16030 Uterine Prolapse

Overview

Uterine prolapse happens when the uterus (womb) slips down into the vagina. The pelvic floor muscles and ligaments that normally hold the uterus in place become weak or stretched, allowing the uterus to push down. It is not life-threatening, but it can cause discomfort and affect daily life.

Yes, it is quite common. Many women have some degree of prolapse, though not everyone notices symptoms. It becomes more likely as you get older.

Uterine prolapse affects women. It is more likely after vaginal childbirth, after menopause, and with age.

Symptoms

Common symptoms

• A feeling of heaviness, pulling, or dragging in the lower belly or vagina
• A bulge or lump you can feel or see inside the vagina, or at the vaginal opening
• Discomfort or pain during sex
• Trouble passing urine or a weak urine flow
• Leaking urine when you cough, sneeze, or exercise
• A feeling that something is falling out of your vagina
• Constipation or trouble emptying your bowels

Symptoms in children

• This condition does not affect children. It is a condition that occurs in adult women.

Symptoms in older adults

• Older women may notice a dragging sensation that gets worse by the end of the day or after standing for a long time.
• They may also have more frequent urinary symptoms, such as needing to urinate often, leaking, or feeling that the bladder does not empty fully.
• The bulge may become more obvious and can sometimes rub on clothing or cause soreness.

Causes

Main causes

• Weakness in the pelvic floor muscles and supportive tissues
• Damage to the pelvic floor during childbirth, especially with a large baby or assisted delivery (forceps or vacuum)
• Low levels of oestrogen after menopause, which can thin and weaken vaginal tissues

Risk factors

• Giving birth vaginally, especially more than once
• Being overweight or obese
• Heavy lifting, straining, or a chronic cough over many years
• Long-term constipation and straining on the toilet
• Getting older
• Having a family history of prolapse

When to see a doctor

See a doctor urgently if:

• If you have sudden severe pelvic pain, cannot pass urine, or have heavy bleeding, call your local emergency number or go to emergency care right away.

Book a routine appointment if:

• If you notice a bulge, heaviness, or discomfort in your pelvic area, or if symptoms are affecting your everyday life, book an appointment with your GP or gynaecologist.

Diagnosis

A doctor can usually diagnose uterine prolapse by asking about your symptoms and doing a vaginal examination. You may be asked to lie down or stand, and to cough or bear down to see how the prolapse moves.

Tests that may be done

• A pelvic examination – the doctor or nurse gently checks inside your vagina with two gloved fingers
• A bladder function test (urodynamics) if you have leaking or bladder emptying problems
• An ultrasound scan may be used to check other pelvic organs if needed

What to expect at your appointment

The examination is quick and usually not painful. You can ask to have a female doctor or nurse, and you are welcome to bring someone with you. The doctor will explain what they find and talk through your options.

Treatment

Treatment depends on how much your symptoms bother you. For mild prolapse, pelvic floor exercises and lifestyle changes can help a lot. For more bothersome symptoms, a vaginal ring (pessary) or surgery may be considered. Your healthcare provider will help you choose the best approach for your situation.

Self-care at home

• Do pelvic floor exercises every day – a physiotherapist can teach you the correct technique
• Avoid heavy lifting and straining, and ask for help with heavy objects
• Prevent constipation by eating plenty of fibre and drinking enough water
• If you are overweight, losing weight can reduce pressure on your pelvic floor
• Keep your bladder and bowels regular, and do not rush on the toilet

Medical treatments

Your doctor or physiotherapist can guide you through pelvic floor muscle training, which is often the first step. A pessary is a soft device inserted into the vagina to hold the uterus in place; it needs to be fitted, checked, and cleaned regularly. For women after menopause, hormone treatments inside the vagina (such as creams or pessaries) may be suggested, but your doctor will discuss the benefits and risks with you. Over-the-counter medicines are not used to treat prolapse itself, so always ask your healthcare provider for advice.

When is surgery considered?

Surgery may be an option if symptoms are severe, if you have tried exercises and pessaries without relief, or if you do not want a pessary. There are different surgical approaches, including repairing the supportive tissues or, in some cases, removing the uterus (hysterectomy). Your surgical team will explain the risks, benefits, and recovery to you.

Living with this condition

Living with uterine prolapse usually means finding small ways to avoid pressure on your pelvic floor. Many women manage their symptoms with exercises and adjustments to daily activities, and they continue to lead active and enjoyable lives. It's normal to feel worried at first, but help is available.

Lifestyle tips

• Do your pelvic floor exercises regularly to keep the muscles strong
• Stay active with low-impact activities like walking, swimming, or cycling
• Avoid high-impact exercises that make symptoms worse
• Treat coughs and constipation quickly to reduce straining
• If you are overweight, aim for gradual weight loss with support from your healthcare team

Diet and exercise

Eat a fibre-rich diet with plenty of fruit, vegetables, and whole grains to prevent constipation. Drink enough water throughout the day. Gentle exercise that does not cause pain is encouraged – a physiotherapist can help you find safe and effective ways to stay fit.

Mental health and emotional wellbeing

Prolapse can affect your confidence, body image, and relationships. You might feel embarrassed, sad, or worried about the future. These feelings are normal and important. Talking to your doctor, a counsellor, or a trusted friend can help you cope and feel more in control.

Prevention

You can lower your chances of developing prolapse by keeping your pelvic floor muscles strong, avoiding heavy lifting, maintaining a healthy weight, and treating constipation early. You cannot always prevent prolapse, especially after childbirth, but these steps can reduce your risk.

Vaccines

Not applicable – there is no vaccine for uterine prolapse.

Screening programmes

There is no routine screening test specifically for prolapse. However, during regular gynaecological check-ups, a doctor may notice signs of prolapse even before you do. If you have symptoms, a pelvic exam is the way to get a clear answer.

Complications

If left untreated

• The prolapse may become more noticeable over time
• Bladder problems may worsen, such as leaking or difficulty emptying the bladder
• Bowel problems like constipation or straining may become more frequent
• The exposed vaginal tissue may become sore, infected, or ulcerated
• Relationship or sexual difficulties can develop

Long-term outlook

The outlook for uterine prolapse is generally good. With the right support, most women find that their symptoms improve and their quality of life returns. Prolapse is not dangerous and it does not shorten your life. Even if your prolapse is severe, there are many effective treatment options available.

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