Ask the Expert: What Is Uterine Prolapse?

Whether you're pregnant or postpartum, you likely have some concerns about pelvic health. Pregnancy and childbirth can affect the pelvic floor, leading to issues such as incontinence, overactive bladder, and prolapse. The latter—specifically uterine prolapse—can cause a lot of worry for new and expecting mamas, so we sat down with Dr. Mickey Karram, an internationally renowned urogynecologist and pelvic surgeon, to better understand the issue.

Dr. Karram has published more than 200 scientific articles, co-written several textbooks, taught and demonstrated surgical techniques internationally, and previously served as president of the American Urogynecology Society. He’s been named as one of the “Best Doctors in America for Women” by Good Housekeeping. Most recently, he and his wife created the Foundation for Female Health Awareness, a nonprofit that raises funds to support education and research for women’s health.

What is uterine prolapse?

Uterine prolapse is a condition in which the support of the uterus breaks down and the uterus begins to descend down the vaginal canal.

How common is uterine prolapse?

Uterine prolapse, when mild and not causing symptoms, is extremely common in women who have had vaginal deliveries. In some cases, the uterine prolapse can descend to the point that it is in the lower vagina or outside of the vaginal opening, and at that point, it may become symptomatic and an intervention may be needed. This occurs much less commonly, but uterine prolapse is one of the primary indications for hysterectomy. Uterine prolapse accounts for around 10 percent of the approximately 600,000 hysterectomies done yearly in the United States.

What causes uterine prolapse?

There is no single cause of uterine prolapse; it is what we call in medicine "multi-factorial," which means it's dependent on a number of factors or causes. That said, women who have had more vaginal deliveries with prolonged labor are generally more likely to develop uterine prolapse (as well as other types of prolapse). When the prolapsed uterus becomes symptomatic—which basically means that the patient is feeling the prolapse near the opening or outside the opening of the vaginal canal—treatment should be considered.

How do you treat uterine prolapse?

There are two treatment options. One involves inserting a pessary, which is a silicone object similar to a diaphragm, in the vaginal canal with the goal of keeping the uterus where it should be. The second option is to surgically remove or suspend the uterus.

What are the symptoms of uterine prolapse?

Uterine prolapse symptoms can begin with lower back pain, as the ligaments that hold the uterus up are stretched. Ultimately, the most common symptom is the feeling of the uterus protruding down the vaginal canal and near or outside the opening. A woman may feel the cervix, which is the lower part of the uterus. This feels different from vaginal wall prolapse from the bladder or rectum, because the cervix has a firm consistency, like the tip of your nose. A prolapse of the bladder or rectum will feel much softer, more like a water balloon.

How does uterine prolapse affect pregnancy?

Once a patient is more than 12 weeks pregnant, the uterus is high up in the pelvis. So, in general, uterine prolapse gets better with pregnancy. However, after delivery, when the uterus comes back down to normal size, there is a high likelihood that it will reoccur.

Can a belly wrap cause uterine prolapse?

Uterine prolapse is actually a chronic condition, which means that the support of the uterus breaks down over time—typically years—leading to the cervix presenting at or beyond the opening of the vagina.

There’s no evidence that wearing a belly wrap postpartum for a limited period of time contributes to this condition. Belly compression in general is not known to be correlated with the development of prolapse. Hospitals have been providing postpartum women with versions of belly wraps for decades. If there was a correlation with prolapse, this would have been observed and documented in medical literature.

Are there any instances when a woman should not wear a belly wrap?

There are no absolute contraindications for wearing a belly wrap, short of pain possibly from a C-section scar or other reasons.

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How do I treat uterine prolapse?

Uterine prolapse only needs to be treated if it is symptomatic and we don’t know the natural history. So, just because a doctor tells you your uterus has dropped doesn’t mean that you will ultimately require surgery—it just needs to be tracked. Many times, the prolapse does not worsen. If it does need to be treated, the only non-surgical treatment for uterine prolapse is a vaginal pessary. Kegel exercises will not actually cause the uterus to be more supported; they may create a perception that your vagina is better supported and thus make the uterine prolapse less symptomatic, but the exercises can’t actually pull the uterus back up into the vagina. The other form of treatment is either a hysterectomy or a uterine suspension.

How can I strengthen my pelvic floor?

The best way to strengthen the pelvic floor is to isolate the pelvic floor muscles. Because these are deep muscles and surrounded by large muscle groups, such as the buttocks, thighs, and abdominals, they are difficult to isolate. A pelvic floor physical therapist or a pelvic floor device can help you isolate these muscles in a better way. Once you learn to isolate them, they should be worked out just like any other muscle group that you are trying to strengthen. But again, it’s so important to ensure you are isolating the appropriate muscles. When patients say they’ve tried Kegels and it hasn’t helped, it’s usually because they are not addressing the correct muscle group.

How can I treat incontinence after childbirth?

Many women will develop some postpartum incontinence that will improve significantly as the pelvis heals from the delivery. If the incontinence persists after that point, it will require evaluation. There are two forms of incontinence: one is urinary stress incontinence, which causes leaks with coughing, straining, and exercising, and the other is caused by an overactive bladder that leads to incontinence (where you can’t make it to the bathroom in time). These are two completely different issues and require completely different treatments. If you’re experiencing leaking after childbirth, consult with a urogynecologist, as they specialize in treating women with incontinence. 

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