Uterine prolapse: symptoms, pelvic-floor care, pessary and surgery
Uterine prolapse means the womb has dropped down into the vagina because the muscles and ligaments of the pelvic floor have weakened, most often after childbirth and menopause. It is common and not dangerous in itself. Treatment ranges from pelvic-floor exercises and a pessary to an operation, chosen by how much it troubles you.
Many women live for years with a feeling of something "coming down", thinking it is just part of getting older or of having had children, and feel too shy to mention it. Prolapse is one of the most common reasons women see a gynaecologist, and there is almost always something that helps. This guide by the Pai Hospital Team explains the symptoms, the checks, and each treatment, from the simplest to surgery.
What is uterine prolapse?
The womb (uterus) is held in place by the pelvic floor: a sling of muscles and ligaments at the base of the pelvis. When this support stretches or weakens, the womb can slip down into the vagina. In a mild prolapse it drops only a little; in a severe one it can come out through the vaginal opening. The bladder can bulge into the front wall of the vagina (a cystocele) and the bowel into the back wall (a rectocele), often together with the womb. After a hysterectomy, the top of the vagina itself can drop; this is called a vault prolapse.
What are the symptoms of a prolapsed uterus?
- a heavy, dragging feeling low in the vagina or the lower back, often worse by evening;
- a soft lump or bulge at the vaginal opening, which you may feel when bathing;
- urine leaking when you cough, sneeze or lift, needing to pass urine often, or a feeling that the bladder does not empty fully;
- difficulty opening the bowels, sometimes needing to press on the vagina to do so;
- discomfort during intercourse;
- a discharge, spotting or a sore on the bulge, where it rubs on clothing.
Some women with a mild prolapse have no symptoms at all, and it is noticed only at a routine examination.
Why does the womb drop?
The main causes are vaginal births, especially several births, a long labour or a large baby, and the fall in hormones after menopause, which thins the supporting tissues. Anything that keeps pushing down on the pelvic floor adds to it: long-standing constipation and straining, a chronic cough, heavy lifting at work or at home, and being overweight. Some women have naturally weaker tissues, and prolapse can run in families.
How is prolapse checked?
The doctor asks about your symptoms, your bladder and bowel habits and your births, then examines you gently, usually lying down and sometimes while you cough or bear down, to see which part has dropped and how far. A urine test checks for infection. An ultrasound may be advised to look at the womb and ovaries before any treatment, and a Pap smear is taken if one is due. If bladder emptying is a problem, that is checked too.
Pelvic-floor care: what helps without an operation?
For a mild prolapse, or while you decide, simple measures often ease the symptoms and can stop the prolapse getting worse:
- Pelvic-floor exercises (also called Kegel exercises): squeezing and lifting the muscles you use to hold in urine and wind, done every day. You are shown how to find the right muscles, because doing them correctly is what makes them work.
- Treating constipation and a chronic cough, so there is less straining.
- Avoiding heavy lifting, and bending the knees when you must lift.
- Keeping a healthy weight, which takes pressure off the pelvic floor.
- After menopause, a vaginal hormone cream may be suggested to strengthen thin tissues, especially when a pessary is used.
What is a pessary, and who is it for?
A vaginal pessary is a soft silicone device, most often shaped like a ring, that sits inside the vagina and holds the womb up. It is fitted at an outpatient visit, without anaesthesia, and a few sizes may be tried to find one that stays in place and cannot be felt. A pessary suits women who would rather not have an operation, who are waiting for one, whose general health makes surgery a higher risk, or who still plan a pregnancy.
A pessary needs regular check-ups, when it is cleaned or changed and the vagina is examined for any rubbing or sores. Tell the doctor about any bleeding, a smelly discharge or pain, and do not wait for the next visit.
When is prolapse surgery advised?
An operation is usually discussed when the symptoms affect your daily life despite pelvic-floor care, when a pessary does not suit you or keeps falling out, or when the prolapse is large, has an ulcer on it, or makes it hard to pass urine. The choice of operation depends on which part has dropped, your age and health, and whether you wish to keep your womb.
- Vaginal hysterectomy with repair: the womb is removed through the vagina and the weak front and back walls are tightened, with no cut on the abdomen. This is the most common operation when the womb itself has dropped; read about the scarless vaginal hysterectomy.
- Repair of the vaginal walls alone: when the bladder or bowel bulge is the main problem and the womb is well supported.
- Operations that keep the womb: the womb is stitched back up to strong ligaments instead of being removed. They may be considered for younger women or for those who wish to keep the womb, and whether one suits you is discussed at the consultation.
For the wider picture of when removing the womb is and is not the right step, see our guide to hysterectomy in Goa.
What is recovery like after prolapse surgery?
Most women stay in hospital for a few days. Walking starts the next day, and light housework usually after two to three weeks. Heavy lifting, straining and intercourse are avoided for about six weeks, while the repair heals. Pelvic-floor exercises are restarted once the doctor says so and are best kept up for life, along with soft, regular bowel habits. You are told before discharge which signs need a call, such as fever, heavy bleeding or difficulty passing urine.
Is prolapse linked to menopause?
Prolapse often first shows itself in the years after menopause, when the supporting tissues lose some of their strength. If you notice heaviness or a bulge at that age, it is worth an examination rather than putting up with it. Read more about menopause care in Vasco.
What decides the cost?
The fee depends on the treatment chosen: a pessary is an outpatient fitting with follow-up visits, while an operation depends on its type, the stay and any tests needed before it. For what decides the bill for surgery, see what affects the cost of surgery in Goa; you receive a written estimate of what is included before a date is set.
Where is uterine prolapse treated?
Women are seen at Pai Hospital, Vaddem, Vasco-da-Gama, by appointment. Our consultant gynaecologist, a practising surgeon of 15 years, examines you, explains every option, and performs the operation himself when one is needed, in the hospital's own operating theatre. If you are coming from elsewhere in Goa for the consultation or the operation, we send a car for you and bring you home again, at zero cost to the patient. Send any old reports by WhatsApp before your visit. See the page on the gynaecologist in Vasco for directions and distances.
Your questions
What does a prolapsed uterus feel like?
Most women describe heaviness or a dragging feeling low in the vagina, or a soft lump or bulge at the opening, often worse at the end of the day or after standing or lifting. Some also notice urine leaking on coughing, trouble emptying the bladder or bowel, or discomfort during intercourse.
Can uterine prolapse be treated without surgery?
Often, yes, when the prolapse is mild or surgery is not wanted. Pelvic-floor exercises, treating constipation and a long-standing cough, keeping a healthy weight and avoiding heavy lifting can ease the symptoms. A pessary, a soft device worn in the vagina, can hold the womb up instead of an operation.
What is a pessary, and is it uncomfortable?
A pessary is a soft silicone device, most often ring-shaped, that sits inside the vagina and supports the womb. It is fitted at an outpatient visit without anaesthesia, and the right size usually cannot be felt once it is in place. It needs regular check-ups, when it is cleaned or changed and the vagina is examined.
When is surgery advised for uterine prolapse?
Surgery is usually discussed when the symptoms bother you despite pelvic-floor care, when a pessary does not suit you, or when the prolapse is large, has a sore on it, or makes it hard to pass urine. The most common operation is a vaginal hysterectomy with repair of the vaginal walls, done from below with no cut on the abdomen.
Can prolapse come back after treatment?
It can. The tissues that gave way are still the same tissues, so some women have a prolapse again in later years, sometimes in a different part of the vagina. Keeping up the pelvic-floor exercises, avoiding constipation and heavy lifting, and coming back early if the heaviness returns all help.
Where is uterine prolapse treated?
At Pai Hospital, Vaddem, Vasco-da-Gama, by appointment. The operations are done in the hospital's own operating theatre. If you are coming from elsewhere in Goa for the consultation or the operation, we send a car for you, at zero cost to the patient.
Or call +91 95459 20817 · +91 75582 52088 · 0832 251 3641
This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.