What Is It?

The uterus and the bladder are held in their normal positions just above the inside end of the vagina by a “hammock” made up of supportive muscles and ligaments. Wear and tear on these supportive structures in the pelvis can allow the bottom of the uterus, the rear of the bladder or both to sag through the muscle and ligament layers. When this occurs, the uterus or bladder can create a bulge into the vagina. In severe cases, it is possible for the sagging uterus or bladder to work its way down far enough that the bulge it creates can appear at the vagina’s opening or even protrude from the opening. When the uterus sags downward, a woman has uterine prolapse. When the bladder sags, it creates bladder prolapse, also known as a cystocele.

Various stresses on the pelvic muscles and ligaments can cause weakening and lead to uterine or bladder prolapse. Understandably, the most significant stress on the pelvic support structures is childbirth. Women who have had multiple pregnancies and vaginal delivery are at an increased risk of developing prolapse of the pelvic organs. Other causes of pelvic pressure, such as constipation with a habit of frequent straining to pass stool and a chronic cough, can contribute over time to a loss of pelvic floor strength. Obesity also can strain the pelvic muscles. Support problems in the pelvis become exaggerated after menopause because the pelvic tissues depend on estrogen to help them keep their tone, and estrogen is not present in significant amounts after menopause.

Some doctors estimate that half of all women have some degree of uterine or bladder prolapse in the years following childbirth. For most women, these conditions remain undiagnosed and untreated. Only 10 percent to 20 percent of women with pelvic prolapse seek medical evaluation for symptoms.

Mild cases of bladder or uterine prolapse sometimes don’t cause any symptoms. Once a prolapse becomes more advanced, any of the following symptoms can occur:

• Pain in the vagina, pelvis, lower abdomen, groin or lower back — The pain associated with prolapse often is described as a pulling or aching sensation. The pain can be worse during sexual intercourse or menstruation.
• Heaviness or pressure in the vaginal area — Some women feel like something is about to fall out of the vagina.
• Leakage of urine, which can be worse with heavy lifting, coughing, laughing or sneezing — Stretching of the bladder’s opening often results in this problem.
• Frequent urination or a frequent urge to urinate
• Frequent urinary-tract infections, caused by the inability of the bladder to empty itself completely when you urinate
• A need to push your fingers into your vagina, into your rectum, or against the skin near your vagina to empty your bladder or have a bowel movement
• Difficulty having a bowel movement
• Pain with sexual intercourse, urinary leakage during sex, or an inability to have an orgasm
• A bulge of moist pink tissue from the vagina — This exposed tissue may be irritated and cause itching or small sores that can bleed.
• Moist discharge that soils your undergarments

Uterine or bladder prolapse usually can be diagnosed after a pelvic examination by an experienced physician. Occasionally, an X-ray video (called fluoroscopy) may be needed confirm the diagnosis. This test is performed after a dye that is visible on X-rays is placed in your rectum, your vagina and your bladder so that the outline and positioning of the uterus can be seen clearly.

In some cases, especially if you are having frequent urinary infections or if you are having difficulty holding your urine, your doctor may order one or more tests to evaluate your bladder function. An X-ray video taken after dye is inserted through your urethra to fill your bladder can show whether your bladder empties completely and whether its shape is distorted. This test is known as a voiding cystourethrogram. Other tests to view the bladder or to test the pressure inside the bladder during urination may be done, depending on the symptoms you are having.

A prolapse of the uterus or bladder usually persists, but sometimes you can reverse a mild case of prolapse by doing exercises that strengthen the pelvic muscles. The degree and severity of the prolapse can increase over time as the woman ages. This can occur more rapidly in some women than in others. Advanced or severe cases of prolapse usually do not respond to exercise or hormonal therapy. Surgery often improves or cures pelvic organ prolapse.

You can take some simple steps to limit stress on the pelvic support system, especially if you have given birth vaginally or have given birth one or more times. Limit your heavy lifting and avoid unnecessary straining to have bowel movements. Avoid smoking so that you have a lower risk of chronic cough. Maintain a normal body weight through careful diet and exercise.

Estrogen supplements after menopause has been credited with helping to maintain strong pelvic muscles and ligaments, but there is no strong evidence that hormone-replacement medicine after menopause prevents or treats a bladder or uterine prolapse. There are known health risks associated with hormone replacement, and in most women, the risks outweigh the benefits. If you are interested in taking hormone-replacement medication, you should review the pros and cons of this treatment with your physician.

For mild cases, measures to strengthen pelvic floor muscles may be enough to limit symptoms from prolapse. Exercises known as Kegel exercises are an excellent way to increase your pelvic support. To perform Kegel exercises, you need to squeeze the pelvic floor muscles that you would use if you were trying to hold back urine or trying to stop urinating when your bladder was only partly empty. Most doctors advise women with pelvic-muscle weakness to tighten these muscles and hold them tight for a few seconds at a time, repeating the exercise 10 times in each session and performing approximately four sessions each day. Over time, most women notice improvement in bladder control and may have a decrease in pain or pressure symptoms.

A physician can fit a rubbery, ring-shaped device called a pessary into the upper portion of your vagina. Pessaries can help to prop up the uterus and bladder and prevent them from sagging into the vagina. They are removable so they can be washed periodically.

A prolapsed bladder or uterus may need to be corrected with surgery, which can be performed through the vagina or the abdomen. The pelvic reconstruction procedure that is chosen depends on the woman’s age, severity of the symptoms, medical history, desire for future fertility and desire to be able to have sex. The goals are to restore normal anatomy, relieve symptoms, restore normal bowel and bladder function, and restore the ability to have sex. In some cases, surgical removal of the uterus (hysterectomy) is recommended.

Prolapse of the pelvic organs is generally a non-threatening problem. It is reasonable to contact your physician for an evaluation if you are having bothersome symptoms, and you suspect you might have this problem.

Minor prolapse of the uterus or bladder can be corrected with strengthening exercises of the pelvic floor muscles. Once prolapse has progressed to a more advanced stage, it will persist and worsen without surgical treatment or pessary support. Mild to moderate prolapse is unlikely to cause significant medical consequences and may not require treatment. Advanced, severe, or complete prolapse usually requires pessary support or surgical treatment to minimize problems with urinary incontinence, urinary retention, vaginal ulceration, sexual dysfunction or difficulties with having a bowel movement.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.