What is a prolapsed uterus?

Prolapsed uterus (also called uterine prolapse or pelvic organ prolapse) is when the uterus drops down towards the vaginal opening. It may protrude outside of the vagina.

Doctors use a grading system to describe how much of the uterus has pushed down into the vagina:

• Stage 1 is when the uterus protrudes a little way into the vagina
• Stage 2 is when the uterus protrudes close to the vaginal opening
• Stage 3 is when the uterus protrudes outside of the vagina

In some women, the bladder and bowel can also prolapse. If the bladder bulges into the front wall of the vagina, it is called a cystocoele. If the bowel bulges through the back wall, it is called a rectocele.

Prolapse usually worsens without any treatment, so it’s important to seek medical help.

What are the symptoms of a prolapsed uterus?

Women who have a prolapsed uterus may :

• a sensation of fullness or pressure inside the vagina
• a lump or bulge in, or out of, the vagina
• a sensation of heaviness or dragging in the pelvis or vagina
• 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
• bowel or bladder urgency (needing to go very suddenly) or incontinence
• pain during sex or less sensation during sex
• lower back pain
• urinary tract infections that keep coming back

What causes a prolapsed uterus?

A prolapse occurs when the ligaments that hold the pelvic organs in place are stretched or weakened. This can happen when something puts pressure on the pelvic floor, for example due to:

• pregnancy and childbirth
• prolonged constipation, or regularly straining on the toilet
• repetitive heavy lifting (for example, of children or grandchildren, or weights)
• being overweight
• smoking
• chronic coughing

Women are more likely to have a prolapse after menopause due to a lack of oestrogen, a hormone that keeps the vagina healthy

How is a prolapsed uterus diagnosed?

If you think you might have a prolapse, your doctor will talk to you and examine you. You will need to have an internal examination. You may also be asked to have tests like ultrasounds and urine tests.

How is a prolapsed uterus treated?

The treatment suggested will depend on the type and extent of the prolapse. Whatever the course of action, it is important that you do something about the prolapse or your symptoms are likely to get worse.

In some women, strengthening the pelvic floor muscles and changing their daily activities may be all that is needed. You may be recommended to see a pelvic floor physiotherapist or a continence nurse to help with this.

Some women may be offered a ring pessary, which is a small disc put high in the vagina as a support.

In severe cases, women will be advised to have surgery to repair weakened tissues, insert synthetic mesh to replace damaged tissues, or remove the uterus entirely (hysterectomy).

You can make some changes to manage the prolapse through:

• regular pelvic floor exercises
• regular physical activity
• avoiding heavy lifting
• avoiding high impact exercise
• eating high fibre foods and drinking plenty of fluid (to prevent constipation)
• achieving and maintaining a healthy weight
• not smoking

Can a prolapsed uterus be prevented?

The best thing you can do to prevent a prolapsed uterus is to keep the pelvic floor muscles strong. You can do this with pelvic floor exercises:

Visit the Continence Foundation's Pelvic Floor First website for more information about the pelvic floor and how to keep it strong.