UTERINE PROLAPSE

General Information

DEFINITION--A uterus that has fallen or sunk from its normal location, causing it to bulge into the vagina. In its most pronounced form, it projects outside the vagina. Associated with prolapse may be urethrocele and cystocele (urethra and/or bladder bulge along the front wall of the vagina) and rectocele (rectal wall bulges into back wall of vagina).

BODY PARTS INVOLVED--Uterus; ligaments that suspend the uterus; vagina.

SEX OR AGE MOST AFFECTED--Women over age 40.

SIGNS & SYMPTOMS

• Lump in front or back of the vagina, or projecting outside it.
• Vague discomfort in the pelvic region.
• Backache that worsens with lifting.
• Discomfort with urinating.
• Occasional stress incontinence (urine leakage when laughing, sneezing or coughing).
• Difficulty in moving bowels.
• Pain with sexual intercourse.

CAUSES--Prolapse occurs when muscles and ligaments at the base of the abdomen become extremely stretched, usually as a result of childbirth or aging.

RISK INCREASES WITH

• Obesity.
• Repeated childbirth, although one pregnancy and vaginal delivery can weaken the area enough to lead to prolapse eventually.
• Advancing age.
• Conditions that cause increased intra-abdominal pressure such as tumors, chronic coughing, chronic constipation.
• Poor physical fitness.
• Occupations requiring heavy lifting.

HOW TO PREVENT

• Maintain appropriate weight.
• Practice pelvic exercises during pregnancy and after childbirth.
• Eat a normal, well-balanced diet.
• Engage in a regular exercise program to maintain good muscle strength.
• Avoid constipation.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Diagnostic tests may include Pap smear, urinalysis, pelvic ultrasound or CT, endometrial biopsy and intravenous pyelogram (See Glossary for all). Most of the tests are to rule out other disorders.

APPROPRIATE HEALTH CARE

• Treatment plan depends on severity of prolapse, age, sexual activity, associated pelvic disorders and desire for future pregnancy.
• Mild symptoms usually treated with exercise program and hormone therapy.
• Pessary (small ring-shaped device that is inserted into the vagina to help maintain the uterus in a normal position) may be prescribed.
• Surgery to remove the uterus (sometimes).

POSSIBLE COMPLICATIONS

• Ulceration of the cervix.
• Increased risk of infection or injury to pelvic organs.
• Urinary tract obstruction.

PROBABLE OUTCOME--Aggressive treatment is not always necessary because prolapse is not a health risk. Exercise can often improve muscle function. If the prolapse is severe, it can be cured with surgery.

How To Treat

GENERAL MEASURES----Follow your doctor's instructions. Compliance with your medical treatment plan is essential for the best outcome.

MEDICATION--Estrogen therapy can increase blood flow to vaginal tissues and increase supporting tissue strength.

ACTIVITY--No restrictions. If surgery is necessary, resume your normal activities gradually.

DIET--

• Lose weight if you are obese (see Weight-Loss Diet in Appendix).
• Eat a diet high in fiber to prevent constipation.

Call Your Doctor If

• You have symptoms of uterine prolapse.
• Symptoms don't improve in 3 months despite treatment or exercise, or symptoms become intolerable and you wish to consider surgery.
• If a pessary is fitted and the following occurs: unusual vaginal bleeding; discomfort; or urination difficulty.