Normally the uterus is held up in the pelvis by various muscles and ligaments. However, following pregnancy, normal labour, difficult child birth or surgery, these muscles may weaken. Moreover, as women age, with the decrease in oestrogen levels in the body, these muscles sag and as a result, the uterus descends into the vagina to varying degrees. This is called uterine prolapse.
There are 4 stages of uterine prolapse:
- First degree: the cervix drops into the vagina
- Second degree: the cervix descends into the vagina up to the vaginal opening
- Third degree: the cervix descends and comes out of the vagina
- Fourth degree: the entire uterus comes out of the vaginal opening. This is called procidentia and is the most complicated stage of uterine prolapse. It occurs when all supporting muscles of the uterus fail.
While mild uterine prolapse may not present with any symptoms, in moderate or severe uterine prolapse, patient may experience vaginal discharge, vaginal bleeding, difficulty in having intercourse, feeling of constipation, a heaviness or pulling sensation in the pelvis, low back pain, a mass protruding out of the vagina or urinary incontinence. As the degree of prolapse worsens, symptoms become more and more prominent.
Treatment of uterine prolapse also depends on the degree of prolapse. Home treatments for minor prolapse include kegel’s exercises to strengthen pelvic floor muscles to reduce the incidence or further worsening of prolapse. Application of estrogen creams and rings can be attempted though these are not very successful.
Insertion of a vaginal pessary to reduce the progress of prolapse can be a temporary solution although its success depends on the degree of prolapse. It may also irritate the vagina and produce a foul smelling discharge.
The mainstay of treatment for chronic uterine prolapse is surgery. Surgery can be performed either to repair the uterus or to remove it if the patient is in the reproductive age group and wishes t have more children, reparative surgery can be performed and the supporting muscles and ligaments strengthened to prevent recurrence of prolapse. Hysterectomy can be performed in older patients.