factors include:

• Childbirth trauma: Multiple or complicated vaginal deliveries
• Hormonal changes: Reduced estrogen after menopause weakens connective tissues
• Chronic pressure: Obesity, coughing, straining during bowel movements
• Pelvic surgery: Surgical disruption of supporting tissues

Risk Factors of Uterine Prolapse

Women are at greater risk of prolapse if they have:

• Delivered multiple children vaginally
• Reached postmenopausal age
• Obesity or chronic cough
• History of pelvic surgery
• Genetic disorders affecting connective tissue (e.g., Ehlers-Danlos syndrome)

Complications of Untreated Prolapse

• Tissue ulceration and bleeding from prolonged exposure of vaginal tissue
• Urinary dysfunction, including retention or frequent infections
• Bowel problems, like constipation or fecal leakage
• Emotional distress, body image issues, and pain during intimacy

Diagnosis of Uterine Prolapse

• Pelvic exam: Manual assessment for bulges or uterine descent
• Imaging: Ultrasound or MRI to assess the pelvic structure
• Pessary trial: Used to gauge severity and provide temporary relief

Uterine Prolapse Treatment Options

1. Non-Surgical Management

• Pessary use: A supportive silicone device placed in the vagina
• Lifestyle changes: Weight loss, pelvic exercises (Kegels), reduced straining
• Estrogen therapy: Vaginal estrogen creams to strengthen pelvic tissues 

Note: Always consult a doctor before starting medication.

2. Minimally Invasive Treatments

• 2D Laparoscopic Prolapse Repair: This method repairs pelvic organ prolapse through keyhole incisions using advanced laparoscopic instruments. It helps restore the natural position of organs like the uterus, bladder, or rectum, with less bleeding, scarring, and recovery time. Mesh or natural tissue may be used, depending on the case.
• Vaginal Hysterectomy : Uterine removal is done through the vaginal canal without external cuts. This is an effective method for treating severe prolapse and is often paired with pelvic floor repairs. It provides relief with minimal pain, faster healing, and a shorter hospital stay.

Prevention

• Strengthen the pelvic floor with daily Kegel exercises
• Treat chronic cough, obesity, or constipation early
• Avoid smoking and lifting heavy loads
• Seek early care for any symptoms of pelvic pressure