Uterine prolapse

Overview

Uterine prolapse is when the womb (uterus) drops down into the vagina because the muscles and tissues that hold it in place become weak.

Yes, uterine prolapse is fairly common, especially in women who have had children.

It mainly affects women, most often after menopause or after having multiple vaginal births. It can also happen in younger women who have had difficult deliveries or a lot of physical strain.

Symptoms

Common symptoms

• A feeling of heaviness or pulling in the lower belly or vagina
• A bulge or lump at the opening of the vagina
• A sensation that something is ‘falling out’
• Lower back pain that eases when you lie down
• Problems with urination, like leaking, difficulty fully emptying the bladder, or needing to go often
• Constipation or trouble passing stool
• Pain during sex

Symptoms in older adults

• Older women may notice the same symptoms but also have more trouble with bladder control or feel a bulge that gets worse with standing or lifting.

Causes

Main causes

• Weakness of the pelvic floor muscles from childbirth, especially if delivery was long or difficult
• Natural ageing and lowering of oestrogen levels after menopause
• Repeated heavy lifting or chronic straining from constipation or a long-term cough

Risk factors

• Having had several vaginal births
• Being overweight or obese
• Going through menopause
• Having a family history of prolapse
• Doing heavy physical work or regular strenuous exercise

When to see a doctor

See a doctor urgently if:

• If you have sudden inability to pass urine with pain
• If the prolapse becomes very painful or changes colour (red, purple, black)

Book a routine appointment if:

• If you notice a bulge or feeling of pressure that does not go away
• If you have leaking urine or trouble emptying your bladder
• If discomfort in your lower back or pelvis is affecting your daily activities

Diagnosis

Your doctor will ask about your symptoms and do a gentle internal pelvic exam to see how far the uterus has dropped.

Tests that may be done

• Pelvic exam – you lie on your back with your knees bent and the doctor checks the position of your uterus while you cough or bear down.
• Bladder function tests – to see if you are emptying your bladder completely.
• Imaging tests like ultrasound or MRI in some cases to look at the pelvic organs.

What to expect at your appointment

The exam is usually quick and not painful. Your doctor will explain the grade of prolapse (how far it has dropped) and talk about what treatments might help.

Treatment

Treatment depends on how bothersome the symptoms are, your age, general health, and whether you plan to have more children. Options range from simple exercises to devices or surgery.

Self-care at home

• Do pelvic floor muscle exercises (Kegel exercises) to strengthen the muscles that support the uterus – your doctor or a physiotherapist can show you how.
• Avoid heavy lifting and straining during bowel movements.
• Lose weight if you are overweight to reduce pressure on the pelvis.
• Treat constipation by eating more fibre and drinking plenty of water.

Medical treatments

Your doctor may recommend a vaginal pessary – a soft ring or device that fits inside the vagina to support the uterus. Pessaries need to be cleaned and checked regularly. Hormone therapy (like oestrogen cream) may be offered for postmenopausal women to strengthen vaginal tissues. These are not specific drug names but general approaches.

When is surgery considered?

Surgery is considered when symptoms are severe or non-surgical treatments do not help. Possible procedures include repairing the pelvic floor or removing the uterus (hysterectomy). Your doctor will discuss the risks and benefits based on your situation.

Living with this condition

Many women manage uterine prolapse well with lifestyle changes and pelvic floor exercises. You can still do most daily activities, though you may need to modify heavy lifting or high-impact exercise.

Lifestyle tips

• Do pelvic floor exercises daily as advised by your physiotherapist.
• Avoid standing for long periods – take breaks to sit or lie down.
• If you use a pessary, learn how to remove and clean it as directed.
• Wear supportive underwear or a support garment if it makes you feel more comfortable.

Diet and exercise

Eat a high-fibre diet with plenty of fruits, vegetables, and whole grains to prevent constipation and straining. Drink enough water. Gentle exercises like walking, swimming, or yoga (avoid heavy weights) can help maintain a healthy weight and muscle tone.

Mental health and emotional wellbeing

It is normal to feel embarrassed or worried about a prolapse, especially if it affects your sex life or body image. Talking to your partner or a counsellor can help. You are not alone – many women have this condition.

Prevention

You cannot always prevent uterine prolapse, but you can lower your risk by keeping your pelvic floor muscles strong, maintaining a healthy weight, avoiding heavy lifting, and treating constipation promptly.

Complications

If left untreated

• Worsening of symptoms – the prolapse may progress to a higher grade and become more uncomfortable.
• Difficulty emptying the bladder or bowel completely, which can lead to urinary tract infections or constipation.
• Sores or ulcers on the prolapsed tissue if it rubs against clothing.
• Rarely, the prolapse can become stuck (incarceration) and require emergency care.

Long-term outlook

With proper management, most women with uterine prolapse can lead full, active lives. The condition does not shorten lifespan, and many women get good relief from non-surgical treatments. If needed, surgery is usually successful in correcting symptoms.

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