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Uterine prolapse

Last reviewed: 9 Apr 2025
Last updated: 10 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • vaginal protrusion/bulge
  • sensation of vaginal pressure
Full details

Other diagnostic factors

  • urinary incontinence
  • defecatory dysfunction
  • pelvic pain
  • voiding dysfunction
  • sexual dysfunction
Full details

Risk factors

  • vaginal delivery
  • advancing age
  • obesity
  • previous surgery for prolapse
  • genetic factors
  • white ancestry
  • connective tissue disorders
  • increased intra-abdominal pressure
Full details

Diagnostic tests

1st tests to order

  • assessment of postvoid residual urine (PVR) volume
  • urinalysis
Full details

Tests to consider

  • urodynamics
Full details

Treatment algorithm

ONGOING

asymptomatic

symptomatic

Contributors

Authors

Lior Lowenstein, MD, MS, MHA, MBA
Lior Lowenstein

Associate Clinical Professor and Head of Gynecology Division

Rambam Health Care Campus

Rappaport Faculty of Medicine

Technion-Israel Institute of Technology

Haifa

Israel

Disclosures

LL declares that he has no competing interests.

Omer Anis, MD

Urology Department

Chaim-Sheba Medical Center

Tel Aviv

Israel

Disclosures

OA declares that she has no competing interests.

Acknowledgements

Dr Lior Lowenstein and Dr Omer Anis would like to thank Dr Linda Brubaker, a previous contributor to this topic.

Disclosures

LB has received editorial honoraria from JAMA, UpToDate, and the Female Pelvic Medicine and Reconstructive Surgery journal. LB is an author of some of the references cited in this topic.

Peer reviewers

Sarah Collins, MD

Associate Professor of Obstetrics and Gynecology

Northwestern University

Feinberg School of Medicine

Chicago

IL

Disclosures

SC declares that she has no competing interests.

Sushma Srikrishna, MRCOG

Locum Consultant Urogynaecologist and Obstetrician

Kings College Hospital

London

UK

Disclosures

SS declares that she has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American College of Obstetricians and Gynecologists. Practice bulletin no. 214: pelvic organ prolapse. Nov 2019 [internet publication].Full text

Winters JC, Dmochowski RR, Goldman HB, et al; American Urological Association; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction. Urodynamic studies in adults: AUA/SUFU guideline. J Urol. 2012 Dec;188(6 Suppl):2464-72. Abstract

National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. Jun 2019 [internet publication].Full text

Maher C, Feiner B, Baessler K, et al. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016 Nov 30;(11):CD004014.Full text  Abstract

Baessler K, Christmann-Schmid C, Maher C, et al. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database Syst Rev. 2018 Aug 19;(8):CD013108.Full text  Abstract

Brubaker L, Cundiff GW, Fine P, et al; Pelvic Floor Disorders Network. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006 Apr 13;354(15):1557-66.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Uterine prolapse images
  • Differentials

    • Cervical elongation
    • Vaginal cyst
    • Gynecologic cancer
    More Differentials
  • Guidelines

    • Non-neurogenic female LUTS
    • AAGL practice report: practice guidelines on the prevention of apical prolapse at the time of benign hysterectomy
    More Guidelines
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