In women, if the pelvic floor muscles and ligaments become stretched and injured, the bladder, rectum or uterus may drop down into the vaginal walls. This is called pelvic organ prolapse. Depending on how bad the prolapse is, the uterus may just bulge into the top part of the vagina or it could stick all of the way out of the opening.
Uterine prolapse can cause a range of symptoms, depending on how far the uterus is protruding into the vagina. Common symptoms include:
- A distinct lump or bulge in the vagina
- A constant ache in the vagina
- Feelings of heaviness or pressure in the vaginal area
- Abnormal tissue sticking out of the vagina
- Persistent ache in the lower back or over the tailbone
- Problems urinating
- Frequent urinary tract infections
- Bleeding or vaginal discharge (more than normal)
- Pain during sex
Some women find that their symptoms are worse when they are standing up, straining or coughing and tend to disappear when they are lying down or relaxing. Very mild cases of uterine prolapse may cause no symptoms at all until the woman gets older.
To check to see if your uterus has prolapsed, your doctor will do a pelvic exam. To do this, he or she will insert a speculum to spread apart the walls of your vagina. During the examination, your doctor may ask you to stand up, bear down on your pelvic floor muscles (like you do when you are having a bowel movement) or cough. All of these activities put more pressure on your pelvis and make any abnormalities or disorders more obvious.
Based on the result of the exam, your doctor will be able to diagnose and categorize your prolapse. The three types of uterine prolapse are:
- First degree (mild) – the bottom of the uterus, called the cervix, protrudes into the top of the vagina
- Second degree (moderate) – the cervix is near the opening of the vagina
- Third degree (severe) – the entire uterus protrudes out of the vagina
In mild to moderate cases, pelvic floor exercises can correct uterine prolapse. These are the same exercises used to treat incontinence issues. Because some people have trouble contracting the correct muscles, a physiotherapist at In Balance Physiotherapy will be able to help you get the most out of these exercises. Your physiotherapist may also recommend:
- Inserting a cone-shaped device in your vagina to help you focus on contracting the correct muscle
- Biofeedback therapy
- Electrical stimulation to ensure the correct muscles contract
In severe cases, pelvic floor exercises will probably not be enough to pull your uterus back into its normal location. As a result, your doctor may recommend that you use a vaginal pessary. This doughnut-shaped device is inserted into the vagina to help prop up the cervix and uterus. This is only a short-term solution though, and surgery may be needed to completely repair the damage.