Uterine Prolapse: Symptoms, Types, Causes and Treatment

Uterine prolapse is a condition that can dramatically affect a woman's quality of life, yet many people remain unaware of its true impact, underlying causes, and diverse treatment options. This article delves into the essential aspects of uterine prolapse—its symptoms, types, causes, and the latest evidence-based treatments—guided by the latest research and clinical experience.

Symptoms of Uterine Prolapse

Uterine prolapse can present with a range of symptoms, from mild discomfort to significant interference with daily activities. Recognizing these symptoms early can empower women to seek timely care, reducing complications and improving outcomes.

Symptom	Description	Frequency/Severity	Source(s)
Vaginal Lump	Feeling of a lump or bulge in the vagina	Most common, especially in advanced degrees	1 4 5
Pelvic Pressure	Heaviness or dragging sensation in the pelvis	Common, worsens by end of day or after standing	1 4 5
Urinary Issues	Incontinence, frequency, urgency, poor stream	Variable; can complicate daily life	5 7
Bowel Symptoms	Constipation, incomplete emptying	Less common, but may occur	5
Sexual Dysfunction	Pain or discomfort during intercourse	Can occur, especially in advanced cases	2 4
Back Pain	Low back discomfort	Occasional, often with other symptoms	4 5

Table 1: Key Symptoms

Understanding the Symptoms

Uterine prolapse symptoms can range from subtle to severe. The most frequent complaint is the sensation of a lump or bulge in the vagina, noticed particularly during activities that increase abdominal pressure, such as lifting or prolonged standing 1 4 5.

Vaginal and Pelvic Sensations

• Vaginal Lump/Bulge: Women may describe the feeling of "something coming down" or even visualize tissue protruding from the vagina, especially in more advanced stages 1 4.
• Pelvic Pressure: A persistent sense of heaviness or dragging, often described as a weight in the pelvis, is common and may worsen as the day progresses 1 4.

Urinary and Bowel Changes

• Urinary Issues: Trouble urinating (such as difficulty starting, weak stream, or incontinence) can be distressing. Some women may experience frequent urinary tract infections or acute retention 5 7.
• Bowel Symptoms: Although less common, constipation and a sensation of incomplete bowel emptying can develop due to pressure on the rectum 5.

Sexual and General Well-being

• Sexual Dysfunction: Painful intercourse (dyspareunia) or decreased sensation can occur, affecting intimacy and quality of life 2 4.
• Back Pain: Low back pain sometimes accompanies other symptoms but is rarely the only sign 4 5.

Early recognition of these symptoms is crucial. Unfortunately, studies show that many women lack awareness of uterine prolapse, which can delay diagnosis and intervention 6.

Types of Uterine Prolapse

Not all cases of uterine prolapse are the same. The condition varies in terms of how far the uterus has descended, and whether other pelvic organs are also involved. Understanding these distinctions helps guide treatment and predict outcomes.

Type	Description	Severity/Stage	Source(s)
Incomplete	Uterus slips partway into the vagina	Mild to moderate	4
Complete	Uterus descends so far that tissue protrudes outside	Severe	4 5
Associated Prolapse	Bladder (cystocele), rectum (rectocele) involved	Frequently co-exists	3 5
Vault Prolapse	Vaginal apex descends (after hysterectomy)	Similar symptoms	3 9

Table 2: Types of Uterine Prolapse

Degrees and Stages of Uterine Prolapse

Uterine prolapse is often classified by how far the uterus has descended:

• Incomplete Prolapse: The uterus sags into the vaginal canal but does not protrude outside the vaginal opening. Women may feel a bulge or fullness but might not see tissue outside 4.
• Complete Prolapse: The uterus descends so far that part or all of it protrudes outside the vaginal opening. This stage is more likely to cause significant discomfort and hygiene issues 4 5.

Co-existing Pelvic Organ Prolapse

Uterine prolapse frequently occurs alongside other forms of pelvic organ prolapse:

• Cystocele: The bladder bulges into the front wall of the vagina.
• Rectocele: The rectum pushes into the back wall of the vagina.

These associated conditions can compound symptoms, especially urinary and bowel complaints 3 5.

Vault Prolapse

After hysterectomy (removal of the uterus), women can develop "vault prolapse," where the top of the vagina loses support and descends, causing similar symptoms 3 9. This highlights that prolapse is not solely a uterine problem, but a manifestation of weakness in the pelvic floor support structures.

Causes of Uterine Prolapse

Understanding the causes of uterine prolapse is essential for both prevention and management. While some risk factors are unavoidable, others can be addressed to reduce risk.

Cause/Risk Factor	Mechanism/Description	Impact	Source(s)
Childbirth (Vaginal)	Trauma, stretching of pelvic floor	Major risk, especially with high parity	5 4 1
Aging	Weakening of muscles and ligaments	Increases with age	1 4 8
Menopause	Loss of estrogen, tissue atrophy	Higher risk postmenopause	1 8
Collagen Disorders	Weak connective tissue (sacrouterine ligament)	Higher risk for severe prolapse	2
Obesity	Increased abdominal pressure	Possible risk	5 8
Chronic Strain	Lifting, constipation, coughing	Ongoing pelvic stress	5
Genetics	Family history, inherited tissue weakness	Contributes	4 5

Table 3: Causes and Risk Factors

Childbirth and Parity

• Vaginal Delivery: Childbirth, especially multiple or complicated deliveries, is the leading cause of pelvic floor trauma. Women with high parity (having four or more children) are at greater risk 1 5.
• Large Infants: Delivering larger babies can increase the likelihood of muscle and ligament damage 5.

Age and Menopause

• Aging: The prevalence and severity of uterine prolapse rise with age as pelvic tissues lose strength and elasticity 1 4 8.
• Menopause: The drop in estrogen levels after menopause accelerates atrophy of the supporting tissues, further increasing risk 1 8.

Connective Tissue Disorders

• Collagen Type-1 Deficiency: Weakening of the sacrouterine ligament, particularly due to low collagen type-1 expression, significantly increases the risk for severe (stage III-IV) uterine prolapse 2.

Lifestyle and Other Factors

• Obesity: Excess body weight increases intra-abdominal pressure, putting more strain on the pelvic floor 5 8.
• Chronic Strain: Lifelong heavy lifting, chronic cough (such as from lung disease), and persistent constipation can all contribute by repeatedly stressing pelvic support structures 5.
• Genetics: A family history of pelvic organ prolapse increases individual risk, underscoring the role of inherited tissue composition 4 5.

Awareness and Education

Despite the prevalence of these risk factors, many women lack knowledge about uterine prolapse and its prevention. Health education remains a critical need 6.

Treatment of Uterine Prolapse

The management of uterine prolapse has evolved, offering a spectrum of options tailored to severity, patient preferences, age, and reproductive plans. Treatment aims to relieve symptoms, restore pelvic anatomy, and improve quality of life.

Treatment	Description	Pros/Cons & Outcomes	Source(s)
Conservative	Pelvic floor exercises, pessary devices	Non-surgical, symptom relief, suitable for mild/moderate cases	4 5 7
Vaginal Hysterectomy	Uterus removal via vaginal approach	Most common, effective, possible complications	10 11 12 13
Uterine-Sparing Surgery	Manchester procedure, hysteropexy	Preserves uterus, fewer complications, similar outcomes	10 11 12 13
Abdominal Procedures	Sacral colpopexy, sacrohysteropexy	Durable, lower recurrence, more invasive	9 12 13
Vaginal Mesh	Synthetic support materials	Controversial, mesh complications, limited evidence	9

Table 4: Treatment Options

Conservative Management

• Pelvic Floor Muscle Training: Also known as Kegel exercises, these strengthen the muscles supporting the uterus and are especially useful in early or mild prolapse 4 5.
• Pessaries: Removable devices placed in the vagina to support the uterus, offering effective symptom relief for women who are not surgical candidates, are awaiting surgery, or prefer to avoid an operation 4 5 7.
• Lifestyle Modifications: Addressing constipation, avoiding heavy lifting, and weight management can help prevent progression 5 6.

Surgical Treatments

Vaginal Hysterectomy

• Procedure: Removal of the uterus through the vagina; often combined with repair of other prolapsed organs 10 11.
• Outcomes: Effective for most women, but comes with potential risks such as bleeding, infection, longer recovery, and a risk of recurrent prolapse 10 11 13.
• Recurrence: Up to 13% may require re-operation for symptomatic recurrence 10.

Uterine-Sparing Procedures

• Manchester Procedure: Shortens and supports the cervix and uterine ligaments, preserving the uterus 10 11 12.
• Hysteropexy: The uterus is suspended using native tissue or synthetic material, either vaginally or abdominally 12 13.
• Advantages: Shorter operative times, less blood loss, faster recovery, retains fertility and hormonal function, and similar symptom relief compared to hysterectomy 10 12 13.
• Considerations: Requires ongoing surveillance for uterine pathology; not suitable for women with abnormal uterine bleeding or malignancy 12.

Abdominal Procedures

• Sacral Colpopexy/Sacrohysteropexy: The top of the vagina or uterus is attached to the sacrum using mesh or sutures, typically via minimally invasive (laparoscopic/robotic) or open surgery 9 12 13.
• Benefits: Lower risk of recurrent prolapse and repeat surgery compared to vaginal approaches; suitable for younger patients or those with recurrent prolapse 9.
• Downsides: More invasive, higher cost, longer recovery 9 13.

Vaginal Mesh

• Mesh Use: Synthetic mesh may be used to reinforce vaginal walls, but is controversial due to complications such as erosion, infection, and pain. Its use is declining and is not routinely recommended 9.

Special Considerations

• Pregnancy: Uterine prolapse during pregnancy is rare but requires individualized management, often with conservative measures to allow for safe delivery 7.
• Patient Preferences: A shared decision-making approach is essential, considering reproductive plans, desired outcomes, and tolerance for surgical risk 12 13.

Conclusion

Uterine prolapse is a multifaceted condition, shaped by life events, genetics, and age. While it can be physically and emotionally challenging, awareness of symptoms, an understanding of risk factors, and knowledge of modern treatment options can empower women to take proactive steps toward better pelvic health.

Key Takeaways:

• Common symptoms include a vaginal bulge, pelvic pressure, urinary and bowel issues, and sexual discomfort 1 4 5.
• Types range from incomplete to complete prolapse, often involving other pelvic organs or, post-hysterectomy, the vaginal vault 3 4 5 9.
• Major causes include childbirth, aging, menopause, connective tissue weakness, and lifestyle factors such as heavy lifting 1 2 4 5 8.
• Treatment options span conservative measures (pelvic exercises, pessaries), various surgical techniques (hysterectomy, uterine-sparing, abdominal procedures), and patient-centered care 4 10 11 12 13.
• Awareness and education remain crucial to early detection and effective management 6.

By recognizing the signs, understanding the risks, and exploring all available therapies, women and clinicians can work together to restore comfort, function, and quality of life.