Pelvic relaxation - uterine prolapse; Pelvic floor hernia; Prolapsed uterus

Treatment is not necessary unless the symptoms are bothersome. Most women seek treatment by the time the uterus drops to the opening of the vagina.

Uterine prolapse can be treated with a vaginal pessary or surgery.

VAGINAL PESSARY

A vaginal pessary is a rubber or plastic donut-shaped device that is inserted into the vagina to hold the uterus in place. It may be a temporary or permanent form of treatment. Vaginal pessaries are fitted for each individual woman. Some pessaries are similar to a diaphragm device used for birth control. Many women can be taught how to insert, clean, and remove the pessary herself.

Pessaries may cause an irritating and abnormal smelling discharge, and they require periodic cleaning, sometimes done by the doctor or nurse. In some women, the pessary may rub on and irritate the vaginal wall ( mucosa), and in some cases may damage the vagina. Some pessaries may interfere with normal sexual intercourse by limiting the depth of penetration.

LIFESTYLE CHANGES

Weight loss is recommended in women with uterine prolapse who are obese.

Heavy lifting or straining should be avoided, because they can worsen symptoms.

Coughing can also make symptoms worse. Measures to treat and prevent chronic cough should be tried. If the cough is due to smoking, smoking cessation techniques are recommended.

SURGERY

Surgery should not be done until the prolapse symptoms are worse than the risks of having surgery. The specific type of surgery depends on:

• Degree of prolapse
• Desire for future pregnancies
• Other medical conditions
• The women's desire to retain vaginal function
• The woman's age and general health

There are some surgical procedures that can be done without removing the uterus, such as a sacrospinous fixation . This procedure involves using nearby ligaments to support the uterus. Other procedures are available.

Often, a vaginal hysterectomy is used to correct uterine prolapse. Any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time.

Images

Uterus

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Review Date: 05/12/2008
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)