Uterine prolapse is a common condition, but it’s sometimes missed by women and their doctors.
Dr. Karyn Eilber, a urologist at Cedars-Sinai Medical Center and co-founder of Glissant Intimate Wellness, tells Yahoo Life that almost every woman who has given birth vaginally and about half of all women over age 50 have “some degree” of uterine prolapse, although women of any age can experience the condition.
What is uterine prolapse?
“Uterine prolapse is often referred to as a ‘falling’ uterus,” Eilber says. “It's when the uterus pushes into the vaginal canal because of loss of support.” The condition is sometimes called a hernia, since “both terms imply an organ is sticking out where it's not supposed to,” she explains.
Dr. Jill Purdie, ob-gyn and medical director at Pediatrix Medical Group, tells Yahoo Life that “this is caused by relaxation or damage to the muscles and ligaments of the pelvic floor.”
When women first notice a prolapsed uterus, Eilber says that they may be “alarmed,” because they think the protruding uterus “may be a tumor or something growing in the vagina.”
What are the symptoms of uterine prolapse?
According to Eilber, most women experiencing uterine prolapse don't have any symptoms. However, for those who do, the most obvious sign is usually “a bulge coming out of her vagina,” says Eilber. “The cervix or entrance to the uterus is usually what sticks out, and can feel firm and rounded.”
Other women may notice “pelvic pressure that increases as the day goes on … the more a woman is on her feet,” which “improves with lying down,” Eilber notes.
Lynn Julian, an actress and singer who has had uterine prolapse twice, tells Yahoo Life that the first symptom she experienced on both occasions was straightforward. She “could physically feel” her cervix “while inserting tampons.”
Edwina Caito, a content creator, knew something was wrong when she started having “incredibly heavy and uncomfortable periods, with a heaviness” in her pelvis and upper thighs. She tells Yahoo Life that she was “getting constant urinary tract infections” and had to “urinate more, with urgency.” Caito also shares that her “vagina felt dry and irritated” constantly: “Some days, it felt like I was carrying a bowling ball in my vagina.”
Unsure what was happening to her body, Caito decided to investigate herself. “I got out a mirror, hoisted my foot onto the toilet lid and stared in disbelief when I couldn't see my vaginal opening,” she says. “It was completely obstructed by a dark pink object. I could push it back up and it would fall back down. This bulge is what was making me feel dry and irritated all the time.”
Caito went to her gynecologist, but was misdiagnosed. She says that her doctor put her on medications “without testing for prolapse.” After a year of being on medication with no improvement, she went for a second opinion. Her new gynecologist tested her “for actual prolapse and was shocked that it was so bad,” Caito says.
What causes uterine prolapse?
Anything from pushing due to chronic constipation to repeated heavy lifting can cause uterine prolapse, but Eilber says that the most common cause is vaginal childbirth. Sometimes prolapse occurs shortly after childbirth, but other times it doesn’t happen until women enter their 50s or 60s, notes Eilber.
Other risk factors include previous “pelvic surgery, obesity and connective tissue disorders,” Eilber explains. Dr. Seth Cohen, a urologic surgeon and urogynecologist at City of Hope Orange County Lennar Foundation Cancer Center, tells Yahoo Life that other causes of uterine prolapse include a “decrease in estrogen as menopause approaches” and pelvic tumors. Aging is another risk factor, says Cohen, because “pelvic muscles and ligaments weaken over time.”
Caito says that her doctor told her that her uterine prolapse “was likely due to a number of things, including a forceps delivery” of her first child and “rapid delivery” of two of her other children. After Caito experienced uterine prolapse, she was diagnosed with a connective tissue disorder called Ehlers-Danlos syndrome, which may also have contributed to her prolapse.
Julian attributes her first bout with uterine prolapse to “a lifetime of exercise,” including “aerobics, trampolines and calisthenics.” She also has Ehlers-Danlos syndrome, but says her doctor doesn’t think the disorder was “solely responsible” for her prolapse. With her second uterine prolapse, Julian believes intense training for the Boston Marathon without using supportive clothing, such as compression pants, played a role.
How does uterine prolapse impact women’s lives?
While uterine prolapse can be uncomfortable, Eilber says that, in general, “prolapse doesn't cause pain.” In terms of intimacy, she explains that the uterus would get “pushed back into the vagina with sex,” so it should not impact a woman’s sex life physically. However, Eilber notes that many women with prolapse avoid sex due to embarrassment.
When Caito experienced uterine prolapse, she says that sex didn't hurt and “didn’t feel much different.” But she explains that she “was easily irritated.” Caito says that while she was experiencing uterine prolapse, her now ex-husband “said it felt tight and cozy,” which she says makes sense, because her “organs” were in her vaginal canal.
Julian’s experience, however, is different. She is still suffering the condition and says that “life with uterine prolapse makes literally everything involving that area of my body more difficult. Pelvic exams are harder to perform and more uncomfortable for me,” adding that “even everyday things, like inserting a tampon, are more difficult and uncomfortable.” As for sex, Julian says it is “awkward,” because she has to explain why her “uterus and cervix are visible.”
How is uterine prolapse treated?
For mild cases of uterine prolapse, treatment isn’t always necessary. Purdie says that “only around half” of women diagnosed with prolapse will undergo treatment. Among Eilber’s patients, some “just want to know that the bulge isn't cancer, … while other women want it treated right away.”
Treatments for mild uterine prolapse include “observation, pelvic floor physical therapy” or using a pessary, a flexible device that goes into the vagina to push up the uterus, explains Eilber.
Purdie says that “a woman has to see her physician to be fitted for the correct type of pessary that will help the most with her prolapse.” Some women with mild cases of uterine prolapse elect to have surgery, because they don’t like having a bulge or find it uncomfortable.
For more severe cases, surgery might be needed to treat the condition. “Sometimes the uterus can be lifted, but other times it may need to be removed,” Eilber explains.
On rare occasions, uterine prolapse can become an emergency. “If you are experiencing severe symptoms, such as difficulty urinating or having a bowel movement, or complete uterine prolapse, in which your uterus is outside of your vagina, seek urgent medical attention,” Cohen advises.
Julian says when she experienced her first uterine prolapse, she “had years of unsuccessful pelvic floor physical therapy to try to fix the prolapse.” When that didn’t work, she underwent surgery. However, even surgery didn’t prevent a recurrence of the problem.
She tried pelvic floor therapy again after her second prolapse but says it “was too severe to be repaired” by therapy alone. For now, she is living with the condition, although Julian says she “has not ruled out surgery in the future, to either lift up or remove my uterus completely.”
If Caito’s uterine prolapse had been diagnosed earlier, she says she would have been able to try pelvic floor physical therapy or use a pessary to treat the condition. “There is a possibility that the year I went being misdiagnosed could have worsened things, causing my only recourse to be prolapse surgery,” she explains.
To address her uterine prolapse, Caito says she needed “radical surgery” — namely, a hysterectomy, as well as anterior and posterior lifting. She also says her pelvic floor required “rebuilding,” specifically, “building a vaginal cuff with suspension, giving me a bladder and urethral sling, and tightening my outer vulva.”
Caito says, “It was a six-hour surgery that took 12 weeks of recovery. It was grueling and awful.” Still, she considers the surgery a success. “It changed my life dramatically,” she says. “The pain relief was the immediate change, the UTIs stopped, that heavy feeling and pain in my low back and upper thighs disappeared and my sex life? It was far better post-op.”
Having experienced uterine prolapse twice, Julian says she would “love to create awareness about this common problem for women, to break the stigma.” Caito feels the same way, saying that she wishes she had known more about pelvic organ prolapse before it happened to her, adding that some gynecologists are not “educating people with vaginas as they should be.”
Although some women are too embarrassed to seek help if they experience uterine prolapse, Eilber says “Prolapse is very common and nothing to be ashamed about — if a woman has prolapse and is bothered, there are doctors who can help.”
Cohen concurs. “It is always essential to voice symptoms or concerns you may have with your health care team, to ensure you receive the right diagnosis and treatment,” he says. “We want to empower patients with education to make informed decisions, from diagnosis to treatment.”
Wellness, parenting, body image and more: Get to know the who behind the hoo with Yahoo Life's newsletter. Sign up here.