Uterine Propapse / Pelvic Relaxation

Uterine prolapse ("dropped uterus") is a condition in which a woman's uterus (womb) sags or slips out of its normal position. The uterus may slip enough that it drops partially into the vagina (the birth canal), creating a perceptible lump or bulge. This is called incomplete prolapse. In a more severe case—known as complete prolapse—the uterus slips to such a degree that some of the tissue drops outside of the vagina.

Prolapse Definition

Prolapse literally means "to fall out of place." In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is generally reserved for organs protruding through the vagina, or for the misalignment of the valves of the heart.

 

Normal Female Anatomy
Illustration of normal female anatomy

 

Prolapsed Uterus
Illustration of severe endometriosis

 

Anatomy of the Vagina

The vaginal vault has three compartments: an anterior compartment (consisting of the anterior vaginal wall), a middle compartment (cervix), and a posterior compartment (posterior vaginal wall). Uterine prolapse involves the cervix.

Signs and Symptoms

Women with mild cases of uterine prolapse may have no obvious symptoms. However, as the slipped uterus falls further out of position, it can place pressure on other pelvic organs—such as the bladder or bowel—causing a variety of symptoms, including:

  • Pelvic pressure: a feeling of heaviness or pressure in the pelvis
  • Pelvic pain: discomfort in the pelvis, abdomen or lower back
  • Pain during intercourse
  • A protrusion of tissue from the opening of the vagina
  • Recurrent bladder infections
  • Unusual or excessive discharge from the vagina
  • Constipation
  • Difficulty with urination, including involuntary loss of urine (female incontinence), or urinary frequency or urgency1

Symptoms may be worsened by prolonged standing or walking, due to added pressure placed on the pelvic muscles by gravity.

Causes of Uterine Prolapse

Trauma incurred during the birthing process, particularly with large babies or after a difficult labor and delivery, is one of the main causes of the muscle weakness that leads to uterine prolapse. Reduced muscle tone from aging, as well as lowered amounts of circulating estrogen after menopause, may also form contributing factors in pelvic organ prolapses. In rare circumstances, uterine prolapse may be caused by a tumor in the pelvic cavity.


Genetics also may play a role; women of Northern European descent experience a higher incidence of uterine prolapse than do women of Asian and African heritage.2


Finally, increased intra-abdominal pressure, stemming from such diverse conditions as obesity, chronic lung disease and asthma, can be contributing factors in uterine prolapse.3

Risk Factors

  • One or more pregnancies and vaginal births
  • Giving birth to a large baby
  • Increasing age
  • Frequent heavy lifting
  • Chronic coughing
  • Frequent straining during bowel movements4

Statistics

In the U.S., pelvic support defects are relatively common and increase with age. One study of more than 16,000 patients found the rate of uterine prolapse to be 14.2%. The mean age at time of surgery for pelvic organ prolapse was 54.6 years.5


U.S. studies have found Hispanic race to be correlated with prolapse. By contrast, African Americans had the lowest risk of uterine prolapse. These findings were independent of parity, age, and body habitus, suggesting a genetic component to prolapse.

Stages of Uterine Prolapse

Four stages of uterine prolapse are commonly defined:

Staging Definitions

Eversion: A turning outward or turning inside out
Procidentia: A prolapse or falling down

  • Stage I of uterine prolapse is defined as descent of the uterus to any point in the vagina above the hymen (or hymenal remnants).
  • Stage II of uterine prolapse is defined as descent to the hymen.
  • Stage III of uterine prolapse is defined as descent beyond the hymen.
  • Stage IV of uterine prolapse is defined as total eversion or procidentia.6

Uterine prolapse always is accompanied by some degree of vaginal vault prolapse.

Screening and Diagnosis

Diagnosing uterine prolapse requires a pelvic examination. You may be referred to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist). The doctor will ask about your medical history, including how many pregnancies and vaginal deliveries you've had. He or she will perform a complete pelvic examination to check for signs of uterine prolapse. You may be examined while lying down and also while standing. Sometimes imaging tests, such as ultrasound or magnetic resonance imaging (MRI), might be performed to further evaluate the uterine prolapse.7

Treatments for Uterine Prolapse/Pelvic Relaxation

 

  1. "Uterine Prolapse," The Cleveland Clinic Health Information Center, www.clevelandclinic.org. URL: http://www.clevelandclinic.org/health/health-info/docs/2600/2662.asp?index=9782
  2. "Women's Health: Uterine prolapse," MayoClinic.com. URL: http://www.mayoclinic.com/health/uterine prolapse/DS00700/DSECTION=3
  3. "Uterine Prolapse," eMedicine from WebMD. www.emedicine.com. URL: http://www.emedicine.com/emerg/topic629.htm
  4. "Women's Health: Uterine prolapse," MayoClinic.com. URL: http://www.mayoclinic.com/health/uterine prolapse/DS00700/DSECTION=3
  5. "Uterine Prolapse," eMedicine from WebMD. www.emedicine.com. URL: http://www.emedicine.com/emerg/topic629.htm
  6. Uterine Prolapse," eMedicine fromWebMD. www.emedicine.com. URL: http://www.emedicine.com/emerg/topic629.htm
  7. "Women's Health: Uterine Prolapse," MayoClinic.com. URL: http://www.mayoclinic.com/health/uterine-prolapse/DS00700/DSECTION=6

 


While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.