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Uterine Prolapse  
uterine prolapse

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Definition  

Uterine prolapse occurs when the uterus slips out of place and into the vaginal canal. The severity of uterine prolapse is defined as:

  • First degree—the cervix protrudes into the lower part of the vagina
  • Second degree—the cervix protrudes past the vaginal opening
  • Third degree—the entire uterus protrudes past the vaginal opening
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Causes  

The uterus is normally supported by pelvic connective tissue. It is held in position by special ligaments. Weakening of the tissue causes the uterus to descend into the vaginal canal.

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Risk Factors  

Increasing age and white race increase your chances of having uterine prolapse. Other factors include:

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Symptoms  

Symptoms may include:

  • Pelvic pressure
  • A feeling of vaginal fullness or heaviness
  • A feeling of pulling in the pelvis
  • Vaginal discharge
  • Urinary urgency and frequency
  • Urination when laughing, sneezing, coughing, or exercising
  • Protrusion of pink tissue from the vagina that may be irritated or itchy
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Diagnosis  

Your doctor will ask about your symptoms and medical history. A physical exam will also be done. Uterine prolapse that has no symptoms may be diagnosed during routine examinations. Your doctor may refer you to a gynecologist, who will do a pelvic exam.

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Treatment  

Talk with your doctor about the best treatment plan for you. First or second degree prolapse without symptoms may not require treatment. Treatment options include:

Kegel Exercises  

Kegel exercises involve tensing the muscles around the vagina and anus, holding for several seconds, then releasing. The repetition of this exercise will help to tone pelvic muscles.

Medication  

Your doctor may recommend estrogen therapy. This may help prevent further weakness of the pelvic floor.

Pessary Insertion  

Your doctor may insert a pessary into the upper portion of the vagina. A pessary is a rubbery, doughnut-shaped device. It helps to prop up the uterus and bladder. Pessary placement is more often used in older women.

Surgery  

Surgery may be needed for severe uterine prolapse. These procedures are usually not done until you have finished having children. Options include:

  • Hysterectomy —This is the removal of the uterus. This will permanently resolve uterine prolapse.
  • Vaginal repair—This is usually done with a hysterectomy. The repair can be done with sutures or with insertion of mesh and slings.
  • Colpocleisis—This involves closing the vagina. It is done only in women who are elderly and who are