Prolapsed Womb

Prolapsed Womb

A condition in which the womb (uterus) descends from its normal position into the vagina.

The womb (uterus) and vagina are supported and kept in their normal position by a number of muscles and ligaments in the pelvis, called the pelvic floor.

During pregnancy, the weight of the foetus, placenta and amniotic fluid mean these ligaments have to withstand a lot more pressure than usual. The extra weight stretches and weakens them and each successive pregnancy increases the damage.

As a result, the womb may begin to sag or move downwards.

The normal ageing process can also weaken the pelvic floor. Women who are overweight are more likely to develop a prolapse. The degree of prolapse varies from first degree, in which there is only slight displacement of the womb, to third degree, where the neck of the womb can be seen outside the vulva.

Sometimes when the pelvic support fails, the condition can be complicated by the herniation of another structure into the vaginal canal. (A hernia is the protrusion of an organ or tissue out of the body cavity in which it normally lies.)

• Herniation of the bladder is called a cystocele. This can lead to urination problems, such as dribbling urine.
  
  
• Herniation of the lower rectum is called a rectocele. This can produce a feeling of rectal fullness.
  
  
• Herniation of a portion of the small intestine is called an enterocele. Few symptoms usually arise.
  
  

What are the Symptoms?

Some women with a prolapsed womb do not have any symptoms. However others experience:

• A feeling of fullness in the vagina or a feeling of something coming down into the vagina.
  
  
• A feeling of pressure on the bladder or urinary dribbling.
  
  
• Difficulties with sexual intercourse.
  
  
• In rare cases, the cervix may protrude from the vaginal opening.
  

How is a Prolapsed Womb Diagnosed?

Prolapse is diagnosed by physical examination. If the bladder is also prolapsed, investigations may be required to assess bladder function.

What is the Treatment for a Prolapsed Womb?

The choice of treatment depends on the severity of the prolapse and the symptoms caused. In less severe cases, a doctor or physiotherapist may teach pelvic floor exercises. Carrying out these exercises regularly will strengthen the muscles of the vagina.

For more severe cases, a vaginal hysterectomy (removal of the womb through the vagina) and tightening of the support ligaments and a vaginal repair may be required.

For women who do not want surgery, or who have other health problems, a pessary may be inserted into the vagina to hold the womb in position. A pessary is a plastic, ring-shaped supportive device. Pessaries will need to be replaced regularly by a doctor.

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