Pelvic floor disorders, which include pelvic organ prolapse, urinary incontinence, and fecal incontinence, are common and affect almost 25% of women in the U.S.1 Pelvic organ prolapse can affect both men and women, but it is particularly common in women. The physical stress and strain of pregnancy and childbirth can weaken or damage the muscles and tissues of the pelvic floor, especially in women who have had multiple children.
Ahead, we’ll examine prolapse of the uterus in more detail, including the causes of uterine prolapse, symptoms, and treatment options. First, it’s necessary to understand the basic anatomy of the pelvic floor.
What Is the Pelvic Floor?
The pelvic floor is a hammock-like system of muscles that keeps your pelvic organs—uterus, vagina, bladder, urethra, and bowel—firmly in place.
The pelvic floor muscles are part of your core; they help your body maintain intra-abdominal pressure when you sneeze, cough, laugh, or otherwise physically exert yourself. If you’ve given birth and you notice that you lose a drop or two of urine when
you laugh, cough, sneeze, or exercise, you’re not alone. A quarter to a third of women in the U.S. will experience it at some point.1,2 It’s called stress urinary incontinence, and it happens when the pelvic floor muscles become weakened.
Since the pelvic floor muscles are also involved in orgasm, weak muscles can lead to diminished sexual satisfaction during vaginal intercourse.
When the pelvic floor muscles become weakened from pregnancy, childbirth, or changes that occur during menopause, an organ (such as the uterus) can slip from its normal position in the pelvis and begin pressing against the vaginal wall. In the case of a prolapsed uterus, the organ can begin to slide down into the vagina.
Any of the pelvic organs can be affected by prolapse; in fact, the bladder is the most commonly affected organ, with the uterus not far behind.
In short, strong muscles are vital for pelvic floor health. It’s important to know that while prolapse is common, it isn’t always a major health problem, and it doesn’t always get worse. In some women, it can get better with time. It’s important to look at causes, symptoms, treatments, and everyday steps you can take to prevent/improve prolapse.
Causes of Prolapsed Uterus
The following conditions can cause uterine prolapse:
- Pregnancy, childbirth, and complicated (or normal) vaginal delivery
- Loss of tissue and tone, and/or loss of natural estrogen after menopause
- Chronic cough (e.g., from asthma or bronchitis), which leads to increased abdominal pressure
- Being overweight or obese, which creates additional strain on the pelvic muscles
- Major surgery in the pelvic area, which can weaken tissues in the pelvis
- Smoking, which can damage tissues and lead to chronic cough
- Excess/improper weight lifting, which creates intra-abdominal pressure
Symptoms of Prolapse
A minor prolapse may not cause symptoms. In fact, in many cases, a woman’s doctor may discover prolapse during a routine pelvic exam. If you do have symptoms, they may include:
- A feeling of fullness, pressure, or bulging in your pelvis (many women describe this as a feeling of sitting on a small ball)
- Feeling that something is falling out of your vagina
- Difficulty with urination or defecation
- Chronic constipation
- Low back pain
- Painful sexual intercourse and/or bleeding with intercourse
- Discomfort while walking
Symptoms of pelvic organ prolapse often become worse when standing, jumping, or lifting heavy objects.
Stages of Prolapsed Uterus
Pelvic organ prolapse is often categorized in stages, from 0 to 4:
- Stage 0: There is no prolapse; the pelvic organs are well supported.
- Stage 1: The pelvic organ (e.g., cervix) has begun to drop into the vagina.
- Stage 2: The pelvic organ has dropped just inside the opening of the vagina.
- Stage 3: The pelvic organ is beginning to bulge beyond the vaginal opening.
- Stage 4: The entire organ is outside the vagina. Also called procidentia, it is caused by weakness in all of the supporting muscles of the pelvic floor.
To diagnose a prolapsed uterus, your doctor will perform a pelvic exam and take your medical history. He or she may also order tests, such as a computed tomography (CT) scan, which uses x-rays to take detailed pictures of your pelvic organs; an intravenous pyelogram, which uses x-rays to show the position, size, and shape of your pelvic organs; an ultrasound, to rule out other problems; and other tests.
Treatments for Prolapsed Uterus
Although prolapse is common, our bodies are quite tough and resilient, and milder cases of prolapse after childbirth can often be rehabilitated with regular physiotherapy and physical training. When this isn’t possible, supportive devices or surgery may
become necessary.
Non-surgical treatments can include:
- Kegel exercises to help strengthen the pelvic floor muscles
- Estrogen replacement therapy
- Wearing a pessary—a device inserted into the vagina that helps push up and stabilize the cervix and uterus
- Avoiding heavy lifting
- Getting a chronic cough under control
Surgical treatments can include:
- Hysterectomy to remove the uterus (through the abdomen or vagina); whether this is an option will depend on the severity of your prolapse, your medical history, and whether you plan on having children in the future. There are also other considerations, including hormonal changes that can occur after a hysterectomy. Your gynecologist will counsel you on the pros and cons of a hysterectomy.
- Uterine suspension, in which the surgeon moves the uterus back into its normal position using mesh/sling devices or by repairing ligaments.
What You Can Do
You might be surprised to learn that if you’ve given birth vaginally, you may already have some degree of prolapse. You may already be experiencing symptoms that aren’t giveaways of prolapse—a frequent sensation of having to urinate or leaking a drop or two of urine when you run or cough, or even hip or back pain.
Whether or not you’re experiencing symptoms, it’s important to protect your pelvic floor to ensure that mild prolapse doesn’t get worse. Here’s what you can do: 
Eat a high fiber diet. Eating a healthy, whole foods diet with plenty of fiber can help keep you regular and prevent constipation.
Do Kegel exercises. This is one of the most important ways to strengthen your pelvic floor muscles. Here’s how to do Kegels:
- Find the right muscles: Identify your pelvic floor muscles by stopping the flow of urine midstream and squeezing your anal muscles. If you’re able to do this successfully, you’ve identified the right muscles.
- Get in position. You can do Kegel exercises standing up, sitting, or lying down. Many women find it easiest lying down.
- Focus. Squeeze, tightening only the pelvic floor muscles and avoiding flexing your abdominal muscles, thighs, or buttocks. Don’t hold your breath—breathe naturally.
- Repeat. Aim for 10 repetitions, three times a day. Try doing your Kegels when you first wake up, while on break or lunch at work, and while lying in bed at night.
If you have difficulty identifying your pelvic floor muscles, you might consider using a Kegel exerciser device, which can be inserted vaginally, equipped with biofeedback sensors that help you identify and contract the right muscles.
Get constipation under control. Repeated straining or even a single episode of intense straining can damage your pelvic floor muscles. Keep constipation under wraps by incorporating plenty of fiber into your diet and using a gentle vegetable laxative or an enema when needed. If you’ve tried everything and are still having problems with chronic constipation, talk to your doctor about other options.
Use correct bowel emptying technique and position. Squatting opens the colon to allow for easier evacuation. A simple toilet stool that you place your feet on while sitting on the toilet can help you get into the ideal position for easier, more complete bowel movements.
Manage your weight. Carrying excess weight puts additional strain on your pelvic floor, which can weaken the muscles over time. It also puts pressure on the bladder, which can contribute to stress incontinence and cause you to leak urine when you strain.
Exercise regularly. While it’s important to avoid exercises that put excessive strain on your pelvic floor, such as intense core exercises, strength training with heavy weights, and (for some women) running, exercise is so vital for overall health that, generally, you should not avoid it. Having good muscle tone and core strength can reduce your risk of developing prolapse or urinary incontinence. Talk to your doctor about which exercises are safe for your pelvic floor.
See your doctor. Advanced cases of pelvic organ prolapse can be devastating for women. Prolapse can make intercourse difficult or impossible and can cause a variety of uncomfortable or painful symptoms, including feelings of embarrassment. If you’ve had one or more vaginal deliveries and you’re noticing symptoms of prolapse, whether you feel a bulging sensation in your pelvis, intercourse has become uncomfortable, or you’re having difficulty with bowel movements, it’s important to see a gynecologist right away.
The caring and experienced OBGYN doctors at Crystal Run Healthcare offer a full range of gynecological care for women of all ages, including routine exams, Pap smears, prenatal and obstetrical care, in-office procedures, and minimally invasive surgery, including laparoscopic/vaginal robotic-assisted surgeries to correct uterine or pelvic organ prolapse. Call us at 845.703.6999 to schedule an appointment at one of our several New York State locations.