#48 Uterine Prolapse

Delivering your baby vaginally stretches the muscles holding your uterus in place. Sometimes the stretching causes these muscles to become weak enough to lose the ability to hold your uterus in place and your uterus begins to slip down into your vagina.  This condition is called uterine prolapse.

Uterine prolapse is not an either or condition, but rather a matter of degree. Most women, even those who have had no children, will probably develop some degree of uterine prolapse, although the condition is more common in women who have vaginal births.

When your cervix lowers to about one third of the way down your vagina, it is called stage-one prolapse. When your uterus is two thirds down your vagina, it is called stage two and when your uterus reaches your introitus (the opening of your vagina) it is stage three.

When your cervix is coming out of your vagina, it is considered to be the fourth stage and considered a complete uterine prolapse. When this happens, your uterus may sometimes pull out your bladder and your ureters (tubes that carry urine from your kidneys to your bladder), as well as your rectum.

In the early stages of uterine prolapse, most women have no symptoms and generally no treatment required. Once your cervix starts coming out of your vagina past your introitus, the remedy is to either surgically move your uterus and cervix back into your abdomen or surgically remove your uterus and provide support for the top of your vagina so to prevent the development of prolapse again.

There are various treatments for uterine prolapse, including removal of the uterus and introduction of support devices to hold the vagina in place. Another option is to surgically decreasing the size of the vagina enough to allow your muscles to keep your uterus in its usual anatomical position. There are various pessaries (mechanical devices placed into your vagina) to keep your uterus in a position high in your vagina. You can insert and maintain pessaries yourself. However, some women simply prefer no treatment at all.

There are some risks to doing nothing about late stage uterine prolapse. If your prolapse progresses to stage 4, you then might have some trouble with your kidneys getting urine to your bladder. The bladder and ureters can be surgically repaired and put back in place without damage to your bladder and ureters. If there is injury to your bladder or ureters, it is usually not catastrophic if noticed and surgically repaired immediately.

Sometimes after a vaginal hysterectomy, your entire vagina can fall out. The prolapsed vagina can be surgically repaired. Vaginal prolapse can occur for many reasons. It is important for you to discuss these problems with your surgeon so that you can get the needed repair done effectively and safely.