Uterine prolapse is when the

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...

descends towards or through the opening of the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

. Symptoms may include vaginal fullness,

pain with sex Dyspareunia ( ) is painful sexual intercourse due to medical or psychological causes. The term ''dyspareunia'' covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the ...

, trouble urinating,

urinary incontinence Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geria ...

, and

constipation Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement ...

. Often it gets worse over time.

Low back pain Low back pain (LBP) or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feel ...

and

vaginal bleeding Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductiv ...

may also occur. Risk factors include

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...

childbirth Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births globall ...

obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...

, and chronic coughing. Diagnosis is based on examination. It is a form of

pelvic organ prolapse Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting. In m ...

, together with bladder prolapse, large bowel prolapse, and small bowel prolapse. Preventive efforts include managing chronic breathing problems, not smoking, and maintaining a healthy weight. Mild cases may be treated with a

pessary A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the locati ...

together with

hormone replacement therapy Hormone replacement therapy (HRT), also known as menopausal hormone therapy or postmenopausal hormone therapy, is a form of hormone therapy used to treat symptoms associated with female menopause. These symptoms can include hot flashes, vaginal ...

. More severe cases may require surgery such as a vaginal hysterectomy. About 14% of women are affected. It occurs most commonly after menopause.

Causes

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.

Pathophysiology

The

(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 The broad ligament of the uterus is the wide fold of peritoneum that connects the sides of the uterus to the walls and floor of the pelvis. Structure Subdivisions Contents The contents of the broad ligament include the following: * Reproduc ...

and the

ovarian ligament The ovarian ligament (also called the utero-ovarian ligament or proper ovarian ligament) is a fibrous ligament that connects the ovary to the lateral surface of the uterus. Structure The ovarian ligament is composed of muscular and fibrous tissue; ...

. 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.

Treatment

Treatment is conservative, mechanical or surgical.

Conservative

Conservative options include behavioral modification and muscle strengthening exercises such as

Kegel exercise Kegel exercise, also known as pelvic-floor exercise, involves repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes colloquially referred to as the "Kegel muscles". The exercise can be performed many t ...

Pessaries A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat Stress incontinence, stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to ...

are a mechanical treatment that supports the vagina and elevates the prolapsed uterus to its normal, correct position. Pessaries are frequently offered as a first-line treatment for uterine prolapse.

Surgery

Surgical options are many and may include a

hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may b ...

or a uterus-sparing technique such as laparoscopic hysteropexy, sacrohysteropexy or the Manchester operation.Surgical correction of uterine prolapse: cervical amputation with uterosacral ligament plication versus vaginal hysterectomy with high uterosacral ligament plication
By de Boer T, Milani F, Kluivers K, Withagen M, Vierhout M. Part o
ICS 2009 Scientific Programme, Thursday 1 October 2009
/ref> In the case of hysterectomy, the procedure can be accompanied by sacrocolpopexy. This is a mesh-augmented procedure in which the apex of the vagina is attached to the

sacrum The sacrum (plural: ''sacra'' or ''sacrums''), in human anatomy, is a large, triangular bone at the base of the spine that forms by the fusing of the sacral vertebrae (S1S5) between ages 18 and 30. The sacrum situates at the upper, back part ...

by a piece of medical mesh material. A Cochrane review found that sacral colpopexy was associated with lower risk of complications than vaginal interventions, but it was unclear what route of sacral colpopexy should be preferred. No clear conclusion could be reached regarding uterine preserving surgery versus vaginal hysterectomy for uterine prolapse. The evidence does not support use of transvaginal mesh (TVM) compared to native tissue repair for apical vaginal prolapse. The use of a transvaginal mesh is associated with side effects including

pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

, and

organ perforation Organ perforation is a complete penetration of the wall of a hollow organ in the body, such as the gastrointestinal tract in the case of gastrointestinal perforation. It mainly refers to accidental or pathologic perforation, rather than intentiona ...

. According to the

FDA The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...

, serious complications are "not rare".

Society and culture

A number of

class action A class action, also known as a class-action lawsuit, class suit, or representative action, is a type of lawsuit where one of the parties is a group of people who are represented collectively by a member or members of that group. The class actio ...

lawsuit - A lawsuit is a proceeding by a party or parties against another in the civil court of law. The archaic term "suit in law" is found in only a small number of laws still in effect today. The term "lawsuit" is used in reference to a civil actio ...

s have been filed and settled against several manufacturers of TVM devices.

References

External links

Illustrated description of Manchester Operation
at atlasofpelvicsurgery.com

treatment, from Merck Professional {{Authority control Noninflammatory disorders of female genital tract Wikipedia medicine articles ready to translate