Uterine Prolapse - what every woman needs to know and what can be done about it.

What is uterine prolapse?

The uterus, a life-giving organ of your reproductive system, that looks like an inverted pear and is located between your bladder and your rectum. It nourishes and houses the fertilized egg until your unborn child is ready to appear and make themselves one loud bundle of messiness and joy.

The uterus is held in position above the inside end of the vagina by a layer of supporting muscles and ligaments. Weakening of these supportive structures in the pelvis through wear and tear can allow the bottom of the uterus, to sag through the muscle and ligament layers. When the uterus sags downward, it is called uterine prolapse. It can create a bulge into the vagina and in severe cases, it is possible for the sagging uterus to work its way down far enough that the bulge can appear at the vagina's opening or even protrude from the opening.

Degrees of uterine prolapse³?

Uterine prolapse is described in stages, indicating how far it has descended.
Other pelvic organs (such as the bladder or bowel) may also be prolapsed into the vagina.

The four categories of uterine prolapse are:
Stage I – the uterus is in the upper half of the vagina
Stage II – the uterus has descended nearly to the opening of the vagina
Stage III – the uterus protrudes out of the vagina
Stage IV – the uterus is completely out of the vagina.

What are the uterine prolapse symptoms?

How do you know you have a uterine prolapse?

• Discomfort in the vagina, pelvis, lower abdomen, groin or lower back. The discomfort associated with prolapse often is described as a pulling or aching sensation or pressure in the vaginal area. It can be worse during sexual intercourse or menstruation. Some women experience a sensation as though something is about to fall out of their vagina.
• A bulge of moist pink tissue from the vagina. This exposed tissue may be irritated and cause itching or small sores that can bleed.
• Leakage of urine, which can be worse with heavy lifting, coughing, laughing or sneezing
• Frequent urination or a frequent urge to urinate
• Frequent urinary tract infections because the bladder cannot empty completely when urinating
• A need to push your fingers into your vagina, into your rectum, or against the skin near your vagina to empty your bladder or have a bowel movement
• Difficulty having a bowel movement
• Pain with sexual intercourse, urine leakage during sex, or an inability to have an orgasm
• Moist discharge that soils your undergarments

What are the risk factors and causes of uterine prolapse?

Some doctors estimate that half of all women have some degree of uterine or bladder prolapse in the years following childbirth. For most women, these conditions remain undiagnosed and untreated. Only 10% to 20% of women with pelvic prolapse seek medical evaluation for symptoms¹. It is absolutely critical to diagnose the type of pelvic prolapse you have. Many pelvic health physiotherapists specialist will say “you are always postnatal” and as uterine prolapse is often associated with prolapse of other pelvic organs, begin looking after your pelvic floor sooner rather than later.  In fact, you can do this, before, during and after pregnancy. Your pelvic floor will thank you. The condition is treatable with many different solutions which we will cover:

Different strains and traumas can cause the pelvic muscles and ligaments to weaken and lead to uterine or bladder prolapse. The most significant stress on the pelvic floor muscles and ligaments is childbirth. Women who have had multiple pregnancies and vaginal delivery are more likely to develop prolapse as are those who give birth to larger babies, have a difficult labour / delivery or trauma during childbirth.

Other risk factors and stresses that can lead to uterine prolapse include:

• Chronic constipation with a habit of frequent straining to pass stool
• Chronic cough from conditions like bronchitis
• Obesity can also place strain the pelvic muscles.
• Pelvic tissues rely on estrogen to help them keep their elasticity and estrogen levels drop after onset of menopause.
• Family history of weakness in connective tissue can also play a role
• Repeated heavy lifting

How to get uterus prolapse diagnosed?

An experienced physician usually can diagnose uterine or bladder prolapse with a pelvic examination. Occasionally, an MRI may be needed to confirm the diagnosis.

Uterus prolapse treatments

Mild to moderate uterine prolapse is unlikely to cause significant medical consequences and may not require treatment. Advanced, severe or complete prolapse usually requires pessary support or surgical treatment to minimize problems with urinary incontinence, urinary retention, vaginal ulceration, sexual dysfunction or difficulties with having a bowel movement. Once prolapse has progressed to a more advanced stage, it will continue and worsen without surgical treatment or pessary support.

For mild cases, strengthening pelvic floor muscles may be enough to minimise uterine prolapse symptoms. Kegel exercises are an excellent way to increase your pelvic strength. To perform Kegel exercises, squeeze the muscles you would use to prevent yourself from passing urine or gas. Hold the contraction for a few seconds, then release. Make sure to completely relax your pelvic floor muscles after the contraction. Repeat 10 times. Try to do four to five sets a day. You can do these exercises anytime, anywhere and no one will even know you are doing them.

Compression garments such as SRC Restore Incontinence and Prolapse Underwear for Women with their patented Anatomical Support Panels, specifically the gusset panel, provide continuous even compression to the entire perineal area² and have evidence⁴ that has shown a reduction in symptoms of mild uterine prolapse while wearing the SRC Restore compression garment.

Your gynaecologist or pelvic health physical therapist can recommend a pelvic floor training tool that can strengthen your pelvic floor muscles to reverse or relieve some symptoms related to a prolapsed bladder. The sensor in the tool can monitor the muscular contractions in the vagina and on the pelvic floor during the exercises, and your health care professional may be able to determine if your pelvic floor will benefit from the exercises.

A physician can fit a pessary, which is a rubbery, ring-shaped device, into the upper portion of your vagina. Pessaries can help to ‘hold up’ the uterus and bladder and prevent them from sagging into your vagina. They are removable so they can be washed periodically.

A uterus prolapse may need to be corrected with surgery, which can be done through the vagina, an incision in the abdomen, or by laparoscopy. The procedure selected will depend on your age, severity of the symptoms, medical history, desire to have more children. The objectives are to restore normal anatomical function, relieve symptoms, restore normal bowel and bladder movement and restore the ability to have sex. In some cases, surgical removal of the uterus or a hysterectomy maybe recommended.

Are there ways you can prevent uterine prolapse?

Sometimes you can reverse a mild case of prolapse by doing exercises that strengthen your pelvic muscles. In other cases, the degree and severity of the prolapse can increase over time as the woman ages and this can occur more rapidly in some women than in others. Advanced or severe cases of prolapse usually do not respond to exercise or hormonal therapy. Surgery often improves or cures pelvic organ prolapse.

To reduce your risk of uterine prolapse, you can:

• Perform Kegel exercises regularly. These exercises can strengthen your pelvic floor muscles — especially important after you have a baby but as previously mentioned it’s never to early to begin looking after
• Treat and prevent constipation. Drink plenty of fluids and eat high- fibre foods, such as fruits, vegetables, beans and whole-grain cereals.
• Avoid heavy lifting and lift correctly. When lifting, use your legs instead of your waist or back. When starting any new exercise routine consult a physiotherapist or exercise physiologist.
• Minimize coughing. Get treatment if you have a chronic cough or bronchitis, and don't smoke.
• Avoid weight gain. Talk with your doctor to determine your ideal weight and get advice on weight-loss strategies, if you need them.

REFERENCES:

1. https://www.health.harvard.edu/a_to_z/uterine-and-bladder-prolapse-a-to-z
2. SRC Recovery Shorts, Research Laboratory analysis of functional effect Antonio I Cuesta-Vargas, Cátedra de Fisioterapia, Universidad de Málaga, Andalucía, Spain June 2017
3. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/bladder-prolapse 
4. https://cdn.shopify.com/s/files/1/0331/1681/5497/files/The_Effect_of_a_New_Compression_Garment_on_Comfort_and_Prolapse_in_Women_63b656f3-301d-476b-b049-2053a27b9d5c.pdf?v=1606196795