UTERINE and VAGINAL VAULT PROLAPSE
Uterine prolapse occurs when the uterus slides down the vagina. It can be felt as the cervix sitting lower than it should in the vagina.
Many women develop mild prolapse (particularly after pregnancy) and are unaware that they have it, this is termed non-symptomatic and it may never bother you. Some women can have a mild prolapse and feel very symptomatic.
Prolapses (uterus, bladder, bowel) are generally given grades or stages based on how far the organ has moved down or into the vagina from its original position.
There are, however, different opinions as to whether we should use these terms as they are slightly arbitary and what is 'normal' has yet to be properly established. As mentioned, some women can have a prolapse and be unaware of it, others are very aware. For many, these differences in awareness can fluctuate throughout the day as well, depending on what you have been doing. A 'grade 2' prolapse may measure at grade 3 by the end of the day and back again after a rest.
It is often best to go by symptoms, learn what makes you symptomatic and develop strategies to help manage the symptoms. See below for some ideas on this.
Pictures used courtesy of Sue Croft Physiotherapist
The uterus in the first diagram is protruding from the vaginal entrance. For many women it will remain inside the vagina but sitting very low.
The second diagram shows the vaginal vault prolapsing. The vaginal vault is the top of the vagina that is left after a hysterectomy (removal of the uterus) and this can prolapse even though the uterus has been removed.
If you are trying to feel on yourself whether you have a prolapsed uterus insert a clean, lubricated finger into the vagina as if inserting a tampon and gently feel for your cervix. When you find it, it will feel firm, much like feeling the end of your nose.
What causes uterine prolapse?
It is commonly believed that prolapse is due to pelvic floor muscle weakness. Whilst this is a contributing factor, prolapse usually occurs due to a combination of factors, and some women are more prone to developing one than others. There will always be a degree of fascial/elastic and/or ligament tissue stretching involved with any prolapse.
- Fascial / elastic tissue damage - this can be torn or stretched.
- Pelvic floor muscle damage - weakened or torn (avulsed on one or both sides)
What are the risk factors for a uterine prolapse?
- vaginal birth
- instrumental birth - particularly forceps
- a third or fourth degree tear during childbirth
- long second stage (pushing ) of delivery >2 hours
- history of constipation
- repeated heavy lifting - if abdominal and thoracic pressures are not well controlled
- family history of prolapse or hernias - may indicate genetically poorer quality of connective tissue
- high impact exercise - if abdominal and thoracic pressures are not well controlled
- hypermobility (as per the Beighton scale) as your tissues are stretchier
You can develop prolapse even if you have never been pregnant or if you have had a caesarean birth - if other risk factors are present.
Or you may have a number of risk factors and never develop prolapse or become symptomatic.
Some estimates suggest that half of all women who have had more than one child have some degree of prolapse, although only 10-20% experience symptoms that lead them to seek help.
- bulging felt in vagina or near the entrance
- bulge seen at vaginal entrance or beyond
- heaviness in the vagina especially after exercising, lifting, doing a bowel motion or by the end of the day
- poor urine flow
- difficulty voiding (urinating)
- urinary urgency and / or freqency
- SUI (stress urinary incontinence) ....although a bladder prolapse can mask SUI as it can kink the urethra and prevent leaks
- constipation, straining to pass a bowel motion, difficulty wiping clean after a bowel motion, post defecation leaks
- painful penetrative sex
- low back pain
Treatment Options for Uterine Prolapse
1. Lifestyle changes aimed at reducing pressures on the pelvic organs, pelvic floor and supporting elastic tissues:
- strengthening the pelvic floor muscles
- losing weight
- avoiding /managing constipation. Learn how to empty your bowel with minimal strain.
- learning how to exercise correctly to avoid overloading the pelvic floor. This does not mean giving up exercise and many women can continue to run and lift weights quite happily with a prolapse.
2. Pessaries are another conservative option that your physiotherapist or doctor may suggest.
- these are silicone devices of varying shape and size which are inserted into the vagina to provide support for the uterus and other pelvic organs. They need to be properly fitted and you can be taught how to self-manage by inserting and removing when you need to use it.
3. Surgical repair may be suggested for cases which have not responded to conservative measures and if the prolapse remains bothersome.
- this can be discussed with your gynaecologist, make sure you have had all the possible consquences explained to you. Ask questions!
- hysterectomy (removal of the uterus) is a common surgical option, it can be done in many ways
- a sacrohysteropexy is an option that preserves the uterus
- always try conservative management first before considering surgery
Physiotherapists trained in pelvic floor conditions can help you with the first two. This is often enough to help you learn to manage your uterine prolapse.
Read more in my previous infographic blog The Story Of The Organs Part 2
The material presented here is intended as an information source only. The information is provided solely on the basis that readers will be responsible for making their own assessment of the matters presented herein and are advised to verify all relevant representations, statements and information. The information should not be considered complete and should not be used in place of the advice of a health care provider. Pelvic Floor Exercise does not accept liability to any person for the information or advice provided , or for loss or damages incurred as a result of reliance upon the material contained herein.
© Fiona Rogers, Pelvic Floor Exercise all rights reserved