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Uterine Prolapse

Pelvic organ prolapse is a medical condition that occurs when the normal support of the vagina is lost, dropping the bladder, urethra, cervix and rectum. As the prolapse of the vagina and uterus progresses, women can feel bulging tissue protruding through the opening of the vagina.

Loss of pelvic support can occur when any part of the pelvic floor is injured during vaginal delivery, surgery, pelvic radiation or back and pelvic fractures during falls or motor vehicle accidents. Hysterectomy and other can be associated with future development of prolapse. Other conditions that promote prolapse include constipation and chronic straining, smoking, chronic coughing, heavy lifting and obesity.

There are different types of prolapse, depending on the organ affected:

  • Anterior Vaginal Prolapse – also known as cystocele, this type of prolapse occurs when the wall between the vagina and the bladder stretches or detaches from the pelvic bones.
  • Posterior Vaginal Prolapse – also known as rectocele, it is the weakening and stretching of the back wall of the vagina, allowing the rectum to bulge into and out of the vagina. This is often due to a damaged back wall of the vagina from vaginal childbirth, although not everyone who has delivered a child vaginally will develop a rectocele.
  • Uterine Prolapse – supporting ligaments and muscles of the pelvic floor are damaged, causing the cervix and uterus to descend into and eventually out of the vagina. Often, uterine prolapse is associated with loss of vaginal wall support (cystocele, rectocele). When the cervix protrudes outside the vagina, it can develop ulcers from rubbing on underwear or protective pads.
  • Vaginal Prolapse after Hysterectomy – if a woman has had a hysterectomy, the very top of the vagina, where the uterus used to be, can become detached from its supporting ligaments, resulting in the tube of the vagina turning inside out. The condition is also known as vaginal “vault” prolapse. One or several pelvic organs (such as the bladder, small and large bowel) may prolapse into the protruding bulge.
  • Rectal Prolapse – known as the rectum, the last 6 inches of the colon can come loose from the rectal wall, resulting in the rectum prolapsing through the anus. It looks like red, often donut shaped, soft tissue coming through the anus. In early stages, it can be confused with a large hemorrhoid.

Symptoms

  • None – in early stages, pelvic organ prolapse has few noticeable symptoms.
  • Inability to keep a tampon inside the vagina
  • Dampness in underwear
  • Discomfort during sexual intercourse, usually due to dryness
  • Pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements
  • Feeling like you are “sitting on a ball”
  • Pushing stool out of the rectum by placing your fingers into the vagina during a bowel movement
  • Difficulty urinating or a weak or spraying stream of urine
  • Urine leakage with sexual intercourse
  • Frequent urge to urinate or the sensation that your bladder is not emptying
  • Lifting up the bulging vagina or uterus to start urination

Treatment

Pessary devices can cause some relief. Pelvic floor reconstruction is the surgery usually necessary to correct the prolapse and relieve symptoms.

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