Procidentia or Prolapsed Uterus: Symptoms, Causes, Treatment

Overview of uterine prolapse

Procidentia occurs when the ligaments and muscles of the pelvic floor are stretched and weakened to the point that they can no longer provide support to the uterus. When this happens, the uterus slips into the vagina or bulges out of it. Uterine prolapse may occur at any age in a woman, but it most often occurs in postmenopausal women with a history of one or multiple vaginal deliveries.

Uterine prolapse is divided into five stages depending on how far the uterus protrudes into the vagina:

• Grade 0: There is no prolapse of the uterus.
• Grade 1: The uterus protrudes into the upper portion of the vagina.
• Grade 2: The uterus protrudes up to the vaginal introitus (vaginal opening).
• Grade 3: The uterine cervix protrudes and reaches outside the vaginal introitus.
• Grade 4: The uterus and the cervix both protrude and lie completely outside the vaginal introitus.

Treatment may not be necessary for mild prolapsed uterus, but if it causes uncomfortable symptoms or disturbs routine life, treatment might be beneficial.

Symptoms of procidentia

Mild uterus prolapse usually doesn’t have any symptoms. But these are some of the symptoms and signs of severe or moderate uterine prolapse:

• Sensation of pulling or heaviness in the pelvic region
• Tissue bulging from the vagina
• Urinary issues such as leakage of urine (incontinence) or retention of urine
• Difficulty passing stool 
• A sensation of something falling out of the vagina or a feeling while sitting that there’s a small ball underneath you
• Sexual issues such as loosening of vaginal tone

Often, symptoms of uterine prolapse cause fewer problems during the morning hours and are more bothersome during the evening.

Prolapsed uterus: causes and risk factors

Prolapsed uterus occurs due to weakening of the muscles and supportive tissues of the pelvis. The pelvic tissues and muscles may weaken due to the following reasons:

• Pregnancy
• Vaginal deliveries
• Trauma while delivering a baby or tough and exhausting labor and delivery
• Delivering a large infant
• Being overweight
• Lower levels of estrogen after menopause
• Chronic bronchitis or cough
• Chronic straining while passing stool or constipation
• History of pelvic surgery
• Lifting heavy objects repeatedly

Treatment of uterus prolapse

Treatment of prolapsed uterus depends on how severe the condition is. According to the severity, your doctor may recommend one or more of the following treatments.

Lifestyle and exercise

Various self-care measures including lifestyle changes and exercise may provide relief if your uterine prolapse causes no or few symptoms. Your doctor may recommend the following self-care measures:

• Do Kegel exercises to strengthen and support the pelvic muscles and tissues.
• Eat foods rich in fiber and drink lots of fluids to avoid constipation.
• Avoid straining and bearing down while passing stool.
• Don’t lift heavy objects.
• Take measures to control coughing.
• If you’re overweight, take measures to lose weight.

Surgery

Your physician may recommend surgery to repair a prolapsed uterus. When deciding on whether or not to have surgery, one of the major factors is the gravity of your symptoms. Your doctor may also consider the following:

• Age: If you are having surgery at a younger age, there are chances of recurrence of your uterine prolapse. If you are considering having surgery during old age, your history of previous surgeries and overall health may have an impact on the kind of surgery your doctor may recommend for uterus prolapse.
• Plans for future pregnancies: If you plan to get pregnant, it’s ideal to postpone your surgery until your family is complete, if possible. This is because prolapse may recur after pregnancy even if you’ve had corrective surgery before.
• Health conditions: There are risks associated with corrective surgery for uterine prolapse if you have a chronic health condition such as heart disease, breathing problems, or diabetes or if you are overweight or smoke. 

Surgery may help relieve many of your symptoms, but it may also cause new problems such as pelvic pain, pain while having sex, or urinary incontinence.

Types of surgery for uterine prolapse:

There are three kinds of surgery for uterus prolapse including:

1. Obliterative surgery: In this procedure, the surgeon closes off or narrows the vaginal cavity to provide support to the prolapsed uterus. It isn’t possible to have penetrative sexual intercourse after this surgery.
2. Reconstructive surgery: In this procedure, the surgeon repairs the weakened tissues of the pelvic floor and restores the prolapsed organs to their normal position. They may approach the pelvic region either through the vagina or through the abdomen. They may graft body tissue, synthetic material, or donor tissue to the weakened pelvic tissues to put the uterus back in its normal position.
3. Hysterectomy: The doctor may recommend the removal of the uterus in certain cases of severe procidentia.

Vaginal pessary

A vaginal pessary is a rubber or a plastic ring that is inserted into the vagina to provide support to the protruding tissues. It’s a good method for supporting a uterine prolapse. A vaginal pessary may be a good option if you don’t want to undergo surgery, have another medical illness that makes corrective surgery risky, or plan to get pregnant.

There are different kinds and sizes of pessaries available, and your physician will choose the best one according to your condition. The type of pessary that is most commonly used is the ring pessary. It is important to get the right size of pessary, and finding your correct size may require more than a single attempt. It’s vital to regularly remove and clean a pessary.

When to see a doctor about procidentia

Many women who have a prolapsed uterus don’t require treatment. You may need treatment if symptoms cause distress or become bothersome. Your doctor may decide to treat the condition based on these factors:

• Your age
• Sexual activity
• Desire to have children in the future
• Severity of symptoms
• Degree of uterine prolapse
• Other medical problems

A general gynecologist can do the workup for uterus prolapse if you don’t have any associated bowel, sexual, or urinary health problems. If you have concurrent symptoms, then a team of different healthcare professionals (which may include a urologist, a urogynecologist, a colorectal surgeon, a geriatrician, a physiotherapist who specializes in women's health, and/or specialized nursing staff) may participate in your care too because the gastrointestinal and urinary outlets are so near each other in the body.

Wrapping up

Procidentia or uterine prolapse occurs due to weakening of the muscles and tissues of the pelvic floor. Symptoms may develop gradually, and you may not notice them initially. Lifestyle changes and pelvic floor exercises may provide relief from symptoms for some people. For others, a vaginal pessary can relieve symptoms. If nonsurgical treatments don’t relieve your symptoms, surgery may be a good option for treating a uterine prolapse.