A female with uterine prolapse will present with the following symptoms:

• Lower backache
• A feeling of heaviness or pressure in the lower pelvis
• Difficulty or pain in performing sexual intercourse
• Bulging out of a mass from the vagina during straining (extreme cases)
• Urinary incontinence
• Recurring lower urinary tract infections
• Vaginal bleeding
• Vaginal ulceration or sores
• Vaginal discharge

Performing any strenuous activity such as straining, squatting, exercising, lifting heavy weights, sitting for a long time or long-term constipation may worsen the symptoms.

• Falling

  Prolapse means "to fall out of place". A uterine prolapse is when the uterus falls into the vagina. Uterine prolapse is categorised into 3 levels depending on the degree to which the uterus has descended into the vagina. [urodynamic.com.au]

  When those muscles and ligaments are weak or damaged, the pelvic organs can begin to fall out of place — or "prolapse" — into the vagina. [umassmed.edu]

  Sometimes they cut a piece of slipper and put it in the vagina just to hold their falling womb, because they have been suffering from so much pain." Hear a leading Nepali advocate describe the crisis of uterine prolapse. [web.archive.org]

  Download Some women experience prolapse (falling) of a pelvic floor organ, such as the vagina or uterus. This occurs when the connective tissue or muscles within the body cavity weaken and cannot hold the pelvis in its proper place. [uvmhealth.org]

  Prolapsed uterus (also called uterine, or pelvic organ prolapse) is when the uterus falls down towards the vaginal opening. This can happen if your pelvic floor muscles are stretched or weakened. [healthdirect.gov.au]

• Surgical Procedure

  Vaginal hysterectomy (VH) is the preferred surgical procedure worldwide, but uterus-preserving alternatives including the Manchester procedure (MP) are available. [ncbi.nlm.nih.gov]

  Surgical options Hysterectomy — Uterine prolapse may be treated by removing the uterus in a surgical procedure called hysterectomy. [drdavidwilkie.ca]

  You may be offered a number of different surgical procedures. [rcog.org.uk]

  In this procedure, surgical mesh is used to hold the vagina in its correct anatomical position. The mesh remains in place permanently. [gwinnettmedicalcenter.org]

• Swelling

  A 55-year-old female patient presented to our hospital with the complaints of protrusion of the uterus for the last 3 months, pollakiuria, nocturia, decreased urine volume, and swelling of her body for the last week, and as well as impaired general status [ncbi.nlm.nih.gov]

  The longer it is left outside the cow's body, the more swelling occurs, and the harder it becomes to replace. If the cow is near calving, this swelling may make the birth process difficult." [beefmagazine.com]

  […] conjunctival hyperaemia, conjunctival oedema, conjunctivitis, corneal dystrophy, corneal epithelium defect, corneal epithelium disorder, corneal oedema, dry eye, endophthalmitis, eye discharge, eye inflammation, eye irritation, eye pruritus, eye redness, eye swelling [tr-ex.me]

  Anti-inflammatory treatment (which includes pain relief as well) will be started to reduce swelling caused by the prolapse and the compromised circulation of the uterus, and to reduce inflammation of the uterus. [alpacasnz.co.nz]

• Constipation

  Eating high fiber foods are also recommended to help prevent straining that is associated with constipation. [drdavidwilkie.ca]

  Stool softeners may be used for constipation, if present. A uterine prolapse is descent or dropping of the uterus through the cervix into the vagina. [symptoma.com]

  […] to uterine prolapse include: Pregnancy and childbirth, including trauma from large babies, multiple deliveries, or difficult labor and delivery Aging Loss of estrogen after menopause Repeated straining over the years (from coughing, obesity, chronic constipation [bcm.edu]

  Avoid constipation by eating a high-fiber diet. Do Kegel exercises to strengthen your pelvic muscles. Avoid heavy lifting or straining. [webmd.com]

  Specialty Gynecology Symptoms Vaginal fullness, pain with sex, trouble urinating, urinary incontinence, constipation[1] Usual onset Gradual[2] Types 1st to 4th degree[1] Risk factors Pregnancy, childbirth, obesity, constipation, chronic cough[3] Diagnostic [en.wikipedia.org]

• Rectal Bleeding

  Most cases are associated with documented endometriosis, and patients will often present with vaginal or rectal bleeding. [ncbi.nlm.nih.gov]

  For example, colon cancer may be suspected if a person has a family history of colon cancer, fever, weight loss, and rectal bleeding.[13] Other alarming signs and symptoms include family or personal history of inflammatory bowel disease, age of onset [en.wikipedia.org]

• Prolapse

  When the pessary was removed after 73 months, the prolapse disappeared and did not recur. In another five patients with uterine prolapse who were fitted with a ring pessary, prolapse also disappeared after pessary removal. [ncbi.nlm.nih.gov]

  Women with mild cases of uterine prolapse may have no obvious symptoms. [drdavidwilkie.ca]

  Surgery can support a prolapsed uterus or remove it. [webmd.com]

• Ulcer

  Vaginal mucosa may become dried, thickened, chronically inflamed, secondarily infected, and ulcerated. Ulcers may be painful or bleed and occasionally resemble vaginal cancer. The cervix, if protruding, may also become ulcerated. [merckmanuals.com]

  The patients, respectively aged 69 and 73 years, were admitted with an ulcerated prolapsed uterus. Biopsy of the ulcerated cervical lesion confirmed epidermoid carcinoma. [ncbi.nlm.nih.gov]

  Complications Complications of uterine prolapse may include exposure or friction of the vaginal epithelial lining leading to vaginal sores and ulceration. [symptoma.com]

• Blister

  In some women, the pessary may rub on and irritate the vaginal wall (mucosa), and in some cases may cause blisters in the vagina. [obgyn.med.miami.edu]

• Low Back Pain

  You have continuing low back pain with difficulty in walking, urinating, and moving your bowels. [webmd.com]

  Prolapsed Uterus Symptoms A feeling of fullness or pressure in the pelvis (it may be described as a feeling of sitting on a small ball) Low back pain Feeling that something is coming out of the vagina Painful sexual intercourse Difficulty with urination [emedicinehealth.com]

  Symptoms can include: Sensation of heaviness or pulling in your pelvis A bulge protruding from your vagina Pain with sexual activity Difficulty inserting tampons Low back pain The three main factors that contribute to the development of Uterine Prolapse [austinurogynecology.com]

• Urinary Incontinence

  Among them, 18 had urodynamic stress incontinence, 30 had occult stress urinary incontinence, and six had mixed urinary incontinence. [ncbi.nlm.nih.gov]

  In April 2019, we updated our guideline on urinary incontinence and pelvic organ prolapse and published patient decision aids to support people to make informed decisions about surgery for stress urinary incontinence, uterine prolapse and vaginal vault [nice.org.uk]

  Mesh is attached to the apex of the vagina and may also be attached to the anterior and/or posterior vaginal wall, with the aim of preventing future vaginal vault prolapse. 2.2.2 This procedure can be combined with surgery for stress urinary incontinence [web.archive.org]

• Pelvic Pain

  Vaginal bleeding, abnormal discharge, dyspareunia, urinary retention, and pelvic pain are possible complications of therapy. Uterine prolapse is the loss of anatomical support for the uterus, typically surrounding the apex of the vagina. [bestpractice.bmj.com]

  When to Call a Doctor Call a doctor if you develop pelvic pain or discomfort or unusual pelvic protrusion. [healthcommunities.com]

  Find your relief Interstitial Cystitis Up to 12 million Americans suffer from interstitial cystitis (IC), often called painful bladder syndrome and generally considered a source of pelvic pain. [hackensackumc.org]

  Additionally, she has had a recent worsening of lower back pain. [step2.medbullets.com]

  SYMPTOMS: • feeling of something coming down per vag • Backache or pelvic pain • Menstrual irregularities • Dyspareunia • Difficulty in urination, incomplete evacuation, urgency, frequency, dysuria. • Bowel symptoms: difficulty in defeacation, 11. [slideshare.net]

• Dyspareunia

  Symptoms include sensation of vaginal bulging, pelvic pressure, urinary frequency or incontinence, incomplete bladder emptying, defecatory dysfunction, and dyspareunia. Diagnosis is made by vaginal examination during resting and straining. [bestpractice.bmj.com]

  This suggests that if 20% of women had dyspareunia after sacrospinous hysteropexy then between 14.6% to 39% would have dyspareunia after uterosacral colpopexy. 3.8.2 De novo dyspareunia There may be no difference between uterosacral colpopexy and high [doi.org]

  Secondary outcomes were: operative time, blood loss, visceral injury, voiding dysfunction, duration of catheterization, length of hospital stay, mesh exposure, dyspareunia, malignant neoplasia and quality of life. [ncbi.nlm.nih.gov]

  […] occurrence not reported). 2.4.4 The Specialist Advisers considered theoretical adverse events to include osteomyelitis, bleeding from local major vessels, bladder or bowel perforation, urinary incontinence, bowel obstruction, mesh infection or rejection, and dyspareunia [web.archive.org]

  Mechanism incomplete prolapse uterus drops part way down into the vagina creates a bulge complete prolapse uterus slips down and protrudes out of the vagina Presentation Symptoms heaviness or pressure in pelvis pelvic pain abdominal or lower back pain dyspareunia [step2.medbullets.com]

• Cesarean Section

  This report presents the surgical correction of uterine prolapse during cesarean section. [ncbi.nlm.nih.gov]

• Urinary Stress Incontinence

  Cystocele may cause pelvic discomfort and sexual dysfunction and may involve urinary stress incontinence (loss of urine with stress such as cough). Rectocele can cause rectal pressure and constipation. [obgyn.net]

  Re-do mid urethral sling for female urinary stress incontinence. Int Urogynecol J and Pelvic Floor Dysfunc, 2007; 18(1): 23-6. 15. [neuman-urogynecology.com]

  Uduak Andy, MD, urogynecologist and assistant professor of obstetrics and gynecology at Penn Medicine, offers these five ways you can fight uterine prolapse and urinary stress incontinence before they start. [pennmedicine.org]

  Our opinion is that a support procedure —at either the bladder neck (Kelly plication) or midurethra (synthetic midurethral sling)—should be performed on all patients, based on preoperative assessment for potential or occult urinary stress incontinence [mdedge.com]

  For more serious cases, common symptoms include: tissue protruding from your vaginal opening pressure, heaviness or a pulling sensation in the pelvis or vagina urinary leakage or urinary stress incontinence problems with sexual intercourse, such as sensing [beaumont.org]

Workup consists of a detailed history and physical examination. The physical examination should be thorough and should help in staging the condition.

Laboratory tests

In uncomplicated cases, laboratory tests are generally not required. In complicated cases, such as cases of uterine prolapse along with infection or ulceration, the following tests may be conducted:

• Complete blood count
• Cervical swab and culture
• Urinalysis
• Pregnancy testing
• Pap smear
• Biopsy

Imaging 

• Pelvic Ultrasound: It is the imaging study of choice.
• MRI: It may be conducted to stage the prolapse.

Test results

A physical examination and history are sufficient to form a diagnosis. In complicated cases, the results of laboratory tests and imaging studies may provide further insight in making a definitive diagnosis.

Vaginal hysterectomy

Often, a vaginal hysterectomy is used to correct uterine prolapse [7]. The procedure can be accompanied by a sacrocolpopexy, in which the apex of the vagina is attached to the sacrum [8].

Pessary insertion

A 2013 Cochrane review found some evidence that pessaries are effective in around 60% of women [9].

Post-surgery care

Generally, women should avoid heavy lifting after surgery and avoid sexual intercourse for 6-8 weeks [10]. If the prolapse remains corrected and the patient conceives, an elective cesarean section may be advisable [10]. 

It has been traditionally assumed that if left untreated, uterine prolapse will gradually worsen. There is some evidence, however, that this may not be the case, and that spontaneous remission may happen [6].

With treatment, prognosis is good, but since the defect is primarily due to physiological weakening of muscles and ligaments, relapse may occur. However, it is possible to preserve fertility in younger patients with adequate treatment.

Complications

Complications of uterine prolapse may include exposure or friction of the vaginal epithelial lining leading to vaginal sores and ulceration. Uterine prolapse and its accompanying symptoms such as urinary incontinence may lead to recurrent lower urinary tract infections. Hemorrhage may also occur in some cases. A uterine prolapse due to weakened muscles may become complicated by accompanying prolapse of other pelvic organs, such as the urinary bladder, resulting in a cystocele, or the rectum, resulting in a rectocele.

The primary cause of uterine prolapse is pregnancy. Multiple factors associated with pregnancy such as trauma or complications during labor, malnutrition of the mother or weight of the fetus may result in undue stress on and damage of the muscles and ligaments supporting the uterus. Some of the damaged muscles and ligaments will never fully regain their strength and elasticity [4].

Other causes [5] that may lead to a uterine prolapse include:
lack of estrogen after menopause, old age, conditions that put a strain on the pelvic muscles such as chronic cough and obesity, pelvic tumor and long term constipation.

Incidence

Pelvic organ prolapse affects millions of women; approximately 200,000 inpatient surgical procedures for prolapse are performed annually in the United States [1]. Approximately half of all women olde than 50 years complain of symptomatic prolapse [2].

Age

Chances of developing uterine prolapse is in direct proportion to increase in age. 11% to 19% of women will undergo surgery for pelvic organ prolapse (POP) or incontinence by age 80 to 85 years, and 30% of these women will require an additional pelvic organ prolapse or in continence surgery [3].

Race

Studies reveal that uterine prolapse is much more common in white and Hispanic women. 

Uterine prolapse is due to weakening of uterosacral and other supporting ligaments of the uterus and pelvic floor muscles. The condition can be staged according to severity of the symptoms.

Staging

According to the Pelvic Organ Prolapse Quantification, uterine prolapse can be staged as per the following criteria:

• Stage 0: No prolapse
• Stage 1: Most distal portion of the prolapsed organ is >1 cm above the plane of the hymen
• Stage 2: Most distal portion of the prolapsed organ is less than or equal to 1 cm above or below the plane of the hymen.
• Stage 3: Most distal portion of the prolapsed organ is >1 cm below the plane of the hymen.
• Stage 4: Total eversion of the prolapsed organ. 

Uterine prolapse, or prolapse of any other pelvic organ for that matter, may be prevented by performing regular Kegel exercises and maintaining a healthy life style. Hormone replacement therapy for post-menopausal women may be helpful. Weight should be controlled and a high fibre diet should be implemented. Stool softeners may be used for constipation, if present.

A uterine prolapse is descent or dropping of the uterus through the cervix into the vagina. It is due to weakening of the various muscles and ligaments supporting the uterus, most important of which are the uterosacral ligaments. Others include the round ligament, broad ligament and ovarian ligaments.

Definition

Uterine prolapse is descent of the uterus (womb) into the vagina.

Cause

It is primarily due to weakening of the supporting muscles of the uterus during pregnancy. It may also occur due to normal aging, long term constipation, occupational hazards particularly in old age like sitting or standing for a long time, etc.

Symptoms

Symptoms include backache accompanied with a feeling of pressure in the lower pelvis or vagina. There may be increased vaginal discharge or bleeding. Urinary tract infections may occur and there may be urinary leakage and a constant feeling of a full-bladder.

Treatment

Treatment can be conservative in terms of exercise and lifestyle modifications, or it can be surgical. Treatment is optional and spends upon the severity of the symptoms. Mild cases may not require treatment at all.

Prevention

By performing regular Kegel exercises and taking a high-fibre diet, a uterine prolapse may be prevented. Hormone replacement therapy (HRT) may help. Obese women should reduce weight and maintain a healthy life style. 

1. Jones KA, Shepherd JP, Oliphant SS, et al. Trends in inpatient prolapse procedures in the United States, 1979-2006. Am J Obstet Gynecol 2010;202:501.e1.
2.  Swift SE. The distribution of pelvic organ support in a population of subjects seen for routine gynecologic health care. Am J Obstet Gynecol. Aug 2000;183(2):277-85.
3. Olsen AL, Smith VJ, Bergstrom JO, et el. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89:501.
4. Tsikouras P, Dafopoulos A, Vrachnis N, Iliodromiti Z, Bouchlariotou S, Pinidis P, et al. Uterine prolapse in pregnancy: risk factors, complications and management. J Matern Fetal Neonatal Med. July 9 2013
5. Lentz GM. Anatomic defects of the abdominal wall and pelvic floor: abdominal and Inguinal hernias, cystocele, urethrocele, enterocele, rectocele, uterine and vaginal prolapse, and rectal incontinence: diagnosis and management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Moseby Elsevier, 2012:chap 20.
6. Handa VL, Garrett E, Hendrix S, et al. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol. 2004 Jan;190(1):27-32.
7. Winters JC, Togamai JM, Chermansky CJ. Vaginal and Abdominal Reconstructive Surgery for Pelvic Organ Prolapse. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier, 2011:chap 72.
8. NICE Interventional Procedure Guidance IPG284: Sacrocolpopexy with hysterectomy using mesh for uterine prolapse repair by the National Institute for Health and Care Excellence. Issued: Jan 2009.
9. Bugge C, Adams EJ, Gopinath D, et al. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013 Feb 28;2:CD004010. doi 10.1002/14651858. CD004010.pub3.
10. Thakar R, Santon S. Management of genital prolapse. BMJ. 2002 May 24;324(7348):1258-62.