“Your uterus will fall out when you get older and you just have to push it back in,” TikTok user Leni shared in a viral video with 9 million views — and she’s right.
Her reaction to learning about uterine prolapse ― a common condition that occurs when the muscles in your pelvis weaken and cause the uterus to release ― led viewers to comment about their similar disbelief while others shared their experiences.
“Yup! I’m having surgery next week because of prolapse uterus. 3 words, ladies: pelvic floor exercises,” one user commented. “That’s what happened to mine. #hysterectomy,” another said.
Uterine prolapse affects nearly half of women ages 50 to 79. A uterine prolapse can happen unexpectedly, and it isn’t only a result of childbirth (although that is a common reason). A sneeze, lifting something heavy or trying to have a bowel movement can all potentially lead to the issue.
The uterus is inside the pelvis and is supported by the pelvic muscles, or floor. When these muscles are weakened or damaged, the uterus can drop down into the vagina. Additionally, other pelvic organs, including the bladder or bowel, may also be prolapsed.
“The most common sensations of uterine prolapse are pressure, fullness, or heaviness in the vagina, and feeling like something is coming out,” Jen Hamilton, a board-certified emergency nurse and member of the Association of Women’s Health, Obstetric and Neonatal Nurses, told HuffPost.
Although the condition isn’t life-threatening, it can cause pain and discomfort depending on the severity or stage of prolapse.
“Some people even need to use a finger to push the bulge back so that they can urinate or have bowel movements,” Dr. Karen Tang, a minimally invasive gynaecologic surgeon and director of the Center for Gynaecologic Surgery, told HuffPost.
However, depending on the stage and cause of uterine prolapse, this can look different for everyone. We asked experts why uterine prolapse occurs, what are its symptoms and the risk factors you should know, and treatment options.
Causes Of Uterine Prolapse
The connective tissues and muscles of the uterus can be destroyed or weakened as a result of pregnancy, multiple births or vaginal childbirth.
“The immediate postpartum period is a critical time for the body to begin recovering from the stresses of pregnancy and childbirth,” Hamilton said. “While the majority of women do not experience immediate uterine prolapse, the risk may be slightly higher during this time due to the temporary weakening of pelvic floor support structures.”
Though the highest risk factor for uterine prolapse is giving birth, other risk factors include age, straining on the toilet, low levels of sex hormones after menopause, fibroids, pelvic tumours, being caucasian, obesity and smoking.
“Uterine prolapse is more common in older women, as the pelvic floor muscles naturally weaken with age, making them more susceptible to prolapse,” Hamilton said. “Factors such as obesity, chronic constipation, chronic cough and a family history of pelvic organ prolapse may also increase the risk of uterine prolapse after childbirth.”
Although the uterus might drop into the vagina, it won’t always completely fall through the vaginal opening. Instead, there are degrees or stages of uterine prolapse.
The first stage occurs when the uterus is in the upper half of the vagina, while stage two refers to the uterus descending to the opening of the vagina. Stage three is when the uterus protrudes, and stage four refers to the complete prolapse, or when the uterus is out of the vagina.
“One of the things to reassure readers about is that most prolapse is not nearly as bad or what they might be thinking when they hear that the uterus can ‘fall out,’” Tang said. “Complete procidentia, where the entire uterus has prolapsed outside the body, is very rare. In most cases, the uterus just drops downwards into the vagina.”
Symptoms May Vary Across Stages
Many women who experience a uterine prolapse don’t have symptoms. However, if symptoms are present, they might include a sensation of heaviness and pressure in the vagina, a lump or bulge in the vagina, painful sexual intercourse, leakage of urine and the inability to completely empty the bladder.
“Some women describe it as feeling like they’re sitting on a ball,” Tang said. “It’s not usually painful, though sometimes it can cause pain with sex. If the uterus has dropped so far that the cervix, or opening of the uterus, is actually outside of the body, it can rub on underwear or clothes and can feel irritated or cause bleeding.”
Other symptoms might include lower-back pain, aching feelings in the lower abdomen and constipation.
“The sensation experienced by people with uterine prolapse can vary depending on how severe the prolapse is,” Hamilton said. “It’s important to add that anything that increases pressure in the abdomen, such as lifting something heavy, sneezing or trying to have a bowel movement, can increase these sensations or make the prolapse worse.”
Treatment Options For Uterine Prolapse
A pelvic exam can determine a prolapsed uterus, as well as a cystoscopy to check the bladder and urethra. Additionally, an MRI can help to look at pelvic organs.
A prolapsed uterus can be treated or prevented through surgical and nonsurgical procedures, including pelvic floor exercises, vaginal surgery or a vaginal pessary, a device that goes into the vagina.
“Encouraging healthy lifestyle changes, such as maintaining a healthy weight, avoiding heavy lifting and treating chronic cough or constipation, can also help manage uterine prolapse,” Hamilton said. “Strengthening the pelvic floor muscles through Kegel exercises can help improve the support for the uterus and other pelvic organs.”
Kegel exercises, or pelvic floor muscle training, include lifting and squeezing the pelvic region muscles that stop or slow urination. With exercise, you should be able to squeeze, hold and release the pelvic floor muscles.
Another non-surgical option is a vaginal pessary, or a removable soft rubber device that is inserted in the vagina to hold the prolapsed uterus in place. A pessary can be inserted and removed at any time and is recommended for people with mild to moderate prolapse.
Surgical options involve reconstructive surgery to restore the organs back to their original positions, while a hysterectomy involves the complete removal of the uterus.
“It’s essential for people experiencing uterine prolapse to consult with their doctor to determine the most appropriate treatment plan tailored to their specific condition and needs,” Hamilton said. “I cannot emphasise enough how important it is that anyone who believes they may be experiencing a uterine prolapse seek care from their trusted health care provider.”