About Uterine Prolapse

Uterine prolapse is a common pelvic floor disorder, especially in women who have given birth. It occurs when the uterus descends into or outside the vaginal canal due to weakened pelvic muscles and ligaments.

Global estimates suggest that uterine prolapse affects up to 50% of women who have given birth vaginally to some degree, though not all are symptomatic.

Clinically significant prolapse (symptomatic and visible) occurs in about 3–6% of women in the general population.

Prevalence increases with:

• Age – most common in postmenopausal women, particularly those over 50 years.
• Parity – higher in women who have had multiple vaginal deliveries.
• Geographic variation – more common in developing countries, partly due to limited access to obstetric care and heavy physical labor.

In India and South Asia, community-based studies estimate a prevalence of 7–20%, with higher rates in rural populations due to lack of postpartum care and occupational strain.

What is Uterine Prolapse?

Uterine prolapse is a common condition as women age. When the muscles and tissues in the pelvis become weak after menopause or damaged due to multiple vaginal childbirths, the uterus can sag into the vagina. The severity of the condition depends on how weakened the supporting muscles and ligaments around the uterus are.

Stages of uterine prolapse

• Stage I: The uterus is in the upper part of the vagina.
• Stage II: The uterus descends to the lower part of the vagina. 
• Stage III: The uterus protrudes out of the vagina.
• Stage IV: The whole uterus is outside of the vagina.

It is possible for other organs in the pelvis to stretch out and prolapse, causing cystocele (prolapsed bladder), enterocele (prolapsed small intestine), and rectocele (bulging rectum).

Signs and symptoms of uterine prolapse

In mild cases, the symptoms may not be obvious. Once the condition progresses, you can develop the following symptoms:

• Pressure in the pelvis.
• Pelvic, abdominal, and lower back pain. 
• Painful intercourse.
• Uterine tissue drops out of the vaginal opening.
• Constipation.
• Urinary incontinence and urinary frequency.

Causes of Uterine Prolapse

Uterine prolapse occurs when the pelvic floor muscles and ligaments that hold the uterus in place become stretched, weakened, or damaged. This leads to the descent of the uterus into the vaginal canal. The main causes include:

• Childbirth Trauma : Vaginal deliveries, especially if multiple, prolonged, or complicated (e.g., with forceps), can damage or overstretch the pelvic floor muscles and supporting ligaments.
• Menopause and Estrogen Deficiency : After menopause, lower estrogen levels lead to decreased elasticity and weakening of pelvic tissues, which are essential for uterine support.
• Chronic Increase in Abdominal Pressure : Ongoing pressure from conditions like chronic coughing (due to smoking or lung disease), constipation, obesity, or heavy lifting weakens the pelvic support structures over time.
• Pelvic Surgery : Surgical procedures involving the uterus or surrounding organs, such as hysterectomy, can disturb the pelvic floor's natural support system.

Uterine Prolapse Risk Factors 

Certain factors increase a person's likelihood of developing uterine prolapse, particularly when combined with the above causes:

• Multiple Vaginal Deliveries :  Each delivery can incrementally weaken the pelvic muscles, especially with large babies or prolonged labor.
• Postmenopausal Age : Aging and estrogen decline together make tissues more prone to laxity and prolapse.
• Obesity : Excess body weight consistently raises intra-abdominal pressure, burdening the pelvic floor.
• Chronic Respiratory Conditions : Long-term coughing from asthma, bronchitis, or smoking puts repetitive stress on the pelvis.
• Genetic Connective Tissue Disorders : Conditions like Ehlers-Danlos or Marfan syndrome cause inherently weaker connective tissues, increasing prolapse risk at an earlier age.
• Previous Pelvic or Uterine Surgeries : Any surgical intervention in the pelvic area can compromise natural support systems.

Complications of Uterine Prolapse

If left untreated, especially in more advanced stages (like Stage III or IV), uterine prolapse can lead to a range of complications that affect both physical and emotional well-being:

1. Ulceration and Vaginal Bleeding : In severe prolapse (Stage IV), the uterus or vaginal walls may protrude outside the body, leading to constant friction against clothing or surfaces. This can cause ulceration, irritation, and even bleeding of the exposed tissues, increasing the risk of infection.

2. Urinary Problems : Prolapse can distort the normal position of the bladder and urethra, resulting in urinary obstruction, difficulty emptying the bladder completely, urinary retention, or recurrent urinary tract infections (UTIs). Some women may also experience stress urinary incontinence, especially during activities like coughing, sneezing, or lifting.

3. Bowel Issues : In some cases, the prolapse may affect the rectum or bowel, leading to bowel obstruction, constipation, or fecal incontinence. Straining during bowel movements may further worsen the prolapse or contribute to discomfort.

4. Emotional and Sexual Distress : Chronic pelvic discomfort, pain, and embarrassment from visible prolapse can cause significant emotional distress. Many women experience low self-esteem, anxiety, or depression, especially if the condition affects sexual function, causes pain during intercourse (dyspareunia), or limits daily activities.

Diagnosis of Uterine Prolapse

• Pelvic exam: to check the position of your uterus. The doctor will place a speculum to see inside your vagina. Your doctor will feel any bulges in your vaginal canal. You may be asked to cough or strain like you are holding your urine to evaluate the degree of your pelvic muscles weakness.
• Imaging: MRI or ultrasound to evaluate pelvic structures.
• Pessary test: Temporary insertion of a device to confirm prolapse impact

Uterine Prolapse Treatment

1. Non-Surgical Options

• Pessary: A silicone device inserted to support the uterus.
• Lifestyle changes: Weight loss, Kegel exercises, and avoiding heavy lifting.
• Hormone therapy: Vaginal estrogen to strengthen tissues.

Note: Medications are only advisable under doctor's consideration.

2. Minimal Invasive Options

• Laparoscopic Repair of Pelvic Prolapse : Also known as pelvic floor reconstruction, this advanced, minimally invasive procedure uses 2D laparoscopic technology to repair and restore support to prolapsed pelvic organs, such as the uterus, bladder (cystocele), or rectum (rectocele). The enhanced 2D view allows for precise dissection and suturing, helping to lift and secure pelvic structures using native tissues or mesh, depending on the case. Benefits include smaller incisions, less blood loss, quicker recovery, and better cosmetic results. It is ideal for women seeking durable repair with minimal downtime, especially those experiencing symptoms like vaginal bulge, urinary incontinence, or pressure.
• Vaginal Hysterectomy : A vaginal hysterectomy involves the removal of the uterus through the vagina, without external incisions. It is commonly performed for uterine prolapse, fibroids, or abnormal bleeding. This approach offers several advantages, such as faster healing, shorter hospital stay, and reduced postoperative pain compared to abdominal hysterectomy. When combined with pelvic floor repair procedures, it provides a comprehensive solution for prolapse while minimizing surgical trauma.

Prevention

• Kegel exercises: Strengthen pelvic floor muscles.
• Manage chronic conditions: Address obesity, coughing, or constipation.
• Avoid smoking and heavy straining.

Early intervention improves outcomes and quality of life