Out of the various health issues that are experienced by women, due to their distinct physiological structure, uterine prolapse is a topic that is often left undiscussed due to stigma or lack of awareness. However, many women suffer from it, not only in Malaysia but across the world.

Let’s understand the causes, symptoms, stages, and treatments to demystify the condition and obtain timely medical intervention in this guide.

Stages of Uterine Prolapse

Uterine prolapse is categorised into four stages based on the extent of the uterus’s descent from its normal position:

• Stage 1 (Mild): The uterus descends slightly into the vagina but remains above the vaginal opening. Symptoms are often mild or absent.
• Stage 2 (Moderate): The uterus drops further into the vaginal canal, approaching or reaching the vaginal opening, causing noticeable symptoms like pelvic discomfort.
• Stage 3 (Severe): The uterus partially protrudes outside the vaginal opening, leading to significant discomfort and visible tissue.
• Stage 4 (Complete): Also known as total uterine prolapse, the uterus is entirely outside the vaginal opening, often accompanied by severe symptoms and complications.

Each stage requires different levels of management, from lifestyle adjustments to surgical interventions, depending on the severity and impact on quality of life.

Uterine Prolapse Causes

Uterine prolapse is caused by the weakening of the pelvic floor muscles and supporting tissues, which can result from various factors, including:

• Childbirth Trauma: Vaginal deliveries, especially with large babies, prolonged labour, or the use of instruments like forceps, can strain or damage pelvic muscles.
• Ageing and Menopause: Reduced oestrogen levels after menopause weaken the pelvic tissues, increasing the risk of prolapse.
• Chronic Pressure on the Pelvic Floor: Conditions like chronic coughing (from smoking or lung issues), obesity, or persistent constipation can exert pressure on the pelvic floor muscles.
• Heavy Lifting: Repeatedly lifting heavy objects can strain the pelvic support system.
• Genetic Predisposition: Inherited connective tissue disorders or a family history of pelvic organ prolapse can increase susceptibility.
• Previous Pelvic Surgery: Surgeries, such as a hysterectomy, may weaken the pelvic floor, contributing to prolapse over time.

By understanding these causes, women can adopt preventive measures and seek timely medical advice to reduce their risk.

Types of Uterine Prolapse

Uterine prolapse can be categorised into two main types based on the extent of the uterus’s descent:

Each type requires tailored management or treatment, ranging from conservative measures for incomplete prolapse to surgical intervention for complete prolapse.

Recognising Uterus Prolapse Symptoms

The symptoms of uterine prolapse can vary based on the stage and severity of the condition. Common symptoms include:

• Pelvic Pressure or Heaviness: A sensation of heaviness or pulling in the pelvis.
• Visible Tissue Protrusion: In severe cases, women may notice tissue protruding from the vaginal opening.
• Urinary Issues: Difficulty urinating, frequent urination, or urinary incontinence.
• Bowel Problems: Straining during bowel movements or feeling of incomplete evacuation.
• Discomfort During Intercourse: Pain or discomfort during intercourse.
• Lower Back Pain: Chronic ache in the lower back region.
• Worsening Symptoms After Standing or Lifting: Prolonged standing or physical exertion may increase discomfort.

If you experience any of these symptoms, consulting a healthcare provider is crucial.

Uterus Prolapse Treatment Options

The stage of the condition, the woman’s age, overall health, and desire for future pregnancies determine the treatment options opted for. Here are the primary treatment options:

Lifestyle Changes

One of the primary aspects of managing this condition is making several lifestyle changes. One of the main aspects of lifestyle management is weight management. Maintaining a healthy weight reduces pressure on the pelvic floor and can prevent worsening of the prolapse. Avoiding heavy lifting or excessive physical strain helps reduce stress on the pelvic floor muscles.

Pelvic Floor Exercises

Your doctor may suggest you do some pelvic floor exercises regularly which can help strengthen the muscles supporting the uterus, alleviating mild symptoms.

Pessary Insertion

A pessary is a removable device inserted into the vagina to provide support to the uterus. It is often used in women who are not considered for surgery or who prefer non-surgical management. Pessaries are particularly helpful for moderate prolapse and can be adjusted by a healthcare provider.

Hormone Therapy

For postmenopausal women, oestrogen therapy may help strengthen the pelvic tissues by improving blood flow and elasticity, especially when combined with pelvic floor exercises.

Surgical Options

Your doctor may consider surgery, especially if the condition is serious. During surgery, the uterus is repositioned and secured in place with stitches or mesh. It is usually recommended for women with moderate to severe prolapse who wish to preserve their uterus. In cases of severe prolapse, especially for women who no longer wish to bear children, a hysterectomy (removal of the uterus) may be necessary. Hysterectomy involves repairing weakened pelvic tissues or supporting structures to restore the uterus to its normal position.

Alternative Therapies

Some women use biofeedback or specialised physical therapy to improve pelvic floor strength and relieve symptoms. These treatments are usually used in combination with other therapies.

Observation

In mild cases where symptoms are not bothersome, doctors may recommend regular monitoring to track the progression of the condition.

Preventing Uterine Prolapse

While some risk factors for uterine prolapse, such as genetics, are beyond control, certain lifestyle changes can help reduce the risk:

• Maintain a Healthy Weight: Excess weight increases pressure on the pelvic floor muscles, which can lead to weakening and prolapse. Maintaining a healthy weight through a balanced diet and regular exercise can help prevent this.
• Practice Pelvic Floor Exercises: Regular pelvic floor exercises, such as Kegel exercises, can strengthen the muscles that support the uterus, reducing the risk of prolapse. Practice these exercises daily to improve muscle tone and function.
• Manage Chronic Conditions: Conditions like chronic coughing (from asthma, allergies, or smoking) and chronic constipation can put extra strain on the pelvic floor. Treating these conditions effectively can help prevent prolapse. Use prescribed medications, lifestyle changes, and therapies as recommended by your healthcare provider.
• Follow a Balanced Diet: A diet high in fibre helps prevent constipation, which reduces strain on the pelvic floor.
• Practice Good Posture: Good posture can alleviate pressure on the pelvic floor. Maintain a straight posture with your shoulders back and your core engaged.
• Avoid Prolonged Standing or Sitting: Prolonged periods of standing or sitting can increase pressure on the pelvic floor. Take breaks and change positions regularly, especially if your job requires long hours of sitting or standing.
• Regular Exercise: Engage in regular aerobic and strength-training exercises to improve overall muscle tone and health. This can include walking, swimming, cycling, or other activities that promote cardiovascular health and pelvic support.
• Avoid Risky Behaviours: Refrain from smoking, as it can lead to chronic coughing, which increases the risk of prolapse. Avoid heavy lifting and straining during activities like childbirth, which can weaken pelvic floor muscles.

Emotional and Psychological Impact of Uterine Prolapse

Living with uterine prolapse can have a significant emotional and psychological impact on many women. While the physical symptoms of uterine prolapse, such as pelvic pressure, urinary issues, and discomfort during sexual activity, can be challenging, the emotional toll is equally important to acknowledge.

Some of the common emotional and psychological effects of uterine prolapse include:

• Embarrassment and Shame: Women with uterine prolapse often experience feelings of embarrassment due to symptoms like visible vaginal protrusion or incontinence. These issues can be difficult to discuss, leading to feelings of shame and isolation.
• Anxiety and Worry: Concerns about the condition worsening or needing surgery can cause anxiety. The fear of not being able to perform daily tasks or feeling like a burden to others can contribute to mental stress.
• Reduced Self-Esteem: Physical discomfort, changes in body image, and challenges during intimacy can affect a woman’s confidence and self-esteem. Many women feel less attractive or less “feminine” as a result of the condition, impacting their sense of identity.
• Depression: Chronic pain, discomfort, and limitations on daily activities can lead to feelings of sadness or hopelessness. The inability to engage in social activities, exercise, or enjoy intimacy can contribute to a decline in mental well-being.
• Fear of Judgment or Stigma: Uterine prolapse is still somewhat of a taboo topic, and women may fear judgment from others, including family, friends, or healthcare professionals. This can make them hesitant to seek help or talk openly about their struggles.

Coping Strategies for the Emotional Impact

Dealing with these challenges may require considerable effort. Here are some of the things you can do:

• Open Communication: Talking openly with a trusted partner, friend, or family member about feelings can help reduce the emotional burden. Emotional support can provide reassurance and understanding, making it easier to manage both the physical and psychological aspects of the condition.
• Seeking Professional Help: Speaking with a counsellor or therapist can help women process feelings of shame, anxiety, and depression. Cognitive-behavioural therapy (CBT) and other therapeutic techniques can teach coping strategies and improve mental health.
• Join Support Groups: Connecting with other women who have experienced uterine prolapse can provide a sense of community and reduce feelings of isolation. Support groups – either in-person or online-offer emotional encouragement and shared experiences.
• Education and Awareness: Educating oneself about uterine prolapse, its causes, and treatment options can empower women to take control of their health. Feeling informed can help reduce anxiety and foster a more positive outlook.
• Therapeutic Exercises: Engaging in pelvic floor exercises, yoga, or other forms of physical therapy can improve both physical symptoms and emotional well-being. These activities help boost self-confidence and alleviate stress.

A Final Word

Uterine prolapse, though common, is a manageable condition with the right awareness and treatment. Understanding the uterine prolapse stages, identifying uterus prolapse symptoms, and exploring the available uterus prolapse treatment options can empower women to take control of their health.

If you or someone you know is experiencing signs of uterine prolapse, don’t hesitate to consult a healthcare provider. Knowledge, support, and timely intervention can make a world of difference in navigating this condition.

Sources:

• https://www.mayoclinic.org/diseases-conditions/uterine-prolapse/symptoms-causes
• https://my.clevelandclinic.org/health/diseases/uterine-prolapse
• https://www.webmd.com/women/prolapsed-uterus
• https://resources.healthgrades.com/right-care/pelvic-prolapse-surgery/uterine-prolapse
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/uterine-prolapse
• https://www.medicalnewstoday.com/articles/risk-factors