Uterus Prolapse

Uterus Prolapse
Medically Reviewed by Traci C. Johnson, MD on September 24, 2022
Your uterus (or womb) is normally held in place inside your pelvis with various muscles, tissue, and ligaments. Because of pregnancy , childbirth or difficult labor and delivery , in some women these muscles weaken. Also, as a woman ages and with a natural loss of the hormone estrogen , their uterus can drop into the vaginal canal, causing the condition known as a prolapsed uterus.
Symptoms of a prolapsed uterus include:
Seek medical care immediately if you have any of the following:
Notify your doctor if you have any of the following symptoms:
Uterine prolapse happens when vaginal childbirth or other conditions weaken the muscles and tissues of the pelvic floor so they can no longer support the weight of the uterus. It can happen as a result of:
Your health care provider can diagnose uterine prolapse with a medical history and physical examination of the pelvis.
Treatment depends on how weak the supporting structures around your uterus have become.
You can strengthen your pelvic muscles by performing Kegel exercises. You do these by tightening your pelvic muscles, as if trying to stop the flow of urine. This exercise strengthens the pelvic diaphragm and provides some support. Have your health care provider instruct you on the proper ways to isolate and exercise the muscles.
Estrogen (a hormone) cream or suppository ovules or rings inserted into the vagina help in restoring the strength and vitality of tissues in the vagina. But estrogen is only for use in select postmenopausal women.
Depending on your age and whether you wish to become pregnant, surgery can repair the uterus or remove it. When indicated, and in severe cases, your uterus can be removed with a hysterectomy . During the surgery, the surgeon can also correct the sagging of the vaginal walls, urethra, bladder, or rectum. The surgery may be performed by an open abdominal procedure, through the vagina, or through small incisions in the abdomen or vagina with specialized instruments.
If you do not want surgery or are a poor candidate for surgery, you may decide to wear a supportive device, called a pessary, in your vaginal canal to support the falling uterus. You can use this temporarily or permanently. They come in various shapes and sizes and must be fitted to you. If your prolapse is severe, a pessary may not work. Also, pessaries can be irritating inside your vagina and may cause a foul-smelling discharge.
If you are not a good candidate for a hysterectomy or a pessary and are not going to have intercourse again, there is an option for a surgery called colpocleisis. During this procedure, the walls of the vagina are sewn shut.
Follow-up depends on how your condition was treated.
Pessaries can be effective temporarily or permanently if they are checked and cleaned as often as necessary. Surgery can support a prolapsed uterus or remove it.
Sarah Samreen, MBBS, Instructor, Department of Health Sciences, Ziauddin Medical University, Pakistan.
George Lazarou, MD, FACOG, Director, Urogynecology and Reconstructive Pelvic Surgery.
Jack D. Weiler, MD, Montefiore Medical Center and assistant professor, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine.
Aneela Naureen Hussain, MD, MBBS, assistant professor, Department of Family Practice, State University of New York Downstate Medical Center.
Suhaib Waqarul Haq, MBBS, Medical Officer, Department of Radiology, Abbasi Shaheed Hospital, Karachi, Pakistan.
Jeter (Jay) Pritchard Taylor III, MD, vice-chief/compliance officer Department of Emergency Medicine, Palmetto Richland Memorial Hospital, University of South Carolina.
Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine.
Lee P. Shulman, MD, professor of Obstetrics and Gynecology, head, Section of Reproductive Genetics, Feinberg School of Medicine, Northwestern University, Chicago.
Cleveland Clinic: “Cystocele (Fallen Bladder).”
John Hopkins Medicine: “Uterine prolapse.”
StatHealth : “Pelvic Prolapse Imaging.”
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Uterine prolapse is a common condition that can happen as a person ages. Over time, and with multiple vaginal childbirths, the muscles and ligaments around your uterus weaken. When this support structure starts to fail, your uterus can sag out of position. Treatment for uterine prolapse involves surgical and nonsurgical options based on the severity of the prolapse.

Chen CJ, Thompson H. Uterine Prolapse. (https://www.ncbi.nlm.nih.gov/books/NBK564429/) [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 9/7/2022.
Merck Manual Professional Version. Uterine and Apical Prolapse. (https://www.merckmanuals.com/professional/gynecology-and-obstetrics/pelvic-organ-prolapse-pop/uterine-and-apical-prolapse) Accessed 9/7/2022.
National Health Service. Pelvic Organ Prolapse. (https://www.nhs.uk/conditions/pelvic-organ-prolapse/) Accessed 9/7/2022.
The American College of Obstetricians and Gynecologists. Pelvic Support Problems. (https://www.acog.org/womens-health/faqs/pelvic-support-problems) Accessed 9/7/2022.
US Department of Health and Human Services, Office on Women’s Health. Pelvic Organ Prolapse. (https://www.womenshealth.gov/a-z-topics/pelvic-organ-prolapse) Accessed 9/7/2022.

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Uterine prolapse is a condition where the muscles and tissues around your uterus become weak. This causes your uterus to sag or drop down into your vagina . It can happen to anyone assigned female at birth (AFAB), but is most common after menopause and in people who’ve had more than one vaginal delivery.
The muscles, ligaments and tissues in your pelvis are called your pelvic floor muscles . These muscles support your uterus, rectum, vagina, bladder and other pelvic organs. A prolapse occurs when your pelvic floor muscles are damaged or weakened to the point where they can no longer provide support. This causes your pelvic organs to drop into or out of your vagina.
Uterine prolapse can be mild or severe depending on how weak the supporting muscles of your uterus have become. In an incomplete prolapse, your uterus may have slipped enough to be partway in your vagina. This creates a lump or bulge. In a more severe case, your uterus can slip far enough that it comes out of your vagina. This is called a complete prolapse.

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Your healthcare provider may use a system to classify uterine prolapse. The stages of uterine prolapse are:
Uterine prolapse is most likely to happen in people who:
Menopause occurs when your ovaries stop producing the hormones that regulate your monthly menstrual period . One of these hormones is estrogen . This particular hormone helps keep your pelvic muscles strong. Without it, you’re at a higher risk of developing a prolapse.
Uterine prolapse is a fairly common condition. Your risk of developing the condition increases with age. You’re also at a higher risk of uterine prolapses if you’ve had multiple vaginal deliveries.
Uterine prolapse can disrupt normal activities and be uncomfortable. Very mild cases may not require treatment or cause any discomfort. However, severe cases may make it difficult to pee or have a normal bowel movement. Uterine prolapse is typically a quality of life issue, and healthcare providers treat it when symptoms of the condition begin to interfere with your daily life.
If you have a mild case of uterine prolapse, you may not have any obvious symptoms. But as your uterus slips farther out of position, it can put pressure on other pelvic organs — such as your bladder or bowel — and cause symptoms like:
Symptoms can get worse when you stand or walk for long periods of time or when you cough and sneeze. In these positions, gravity puts extra pressure on your pelvic muscles.
Your uterus is held in place within your pelvis by a group of muscles and ligaments (pelvic floor muscles). When these structures weaken, they become unable to hold your uterus in position and it begins to sag. Several factors can contribute to the weakening of the pelvic muscles, including:
Other organs in your pelvic region can fall out of position when the muscles around it become too weak. Some of the other types of pelvic organ prolapse are:
Your healthcare provider will perform a pelvic examination to determine if your uterus has lowered from its normal position. During a pelvic exam, your healthcare provider inserts a speculum (an instrument that lets them see inside your vagina) and examines your vagina and uterus. Your provider will feel for any bulges caused by your uterus dropping down into your vaginal canal. They may also ask you to cough, strain or act like you’re holding in your pee. This can help them see how weak your muscles are.
There are surgical and nonsurgical options for treating uterine prolapse. Your healthcare provider will pick your treatment path based on the severity of your prolapse, your general health, age and whether or not you want children in the future. Treatment is generally effective for most people. Treatment options can include:
It depends on the severity of the prolapse. In mild cases where your quality of life isn’t affected, your healthcare provider may not recommend treatment. Uterine prolapse can affect other organs in the pelvic area of your body (like your bladder and rectum). Healthcare providers typically recommend treatment when uterine prolapse becomes bothersome.
No, you can’t push your uterus back up. Only your healthcare provider can treat a prolapsed uterus.
Some factors like having multiple vaginal births or experiencing menopause can’t be avoided.
There are ways to reduce your risk of developing a prolapse. A few lifestyle tips that can reduce your risk of prolapse include:
There are several tips for lifting heavy objects that can help you avoid injury, including:
Most of the time, treatment for uterine prolapse is effective. But sometimes, a prolapse can come back. This is more common if you:
In most cases, the outlook for uterine prolapse is very good. Seeking treatment and making lifestyle changes (maintaining a healthy weight and exercising) can help prevent a prolapse from happening again. Talk to your healthcare provider about any concerns you may have about prolapses. Your provider can help develop a treatment plan and build good lifestyle habits to prevent any future prolapses.
Contact your healthcare provider if you have any of the following signs of uterine prolapse:
Uterine prolapse is a condition common in people who’ve had several vaginal deliveries or have gone through menopause. Symptoms vary depending on how far your uterus has slipped out of place, but it can be quite uncomfortable. Talk to your provider if you have symptoms of a prolapsed uterus like bulging from your vagina or pressure in your pelvic area. There are treatments to help you feel better before other organs are affected.
Last reviewed by a Cleveland Clinic medical professional on 09/07/2022.

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Ferri FF. Pelvic organ prolapse. In: Ferri's Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed May 31, 2022.
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Hoffman BL, et al. Pelvic organ prolapse. In: Williams Gynecology. 4th ed. McGraw Hill; 2020. https://accessmedicine.mhmedical.com. Accessed May 31, 2022.
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A diagnosis of uterine prolapse often occurs during a pelvic exam. During the pelvic exam your health care provider may have you:
You also might fill out a questionnaire. This helps your provider assess how uterine prolapse affects your life. This information helps guide treatment decisions.
If you have severe urinary incontinence, you might have tests to measure how well your bladder works. This is called urodynamic testing.
Pessaries come in many shapes and sizes. The device fits into the vagina and provides support to vaginal tissues displaced by pelvic organ prolapse. A health care provider can fit a pessary and help provide information about which type would work best.
If you have uterine prolapse and it doesn't bother you, treatment may not be needed. You might choose to wait and see what happens. But when prolapse symptoms bother you, your provider may suggest:
Surgery may be needed to repair uterine prolapse. Minimally invasive surgery, called laparoscopic surgery, or vaginal surgery might be an option.
If you only have a uterine prolapse, surgery may involve:
But if you have prolapse of other pelvic organs along with uterine prolapse, surgery may be a bit more involved. Along with a hysterectomy to take out the uterus, your surgeon may also:
All surgeries have risks. Risks of surgery for uterine prolapse include:
Talk with your health care provider about all your treatment options to be sure you understand the risks and benefits of each.
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Depending on how severe uterine prolapse is, self-care measures might provide relief from symptoms. You might try to:
Kegel exercises can strengthen pelvic floor muscles. A strong pelvic floor provides better support for pelvic organs. This might relieve symptoms that can happen with uterine prolapse.
Kegel exercises might be most successful when a physical therapist teaches them and reinforces the exercises with biofeedback. Biofeedback uses monitoring devices that help ensure proper tightening of the muscles for long enough to work well.
Once you learn how to do them properly, you can do Kegel exercises discreetly just about anytime, whether sitting at a desk or relaxing on the couch.
For uterine prolapse, you may see a doctor who specializes in conditions affecting the female reproductive system. This type of doctor is called a gynecologist. Or you may see a doctor who specializes in pelvic floor problems and reconstructive surgery. This type of doctor is called a urogynecologist.
Here's some information to help you get ready for your appointment.
For uterine prolapse, some basic questions to ask include:
Don't hesitate to ask other questions you have.
Your provider is likely to ask you questions, including:
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