When a woman experiences a uterine prolapse it means the internal slipping or dropping of the uterus. The resulting pressure may cause a bulge or protrusion through the vaginal canal. The symptoms of prolapse vary depending upon how far the uterus has dropped into the vaginal canal. A woman with a mild prolapse may notice few, if any symptoms. As the condition progresses she may experience the following:

  • A sensation of heaviness or pulling due to stretching of abdominal muscles and ligaments as the uterus is pulled down from its normal position.
  • Painful intercourse
  • A sensation of sitting on a small ball as the uterus moves closer to the vagina
  • Back pain due to the incorrect position of the uterus
  • Discomfort while walking
  • Vaginal bleeding or excessive discharge
  • Feeling or seeing tissue coming out of the opening of the vagina. This may be the prolasping cervix, uterus or even the walls of the vagina.

Causes

Uterine prolapse is more common in women who have had one or more vaginal births, or giving birth to a large baby. Other things that can cause or lead to uterine prolapse include:

  • Normal aging
  • Genetic predisposition to weakness in connective tissue
  • Race (more common in Caucasian or Hispanic women)
  • Lack of estrogen after menopause
  • Anything that puts pressure on the pelvic muscles, including:
    • Chronic cough
    • Obesity
    • Heavy lifting
    • Frequent straining during bowel movements
    • Long-term constipation
  • Prior pelvic surgery
  • Pelvic tumor (in rare cases)

Uterine Prolapse Treatment Options

Treatment for these conditions depends on the severity of symptoms.

In mild cases

  • Pelvic floor exercises may relieve symptoms and improve the condition (Grades 1 and 2).
  • Weight loss is recommended, especially for obese women.
  • Avoid heavy lifting and lift correctly when needed.
  • Avoid constipation by eating foods that are rich in fiber, such fruits, vegetables, beans and whole-grain cereals. Drink plenty of water.
  • If you have a chronic cough, ask your doctor how to prevent or treat it. If you smoke, try to quit. Smoking can cause a chronic cough.

Physical Therapy

Alegent Creighton Health Physical Therapy provides physical therapy to help male and female patients with Pelvic Floor Disorders avoid surgery. They also provide rehabilitation for men and women who have undergone surgery.

Medications

There are a number of medications are available to treat stress incontinence, urge incontinence or overactive bladder. Depending on the condition, they work by increasing sphincter or pelvic muscle strength or relax the bladder, thus increasing its capacity to hold urine. Medications are generally most helpful for urge incontinence. Incontinence pads and liners assist with light to heavy leaks.

Vaginal Pessary

A pessary is a flexible silicone device that is placed into the vagina to help support the uterus, vagina, bladder or rectum. It helps improve incontinence and bladder emptying. Pessaries are fitted at the physician’s office. A properly-fitted pessary is not noticeable when it is in place. A Pessary may be a temporary or permanent treatment option.

Surgery

Surgery should not be done until the prolapse symptoms are severe and other treatment options, such as vaginal pessary, are no longer effective. Alegent Creighton Health Women’s Health physicians perform a variety of minimally invasive and vaginal procedures to correct uterine prolapse:

The specific type of surgery depends on:
  • Degree of prolapse (Grade 3 and 4)
  • Desire for future pregnancies
  • Other medical conditions
  • The women's desire to retain vaginal function
  • The woman's age and general health

Sacrospinous Fixation

There are some surgical procedures that can be done without removing the uterus, such as a sacrospinous fixation. This procedure involves using nearby ligaments to support the uterus. Other procedures are available.

Vaginal Hysterectomy

Often, a vaginal hysterectomy is used to correct uterine prolapse. Any sagging of the vaginal wall, urethra, bladder, or rectum can be surgically corrected at the same time.
Alegent Creighton Health offers robotic-assisted, minimally invasive surgical repair of uterine prolapse and hysterectomy.

Benefits of minimally invasive surgery for uterine prolapse are:
  • 4-5 mini incisions
  • The patient may go home the same day or the next day
  • Less pain
  • Return to normal activities within two weeks

Rehabilitation

Exercise is helpful for regaining muscle tone and maintaining the integrity of the surgery. Alegent Creighton Health offers specialized outpatient physical therapy for patients who have undergone uterine prolapse surgery and hysterectomy. The treatment regimen length is dependent upon on compliance, and patient’s ability to do the exercises correctly. Physical therapists that specialize in pelvic floor rehabilitation are available at Immanuel Rehabilitation Center’s outpatient center and the La Vista physical therapy clinic.
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