Uterine Prolapse
Introduction to Uterine Prolapse
Uterine prolapse ("dropped uterus") is a condition in which a woman's uterus (womb) sags or slips out of its normal position. The uterus may slip enough that it drops partially into the vagina (the birth canal), creating a perceptible lump or bulge. This is called incomplete prolapse. In a more severe case—known as complete prolapse—the uterus slips to such a degree that some of the tissue drops outside of the vagina.
Vaginal prolapse, also known as vaginal vault prolapse, involves the collapse of the vagina that can occur after a hysterectomy, and is co-incidental with uterine prolapse. This article covers both of these related conditions. Uterine and vaginal prolapse are considered specific types of a more general medical category, known as pelvic support defect or pelvic organ prolapse.
Prolapse Definition
Prolapse literally means "to fall out of place." In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is generally reserved for organs protruding through the vagina, or for the misalignment of the valves of the heart.
Anatomy of the Vagina
The vaginal vault has three compartments: an anterior compartment (consisting of the anterior vaginal wall), a middle compartment (cervix), and a posterior compartment (posterior vaginal wall). Uterine prolapse involves the cervix.
Uterine Prolapse Symptoms & Signs
Women with mild cases of uterine prolapse may have no obvious symptoms. However, as the slipped uterus falls further out of position, it can place pressure on other pelvic organs—such as the bladder or bowel—causing a variety of symptoms, including:
- Pelvic pressure: a feeling of heaviness or pressure in the pelvis
- Pelvic pain: discomfort in the pelvis, abdomen or lower back
- Pain during intercourse
- A protrusion of tissue from the opening of the vagina
- Recurrent bladder infections
- Unusual or excessive discharge from the vagina
- Constipation
- Difficulty with urination, including involuntary loss of urine (female incontinence), or urinary frequency or urgency1
Symptoms may be worsened by prolonged standing or walking, due to added pressure placed on the pelvic muscles by gravity.
Causes of Uterine Prolapse
Trauma incurred during the birthing process, particularly with large babies or after a difficult labor and delivery, is one of the main causes of the muscle weakness that leads to uterine prolapse. Reduced muscle tone from aging, as well as lowered amounts of circulating estrogen after menopause, may also form contributing factors in pelvic organ prolapses. In rare circumstances, uterine prolapse may be caused by a tumor in the pelvic cavity.
Genetics also may play a role; women of Northern European descent experience a higher incidence of uterine prolapse than do women of Asian and African heritage.2
Finally, increased intra-abdominal pressure, stemming from such diverse conditions as obesity, chronic lung disease and asthma, can be contributing factors in uterine prolapse.3
Risk Factors
- One or more pregnancies and vaginal births
- Giving birth to a large baby
- Increasing age
- Frequent heavy lifting
- Chronic coughing
- Frequent straining during bowel movements4
Statistics
In the U.S., pelvic support defects are relatively common and increase with age. One study of more than 16,000 patients found the rate of uterine prolapse to be 14.2%. The mean age at time of surgery for pelvic organ prolapse was 54.6 years.5
U.S. studies have found Hispanic race to be correlated with prolapse. By contrast, African Americans had the lowest risk of uterine prolapse. These findings were independent of parity, age, and body habitus, suggesting a genetic component to prolapse.
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