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Uterine Prolapse

(Pelvic Floor Hernia; Pudendal Hernia; Pelvic Relaxation)

Definition

Uterine prolapse occurs when the uterus slips out of place and into the vaginal canal. The severity of uterine prolapse is defined as:
Uterine Prolapse
uterine prolapse
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Causes

The uterus is normally supported by pelvic connective tissue. It is held in position by special ligaments. Weakening of the tissue causes the uterus to descend into the vaginal canal.

Risk Factors

Uterine prolapse is more common in Caucasians.
Factors that may increase your chance of uterine prolapse include:

Symptoms

Symptoms may include:

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Uterine prolapse without symptoms may be diagnosed during routine examinations. Your doctor may refer you to a gynecologist, who will do a pelvic exam.

Treatment

Talk with your doctor about the best treatment plan for you. First or second degree prolapse without symptoms may not require treatment. Treatment options include:

Kegel Exercises

Kegel exercises involve tensing the muscles around the vagina and anus, holding for several seconds, then releasing. The repetition of this exercise will help to tone pelvic muscles.

Medication

Your doctor may recommend estrogen therapy. This may help prevent further weakness of the pelvic floor.

Pessary Insertion

Your doctor may insert a pessary into the upper portion of the vagina. A pessary is a rubbery, doughnut-shaped device. It helps to prop up the uterus and bladder. Pessary placement is more often used in older women.
Your doctor may insert a pessary into the upper portion of the vagina. A pessary is a rubbery, doughnut-shaped device. It helps to prop up the uterus and bladder. Pessary placement is more often used in older women.

Surgery

Surgery may be needed for severe uterine prolapse. These procedures are usually not done until you have finished having children. Options include:
  • Hysterectomy—This is the removal of the uterus. This will permanently resolve uterine prolapse.
  • Vaginal repair—This is usually done with a hysterectomy. The repair can be done with sutures or with insertion of mesh and slings.
  • Colpocleisis—This involves closing the vagina. It is done only in women who are elderly and who are no longer sexually active.

Prevention

To help reduce your chance of uterine prolapse:

RESOURCES

American Congress of Obstetricians and Gynecologists http://www.acog.org

Office on Women's Health http://www.womenshealth.gov

CANADIAN RESOURCES

Canadian Women's Health Network http://www.cwhn.ca

Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

References

Pelvic organ prolapse. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 23, 2015. Accessed March 8, 2016.

Pelvic organ prolapse. International Urogynecological Association website. Available at: http://c.ymcdn.com/sites/www.iuga.org/resource/resmgr/Brochures/eng%5Fpop.pdf. Published 2011. Accessed March 23, 2016.

Uterine and vaginal prolapse. The Merck Manual Professional Edition. Available at: http://www.merckmanuals.com/professional/gynecology%5Fand%5Fobstetrics/pelvic%5Frelaxation%5Fsyndromes/uterine%5Fand%5Fvaginal%5Fprolapse.html. Updated December 2013. Accessed March 8, 2016.

Vaginal pessary. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/drugs-procedures-devices/procedures-devices/vaginal-pessary.html. Updated May 2015. Accessed March 8, 2016.

10/21/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Shariati A, et al. High-fiber diet for treatment of constipation in women with pelvic floor disorders. Obstet Gynecol. 2008;111:908-913.

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