The organs of the pelvis — the area of the body between the hip bones — include the vagina, cervix, uterus, bladder, urethra, intestines, and rectum. These organs are held in place by a group of muscles and other tissue. When this support system becomes stretched or torn, it allows pelvic organs to slip out of their normal places or sag down prolapse. The vagina is also called the birth canal. A prolapse occurs when an organ of the body droops down or slips out of its normal place.
The bulging can be:. These procedures can be done in a minimally invasive fashion. The physical examination will determine:. The pelvic organs include the cervjxuterusbladderurethraand rectum. Search the Jean Hailes website using keywords. Moderate to severe prolapse may cause symptoms, such as:.
Sasha starr and toby nugent. What causes a prolapsed uterus?
The pelvic organs include the vagina , uterus , bladder , urethra , and rectum.
- Medically reviewed by Drugs.
- The uterus is a pear shaped, hollow, muscular organ of tghe female reproductive system.
- Uterine prolapse is when the uterus or womb prolapses into or out of the vagina.
- Uterine prolapse is when the uterus drops down into the vagina, and in severe cases, outside the vagina.
There are many different types of prolapse, including uterine, bladder and bowel prolapse. Causes of prolapse, symptoms, tests used to diagnose prolapse, and management and treatment of prolapse are discussed. Prolapse is caused by a stretching of the ligaments and muscles that support the pelvic organs, causing those organs to drop down.
The word prolapse literally means to 'fall out of place'. The walls of the vagina become overstretched and bulge downwards towards the vaginal entrance.
The bulging can be:. The trigger is a loss of oestrogen during menopause. This hormone helps to keep the pelvic floor muscles, which support the vagina and bladder, well toned. Once oestrogen levels drop after menopause, these muscles become thinner, weaker and less elastic. The vaginal skin may also stretch, which may allow the bladder or bowel to bulge into the vagina. The symptoms of a prolapse depend on individual factors, such as the severity of the prolapse and level of physical activity.
A prolapse is diagnosed by a medical history check and a physical examination. The physical examination will determine:. Gynaecologists with a special interest in prolapse use a grading system called the POP-Q system to measure the degree of prolapse in centimetres.
A prolapse is graded by how much the organ or vaginal wall is pushing down into the vagina. Without intervention, the symptoms of prolapse usually worsen over time. However, there is a lot you can do to improve the symptoms.
Before a prolapse occurs, there may be a slackening in the walls of the vagina, so awareness of this weakening and preventing it from getting worse are vital. Treatment will depend on the severity of the prolapse and the degree it interferes with a woman's lifestyle.
In some women, strengthening the pelvic floor muscles and modifying daily activities may be all that is required. Last updated 26 September — Last reviewed 04 August This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner.
The information above is based on current medical knowledge, evidence and practice as at August Published twice a year, the Jean Hailes Magazine features up to date women's health information that is easy to understand, expertly written and evidence based. Women across Australia are at the centre of everything we do. Skip to navigation Skip to content. Popular Topics. Search the Health A-Z.
View all topics. Resource types. Booklets Books External Links Fact sheets. Tools Videos Webinar. Search resources. View all resources Order bulk resources. Back Overview Events Postcards from Search the Jean Hailes website using keywords. On This Page. What is prolapse? There are different types of prolapse, including: Types of prolapse What happens Vaginal prolapse The walls of the vagina become overstretched and bulge downwards towards the vaginal entrance.
The bulging can be: the front vaginal wall with the bladder in front of it the back vaginal wall with the rectum immediately behind. Uterine prolapse The uterus womb and cervix opening to the womb drop down towards the vaginal entrance and may protrude outside the vagina. A cystocele usually occurs because of a weakening of the pelvic floor muscles, which support the uterus, bladder and bowel.
A cystocele can occur by itself or it may happen along with other abnormalities, such as a rectocele see below or uterine prolapse. Bowel prolapse also called rectocele When the bowel bulges forward into the back vaginal wall. Women who have had pelvic surgery may also be at increased risk of prolapse. Symptoms The symptoms of a prolapse depend on individual factors, such as the severity of the prolapse and level of physical activity.
The symptoms can include: an inability to completely empty the bladder or the bowel when going to the toilet straining to get urine flow started, or to empty the bowel a slow flow of urine that tends to stop and start a sensation of fullness or pressure inside the vagina a sensation of vaginal heaviness or dragging a bulge or swelling felt in the vagina bladder or bowel urgency or incontinence lower back ache.
In severe cases, the vaginal wall or cervix may protrude outside the vaginal entrance. Diagnosis A prolapse is diagnosed by a medical history check and a physical examination. Tests Tests that may be done include: Test What it assesses Pelvic ultrasound Whether there are any masses or cysts in the pelvic area. Urodynamics: a test of bladder function Different types of incontinence, particularly stress or urge incontinence.
Bladder ultrasound Residual urine urine left in the bladder after passing urine. Mid-stream urine test Rules out infection if there are bladder symptoms. Degrees of prolapse Gynaecologists with a special interest in prolapse use a grading system called the POP-Q system to measure the degree of prolapse in centimetres. Being sexually active does not cause or worsen prolapse. Level of prolapse Management and treatment Prevention and mild cases of prolapse Lifestyle changes and preventive measures such as pelvic floor exercises Moderate cases Lifestyle changes Sessions with a pelvic floor physiotherapist to learn the best exercise technique to strengthen the pelvic floor muscles Surgery may be required For women who are not able to have surgery or who wish to delay surgery, a ring pessary can be inserted high into the vagina to support the prolapse.
This is done in the gynaecologist's consulting room. Severe cases Surgery is usually required to repair a severe prolapse There are different surgical techniques available.
Current techniques may involve the use of supporting mesh, tissue graft or a tape to hold the bladder and urethra in place. The length of time the operation takes will depend on the particular operation.
Some operations are day procedures The surgery is usually done under general anaesthesia Full recovery usually takes around six weeks, during which time you need to avoid lifting and straining. Walking for exercise is best during this time.
To avoid straining and pushing the prolapse down Weight range Keep within a healthy range. Being overweight has been shown to worsen prolapse. To help prevent constipation, because even one instance of straining can worsen the prolapse. Fluid Drink between 6 and 8 glasses of fluid each day. Not drinking enough fluid can make stools hard, dry and difficult to pass, which can cause straining.
Toilet habits Avoid straining on the toilet for either bowels or bladder. Using your hand to support the prolapse can help. Sit down and relax, leaning forwards, forearms on thighs. Putting your feet apart on a small stool can help when emptying bowels.
Take your time and don't hurry. Physical activity Exercise daily Use lighter weights Opt for core strengthening on an exercise ball, and cardiovascular exercise such as walking, swimming or bike riding rather than running, jumping or high-impact aerobics To help keep your bowels regular To avoid straining and worsening the prolapse. Pelvic floor exercises Do pelvic floor exercises daily Always squeeze up pelvic floor muscles before lifting, coughing, laughing or sneezing If you have symptoms of a prolapse, have a private consultation with a specially trained pelvic floor physiotherapist To strengthen the muscles supporting the pelvic organs, because stronger pelvic floor muscles can help reduce symptoms of prolapse.
Seek medical advice Seek medical advice for any condition that causes coughing and sneezing, such as asthma, chest infections and hay fever. Repetitive sneezing and coughing may cause or worsen cystocele. Medication Seek a prescription for hormone therapy, such as a cream, pessary or a vaginal tablet.
Share Facebook Tweet Email. Was this helpful? YES, it was. NO, it wasn't. Do not fill out business name. What happens when you see a pelvic floor physiotherapist or endocrinologist? Maintaining pelvic floor fitness - video. Inside out — A complete guide to pelvic floor safe exercises for women.
Transvaginal mesh: what you need to know. Transvaginal mesh complications - Health Professional tool. Urinary continence management in women — Health professional webinar. Pelvic floor and exercise - Health Professional webinar. Pelvic floor fitness and dysfunction - Health Professional webinar. View all resources. Free Jean Hailes Magazine.
Subscribe for free. Free women's health email updates. Sign up for free! Your voice matters. Get social with us Twitter. The uterus womb and cervix opening to the womb drop down towards the vaginal entrance and may protrude outside the vagina.
Written By: A. Due to increased strain on the muscles that support the uterus. Kegels and pelvic physical therapy help in mild cases of prolapse, but are not going to fix a severe case. Urodynamic studies test your bladder function and can show if your bladder empties completely. If you are interested in taking hormone replacement medication, you should review the pros and cons of this treatment with your physician.
Fallen cervix and uterus. 1. Feeling Like You're Sitting On A Ball
It can be classified as the following:. Next are Asians and blacks. The other names of a prolapsed uterus are uterine prolapse, pelvic relaxation, or pelvic relaxation.
The uterus placed inside the pelvic cavity, near the bladder and towards to the rectum. It is divided into four sections: the fundus, internal OS, corpus, and the cervix. It is supported by muscles and ligaments. Uterine prolapse happens if this supporting structure is weakened. The uterus may slip down the vaginal canal and even extend outside the vaginal orifice. When the uterus falls down, it may also pull the other nearby organs like vaginal walls, bladder, and rectum. Damage to the muscles supporting the uterus is likely because of compression and increased pressure from the fetal head and maternal forces during delivery.
It causes stretching and tearing in the muscles. Obstetric trauma to the muscles also occur during vaginal delivery. Due to increased strain on the muscles that support the uterus. Diagnosis Complete pelvic examination The doctor will conduct a pelvic examination to look for a protruding uterus. This is done while lying down and standing up. Treatment depends on the degree of the prolapse. For a mild prolapse, usually no treatment is needed. A vaginal pessary is inserted into the vagina to support the uterus and prevent it from falling down.
Minimal discomfort and irritation can be felt since it presses the vaginal muscle. Prolonged usage of pessary may lead to necrosis and ulceration. Pessary should be cleaned frequently and removed every one to two months.
A surgical procedure used to correct sagging of the supporting muscle of the pelvis. If the prolapse is not seen with the patient laying down, then an exam should also be done in the standing position. The ligaments that support the uterus ie the uterosacral ligaments originate in the sacral spine area and therefore if the uterus is falling, these ligaments are stretched or torn and a woman may suffer from low back discomfort from the prolapse.
Some women find relief by getting off their feet or laying down, which helps take the pressure off of the pelvic floor. If the uterine prolapse is mild and not causing any symptoms, it can just be monitored and observed until it starts causing symptoms.
Conservative or non-surgical therapy includes pelvic floor physical therapy which includes specialized training in Kegel or pelvic floor muscle exercises, electric stimulation, biofeedback, bowel movement strategy and other treatment modalities that can help reduce symptoms, however will not cure prolapse.
Another non-surgical option is a pessary. A pessary is a rubber or silicone donut shaped device that is placed inside of the vagina to support the prolapse. It must be big enough to stay in the vagina and support the prolapse, but not too big to cause discomfort.
A surgeon should be experienced and an expert in Urogynecology and Female Urology surgery to be able to identify other defects in pelvic support and then utilize the appropriate surgical treatments to achieve the best cure rate for the patient. Cure rates are dependent not just on the treatment of the uterine prolapse, but also support at the apex of the vagina, ie treating vault prolapse or uterine prolapse at the same time.
In women that would like to preserve their uterus and not undergo hysterectomy, Uterine suspension surgery is an option. However, if the uterus has abnormalities such as large fibroids or the woman has any history of pre-cancerous lesions of the uterus or cervix, she may not be a good candidate to keep the uterus in place.
Many times, with uterine prolapse, the uterus is in the way of achieving a good suspension of the top of the vagina.
There may be hernias also known as enterocele in front of or behind the uterus and these are difficult to repair with the uterus in place. The abdominal approach to hysterectomy and vault suspension can be achieved through an open abdominal incision called a laparotomy or through a minimally invasive approach with laparoscopic or robotic surgery.
Laparoscopic surgery is completed by placing a camera through a small incision hidden in the belly button, and then using several other tiny incisions to work through. Laparoscopic surgery is done with the surgeons own hands whereas Robotic surgery, the same incisions are used however the arms of the robot are controlled by the surgeon sitting at a console away from the patient.
It is also referred to Robotic-assisted Laparoscopic surgery. Hysterectomy is traditionally completed at the time of uterine prolapse surgery. Hysterectomy means removal of the uterus or the womb only.
The uterus is an end organ, meaning it does NOT produce any hormones such as estrogen or progesterone , its only job is to maintain and carry a pregnancy. Each month the OVARIES produce hormones working in conjunction with the pituitary gland and the brain to get the lining of the uterus ready for a pregnancy.
If a pregnancy does not occur, the woman then sluffs this lining and the woman has her period or menses. Many women think of hysterectomy as an automatic entrance into menopause, and unless the ovaries are removed, this is not true at all.
The hormone levels should not change if the ovaries are left in place. Studies have shown that sexual function does not change, nor is affected by hysterectomy. Hysterectomy does not cause prolapse either, ie the prolapse is already present, however the vaginal vault must be suspended after the hysterectomy as the prolapse is not cured by hysterectomy alone! The fallopian tubes should be removed at time of hysterectomy as they have been shown to be a cause of cancer later in life.
The ovaries should be removed at time of surgery in post-menopausal women over 65 years old or in younger women that have a high risk of ovarian cancer, otherwise the ovaries should be left in place at the time of the surgery.
Surgery for Pelvic Organ Prolapse - ACOG
The pelvic organs include the vagina , uterus , bladder , urethra , and rectum. These organs are held in place by muscles of the pelvic floor. Layers of connective tissue also give support. There are several types of prolapse that have different names depending on the part of the body that has dropped. Symptoms of POP can come on gradually and may not be noticed at first.
A health care professional may discover a prolapse during a physical exam. Women with symptoms experience the following:. If you have POP symptoms, and they interfere with your normal activities, you may need treatment. Nonsurgical treatment options usually are tried first. If these options do not work and if your symptoms are severe, you may want to consider surgery. Often the first nonsurgical option tried is a pessary.
This device is inserted into the vagina to support the pelvic organs. Changes in diet and lifestyle may help relieve some symptoms. For example, limiting excessive fluid intake may help with urinary incontinence. Sometimes a medication that softens stools is prescribed. If a woman is overweight or obese, weight loss can help improve her overall health and possibly her prolapse symptoms. For some women, Kegel exercises may be helpful.
A major factor in this decision is the severity of your symptoms. The following factors also should be considered:. There is no guarantee that any treatment—including surgery—will relieve all of your symptoms. Also, new problems may occur after surgery, such as pain during sexual intercourse , pelvic pain, or urinary incontinence.
In general, there are two types of surgery: 1 obliterative surgery and 2 reconstructive surgery. Obliterative surgery narrows or closes off the vagina to provide support for prolapsed organs. Sexual intercourse is not possible after this procedure. The goal of reconstructive surgery is to restore organs to their original position. Some types of reconstructive surgery are done through an incision in the vagina.
Others are done through an incision in the abdomen or with laparoscopy. Recovery time varies depending on the type of surgery. You usually need to take a few weeks off from work. For the first few weeks, you should avoid vigorous exercise, lifting, and straining.
You also should avoid sex for several weeks after surgery. Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.
Kegel Exercises: Pelvic muscle exercises. Doing these exercises helps with bladder and bowel control as well as sexual function. Laparoscopy: A surgical procedure in which a thin, lighted telescope called a laparoscope is inserted through a small incision cut in the abdomen.
The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery. Ligament: A band of tissue that connects bones or supports large internal organs.
Obliterative Surgery: A type of surgery in which the vagina is narrowed or closed off to support organs that have dropped down. This condition is caused by weakening of the muscles and tissues that support the organs in the pelvis, including the vagina, uterus, and bladder.
Pessary: A device that can be inserted into the vagina to support the organs that have dropped down or to help control urine leakage. Reconstructive Surgery: Surgery to repair or restore a part of the body that is injured or damaged.
Sacrocolpopexy: A type of surgery to repair vaginal vault prolapse. The surgery attaches the vaginal vault to the sacrum with surgical mesh. Sacrohysteropexy: A type of surgery to repair uterine prolapse. The surgery attaches the cervix to the sacrum with surgical mesh. Sexual Intercourse: The act of the penis of the male entering the vagina of the female. Urethra: A tube-like structure. Urine flows through this tube when it leaves the body.
Uterus: A muscular organ in the female pelvis. During pregnancy this organ holds and nourishes the fetus. Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body. Vaginal Vault: The top of the vagina after hysterectomy removal of the uterus. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. Please check for updates at www. Women's Health Care Physicians.