Uterine prolapse is a very common problem that occurs when the ligaments and muscles that normally hold the uterus in place are stretched or damaged, usually by pregnancy or childbirth. As a result, the uterus drops down into the vagina. The same problem can affect the bladder (a condition called cystocele or anterior wall prolapse), the rectum (rectocele), and the top of the vagina or vaginal vault. Symptoms include a feeling of pelvic heaviness or fullness or a sense that something is falling out of the vagina (or, in the case of a rectocele, difficulty having bowel movements). You also may feel a pulling or aching in the lower abdomen or pelvis. If you have a prolapsed bladder, you may experience urine leakage when you cough, sneeze, lift heavy objects or exercise. In severe cases the uterus (or bladder) bulges into the vagina and may even protrude from the vaginal opening.
Mild cases of uterine (or bladder) prolapse don't require treatment. More bothersome cases can sometimes be helped by taking one or more of the following measures:
- Cut down or avoid caffeine, which acts as a diuretic and may worsen problems with urine leakage.
- Use a vaginal pessary, a plastic device that can be inserted into the vagina to support the pelvic organs. You must remove the pessary periodically to clean it but otherwise you can wear it continuously, even during sex.
- Try Kegel exercises, which can strengthen the muscles surrounding the openings of the urethra and vagina. To learn how to do them, log on to: http://kidney.niddk.nih.gov/kudiseases/pubs/exercise_ez/index.htm
If these measures don't help, I'm afraid the only remaining option is surgery. Hysterectomy has long been the most commonly performed operation for these problems, but pelvic support surgery, which puts the sagging organs back in place, is also done. Your gynecologist can assess whether you're a candidate or refer you to a specialist (urogynecologist) who performs these operations.
Andrew Weil, M.D.