Uterine prolapse

Uterine prolapse is when the uterus descends towards or through the opening of the vagina. Symptoms may include vaginal fullness, pain with sex, trouble urinating, urinary incontinence, and constipation. Often it gets worse over time. Low back pain and vaginal bleeding may also occur. Risk factors include pregnancy, childbirth, obesity, constipation, and chronic coughing. Diagnosis is based on examination. It is a form of pelvic organ prolapse, together with bladder prolapse, large bowel prolapse, and small bowel prolapse. Preventative efforts include managing chronic breathing problems, not smoking, and maintaining a healthy weight. Mild cases may be treated with a pessary together with hormone replacement therapy. More severe cases may require surgery such as a vaginal hysterectomy. About 14% of women are affected. It occurs most commonly after menopause. The uterus (womb) is normally held in place by a hammock of muscles and ligaments. Prolapse happens when the ligaments supporting the uterus become so weak that the uterus cannot stay in place and slips down from its normal position. These ligaments are the round ligament, uterosacral ligaments, broad ligament and the ovarian ligament. The uterosacral ligaments are by far the most important ligaments in preventing uterine prolapse. In some cases of uterine prolapse, the uterus can be unsupported enough to extend past the vaginal wall for inches. The most common cause of uterine prolapse is trauma during childbirth, in particular multiple or difficult births. About 50% of women who have had children develop some form of pelvic organ prolapse in their lifetime. It is more common as women get older, particularly in those who have gone through menopause. This condition is surgically correctable.