Uterine Prolapse

Diagnosis

Uterine prolapse is often diagnosed during a pelvic exam. During the exam, your healthcare provider may ask you to:

• Bear down as if having a bowel movement to assess how far the uterus has slipped into the vagina.

• Tighten your pelvic muscles as if stopping a stream of urine to check pelvic muscle strength.

• Complete a questionnaire to help assess how prolapse affects daily life and guide treatment decisions.

If severe urinary incontinence is present, urodynamic testing may be performed to evaluate how well the bladder functions.

Treatment

Treatment for uterine prolapse depends on symptom severity, personal preference, and overall health.

• Watchful waiting: If prolapse is mild and not bothersome, treatment may not be necessary.

• Self-care measures:

  • Perform Kegel exercises to strengthen pelvic muscles.

  • Maintain a healthy weight.

  • Manage constipation to reduce pressure on the pelvic floor.

• Pessary: A silicone device inserted into the vagina to support bulging tissues. Must be removed regularly for cleaning.

Surgery

Surgery may be recommended if symptoms are bothersome or prolapse is severe. Options include:

• Hysterectomy: Removal of the uterus for uterine prolapse.

• Uterus-sparing procedures: Surgeries that repair prolapse while keeping the uterus, suitable for those planning future pregnancies.

If prolapse involves other pelvic organs, surgery may also include:

• Reinforcing weak pelvic floor structures with stitches.

• Colpocleisis: Closing the vaginal opening for recovery, only for those who no longer wish to use the vagina for sexual activity.

• Placing synthetic mesh to support vaginal tissues.

Risks of Surgery

Surgical treatment for uterine prolapse carries potential risks, including:

• Heavy bleeding

• Blood clots in the legs or lungs

• Infection

• Adverse reaction to anesthesia

• Injury to nearby organs such as bladder, ureters, or bowel

• Recurrence of prolapse

• Urinary incontinence

It is important to discuss all treatment options with your healthcare provider to understand the benefits and potential risks of each approach.