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1. UTERINE PROLAPSE
Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and
weaken, providing inadequate support for the uterus. The uterus then slips down
into or protrudes out of the vagina.
Uterine prolapse can happen to women of any age, but it often affects
postmenopausal women who've had one or more vaginal deliveries. Weakening
of the pelvic muscles that leads to uterine prolapse can be caused by:
 Damage to supportive tissues during pregnancy and childbirth
 Effects of gravity
 Loss of estrogen
 Repeated straining over the years
If you have mild uterine prolapse, treatment usually isn't needed. But if uterine
prolapse makes you uncomfortable or disrupts your normal life, you might benefit
from treatment.
Symptoms
Uterine prolapse varies in severity. You may have mild uterine prolapse and
experience no signs or symptoms. If you have moderate to severe uterine
prolapse, you may experience:
 Sensation of heaviness or pulling in your pelvis
 Tissue protruding from your vagina
 Urinary problems, such as urine leakage or urine retention
 Trouble having a bowel movement
 Low back pain
 Feeling as if you're sitting on a small ball or as if something is falling out of your
vagina
 Sexual concerns, such as a sensation of looseness in the tone of your vaginal
tissue
 Symptoms that are less bothersome in the morning and worsen as the day
goes on

2. Uterine prolapse doesn't require treatment unless it's severe. If your signs and
symptoms become bothersome and disrupt your normal activities, make an
appointment with your doctor to discuss your options
Causes
Weakening of pelvic muscles and supportive tissues contribute to uterine
prolapse. This may happen as a result of:
 Pregnancy
 Trauma during childbirth
 Delivery of a large baby
 Difficult labor and delivery
 Loss of muscle tone
 Less circulating estrogen after menopause
Risk factors
Certain factors may increase your risk of uterine prolapse:
 One or more pregnancies and vaginal births
 Giving birth to a large baby
 Increasing age
 Frequent heavy lifting
 Chronic coughing
 Prior pelvic surgery
 Frequent straining during bowel movements
 Genetic predisposition to weakness in connective tissue
 Being Hispanic or white
Some conditions — such as obesity, chronic constipation and chronic obstructive
pulmonary disease (COPD) — can place a strain on the muscles and connective
tissue in your pelvis and may play a role in the development of uterine prolapse.
Complications
Possible complications of uterine prolapse include:

3.  Ulcers. In severe cases of uterine prolapse, part of the vaginal lining may be
displaced by the fallen uterus and protrude outside your body, rubbing on
underwear. The friction may lead to vaginal sores (ulcers). In rare cases, the
sores could become infected.
 Prolapse of other pelvic organs. If you experience uterine prolapse, you
might also have prolapse of other pelvic organs, including your bladder and
rectum. A prolapsed bladder (cystocele) bulges into the front part of your
vagina, which can lead to difficulty in urinating and increased risk of urinary
tract infections. Weakness of connective tissue overlying the rectum may result
in a prolapsed rectum (rectocele), which may lead to difficulty having bowel
movements
Tests and diagnosis
Tests or exams to diagnose uterine prolapse include:
 Pelvic exam. During this exam, your doctor may ask you to bear down as if
having a bowel movement, which can help your doctor assess how far the
uterus has slipped into your vagina. To check the strength of your pelvic
muscles, your doctor may ask you to tighten (contract) them, as if you're
stopping the stream of urine. You may be examined while lying down and while
standing up.
 Questionnaire. You may fill out a form that helps your doctor assess how
uterine prolapse affects your quality of life. This information also helps guide
treatment decisions.
Imaging tests, such as an ultrasound or magnetic resonance imaging (MRI),
aren't generally needed for uterine prolapse. But they're sometimes helpful in
assessing the degree of prolapse.
Treatments and drugs
If you have mild uterine prolapse, either without symptoms or with symptoms that
don't bother you, you probably don't need treatment. However, your pelvic floor
may continue to lose tone, making uterine prolapse more severe as time goes
on. Check back with your doctor to monitor the extent of your prolapse and
review your symptoms.

4. Simple self-care measures, such as performing exercises called Kegels to
strengthen your pelvic muscles, may provide symptom relief. Maintaining a
healthy weight and avoiding heavy lifting may help reduce pressure on
supportive pelvic structures.
For advanced cases of uterine prolapse, treatment options include:
 Vaginal pessary. This device fits inside your vagina and holds your uterus in
place. Used as temporary or permanent treatment, vaginal pessaries come in
many shapes and sizes. Your doctor measures and fits you for the proper
device. You'll learn how to insert, remove and clean the pessary. You may be
able to take the pessary out overnight and reinsert it each day; other pessaries
can be left in place for longer periods of time.
But a vaginal pessary may be of little use if you have severe uterine prolapse.
A pessary also can irritate vaginal tissues, possibly to the point of causing
sores (ulcers) on vaginal tissues, and it may interfere with sexual intercourse.
 Surgery. To repair damaged or weakened pelvic floor tissues, your surgeon
may perform the procedure through your vagina, although sometimes an
abdominal surgery is needed. Surgical repair of your prolapse may involve
grafting your own tissue, donor tissue or some synthetic material onto
weakened pelvic floor structures to support your pelvic organs. Your surgeon
may recommend a hysterectomy, which removes your uterus.
In some cases, minimally invasive (laparoscopic) surgery is a possibility. This
procedure involves smaller abdominal incisions, special surgical instruments
and a lighted camera-type device (laparoscope) to guide the surgeon.
Which surgery and surgical approach your doctor recommends depends on
your individual needs and circumstances. Each procedure has pros and cons
that you'll need to discuss with your surgeon.
If you plan future pregnancies, you might not be a good candidate for surgery to
repair uterine prolapse. Pregnancy and delivery of a baby put strain on the
supportive tissues of the uterus and can undo the benefits of surgical repair.
Also, for women with major medical problems, the risks of surgery might
outweigh the benefits. In these instances, pessary use may be your best
treatment choice for bothersome symptoms.

5. Talk with your doctor to learn your options, including the benefits and risks.
Lifestyle and home remedies
Depending on the severity of your condition, these self-care measures may help
with uterine prolapse:
 Perform Kegel exercises.
 Avoid constipation by eating high-fiber foods and drinking plenty of fluids.
 Avoid heavy lifting and straining.
 Try to control coughing.
 Lose weight if you're overweight or obese.
Kegel exercises
Kegel exercises strengthen your pelvic floor muscles, which support the uterus,
bladder and bowel. A strong pelvic floor provides better support for your pelvic
organs and relief from symptoms associated with uterine prolapse.
To perform Kegel exercises, follow these steps:
 Tighten (contract) your pelvic floor muscles — the muscles you use to stop
urinating.
 Hold the contraction for five seconds, then relax for five seconds. (If this is too
difficult, start by holding for two seconds and relaxing for three seconds.)
 Work up to holding the contractions for 10 seconds at a time.
 Do three sets of 10 repetitions each day.
Ask your health care provider for feedback on whether you're using the right
muscles. Kegel exercises may be most successful when they're taught by a
physical therapist and reinforced with biofeedback. Biofeedback involves using
monitoring devices that help ensure you're tightening the proper muscles with
optimal intensity and length of time.
Once you've learned the proper method, you can do Kegel exercises discreetly
just about any time, whether you're sitting at your desk or relaxing on the couch.
Prevention
Although uterine prolapse isn't always preventable, you may be able to decrease
your risk if you:

6.  Perform Kegel exercises on a regular basis. These exercises can
strengthen your pelvic floor muscles — especially important after you have a
baby.
 Treat and prevent constipation. Drink plenty of fluids and eat high-fiber
foods, such as fruits, vegetables, beans and whole-grain cereals.
 Avoid heavy lifting and lift correctly. When lifting, use your legs instead of
your waist or back.
 Control coughing. Get treatment for a chronic cough or bronchitis, and don't
smoke.
 Avoid weight gain. Talk with your doctor to determine your ideal weight and
get advice on weight-loss strategies, if you need them.