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Prolapse of the Uterus and Vagina

Downward displacement of the uterus and/or wall of the vagina

  • More common after the menopause
  • Being overweight and having had children are risk factors
  • Genetics is not a significant factor

The uterus and vagina are held in place by ligaments and muscles in the pelvis. If these supporting structures become weakened or stretched, often as a result of childbirth, the uterus and/or vaginal walls may be displaced downwards. This condition, called a prolapse, usually occurs after the menopause, when low levels of the hormone oestrogen lead to weakening of the ligaments. The risk of prolapse of the uterus and/ or vagina is increased by conditions that put extra pressure on the muscles and ligaments in the pelvis, such as obesity, a persistent cough, or straining during bowel movements.

Prolapse of the uterus and vagina

In this prolapse, the uterus is displaced, the bladder bulges into the front vaginal wall (cystocele), and the rectum bulges into the back vaginal wall (rectocele).

What are the types?

In uterine prolapse, the uterus moves down into the vagina. The amount of movement ranges from slight displacement into the vagina to projection of the uterus outside the vulva.

There are two main types of vaginal prolapse: cystocele and rectocele. In a cystocele, the bladder presses inwards against the weak front vaginal wall. In a rectocele, the rectum bulges against the weakened back vaginal wall. Both types of vaginal prolapse may occur together with or without uterine prolapse.

What are the symptoms?

The symptoms of any type of uterine or vaginal prolapse may include:

  • A feeling of fullness in the vagina.

  • A lump protruding into or even out of the vagina.

  • A dragging sensation or mild pain in the lower back.

  • Difficulty passing urine or stools.

  • Passing urine more frequently.

A cystocele can cause leakage of urine when laughing or coughing (see Stress incontinence). It also increases the risk of an infection in the bladder (see Cystitis) because the bladder may not empty properly.

What might be done?

Your doctor may be able to see that you have a prolapse by looking at the position of the uterus and the walls of the vagina while using a speculum to hold the vagina open. He or she may ask you to cough or strain so that the prolapse can be assessed. A sample of urine may also be taken to check for infection.

Pelvic floor exercises, which strengthen the supporting muscles, can help prevent the condition from developing and should be continued indefinitely. Weight control, avoiding constipation (to avoid straining during bowel movements), and not smoking (to minimize coughing) will also reduce the likelihood of a prolapse. Some women may be offered treatment in which a plastic ring pessary is inserted into the vagina to help keep the uterus in place; the ring needs to be replaced every 6 months. Surgical techniques may also be used to treat a prolapse. The aim of surgery is to restore the uterus and/or the vagina to their normal positions. However, if a uterine prolapse is severe and surgical repositioning is not possible, you may be offered a hysterectomy to completely remove the uterus.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

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