Utero Vaginal Prolapse

Utero-vaginal prolapse is classified based on the extent of uterine descent.

• Incomplete uterine prolapse occurs when the uterus slips partly into the vagina, creating a bulge.
• Complete uterine prolapse occurs when the uterus descends so far that it protrudes outside the vagina.

Mild cases of uterine prolapse may be associated with the absence of any obvious symptoms. However, as the uterus slips farther out, other pelvic organs (bowels or the bladder) might be affected, resulting in one or more of the following symptoms:

• Pressure or heaviness in the pelvic region is experienced by many women, especially towards the end of the day and after prolonged standing.
• Bulging or protrusion may be noticed as a bulge or lump in the vaginal area, which can be more pronounced when straining or during physical activity.
• Urinary issues may develop, including increased frequency of urination, urgency, or even incontinence, as the prolapse affects bladder function.
• Bowel problems may arise, such as difficulty emptying the bowels or a feeling of incomplete bowel evacuation.
• Discomfort during intercourse is reported by some women as the prolapse causes pain during sexual activity.
• Lower back pain may occur, as chronic discomfort or pain in the lower back and can sometimes be associated with prolapse.

The main cause of utero vaginal prolapse is weakened pelvic floor muscles, which can be attributed to:

• Childbirth particularly multiple pregnancies and vaginal deliveries can weaken pelvic floor muscles and tissues, increasing the risk of prolapse.
• Ageing increases the risk of prolapse as pelvic muscles lose strength and elasticity, especially after menopause.
• Hormonal changes during menopause reduce oestrogen levels, weakening the pelvic support tissues.
• Obesity adds extra pressure on the pelvic floor, leading to weakening over time.
• Chronic coughing or straining, due to conditions such as chronic bronchitis or constipation can repeatedly stress the pelvic floor, weakening it over time.
• Genetic predisposition may make some women more susceptible to pelvic floor disorders.

Diagnostic of utero vaginal prolapse involves clinical evaluation and specific tests:

• A pelvic examination allows the doctor to assess the position of the uterus and other pelvic organs.
• Imaging tests such as ultrasound or MRI help detect changes in the position of the uterus.
• Urodynamic testing evaluates bladder and urethra function and may be recommended if urinary symptoms are present.

Treatment options for utero vaginal prolapse depend on severity and patient preference:

• Lifestyle modifications such as weight loss, pelvic floor exercises (such as Kegel exercises), and avoiding heavy lifting can alleviate symptoms.
• Pessaries are a non-surgical option that is inserted into the vagina to support the uterus.
• Physical therapy provides targeted exercises to strengthen pelvic muscles and relieve symptoms.
• Medications help manage urinary symptoms associated with prolapse.
• Surgery becomes an option when symptoms are severe or persistent and non-surgical methods fail, ranging from uterine support procedures to hysterectomy.

Medical consultation should be sought in the following situations: 

• A noticeable bulge or protrusion is observed in the vaginal area.
• Symptoms of urinary or bowel dysfunction are experienced.
• Discomfort or pain in the pelvic region.
• Changes in menstrual pattern or unusual bleeding are noticed.

Prevention of utero vaginal prolapse focuses on maintaining pelvic health. The following steps can be followed for the same:

• Maintaining a healthy weight reduces strain on the pelvic floor.
• Practising pelvic floor exercises improves muscle tone and support.
• Avoiding heavy lifting helps reduce pelvic floor stress.
• Managing chronic cough or constipation prevents repeated straining on the pelvic muscles.

Management of utero vaginal prolapse requires specialist care. A gynaecologist should be consulted for diagnosis, treatment planning, and ongoing management of the condition.