Uterine prolapse

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Last reviewed: March 2019

Last updated: December 2017

Summary

Loss of anatomic support for the uterus.

Late-stage prolapse usually presents as a palpable protruding cervix with vaginal tissue, which is often noticed by the patient.

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.

Conservative management encompasses observation, physical therapy, and use of pessaries.

Surgical intervention is by either a vaginal or an abdominal approach, with or without augmenting graft material.

Vaginal bleeding, abnormal discharge, dyspareunia, urinary retention, and pelvic pain are possible complications of therapy.

Definition

Uterine prolapse is the loss of anatomic support for the uterus, typically surrounding the apex of the vagina. The anterior and/or posterior vaginal wall may also be involved.

Uterine prolapse is one of the conditions encompassed by the term pelvic organ prolapse (POP), and the names may be used synonymously. POP describes cystocele (bladder prolapse), rectocele (prolapse of rectum or large bowel), and enterocele (prolapse of small bowel); all of these are often associated with prolapse of the uterus.

History and exam

Key diagnostic factors

vaginal protrusion/bulge
sensation of vaginal pressure

Full details

Other diagnostic factors

urinary incontinence
constipation
pelvic pain
urinary retention
disordered defecation
sexual dysfunction
lower back pain

Full details

Risk factors

vaginal delivery
older age
high BMI
previous surgery for prolapse
genetic factors
white ancestry
increased intra-abdominal pressure

Full details

Diagnostic investigations

1st investigations to order

assessment of postvoid residual urine (PVR) volume
urinalysis

Full details

Investigations to consider

urodynamics

Full details

Treatment algorithm

ONGOING

asymptomatic

symptomatic

Contributors

Authors VIEW ALL 

Lior Lowenstein, MD, MS, MHA, MBA

Lior Lowenstein

Associate Clinical Professor and Deputy Chairman

Department of Obstetrics and Gynecology

Rambam Health Care Campus

Rappaport Faculty of Medicine

Technion-Israel Institute of Technology

Haifa

Israel

Disclosures

LL declares that he has no competing interests.

Linda Brubaker, MD, MS

Professor

Dean of the Faculty of Medicine

Loyola University

Chicago

IL

Disclosures

LB has received an editorial honorarium from UpToDate.

Peer reviewers VIEW ALL 

Chiara Ghetti, MD

Assistant Professor

Department of Obstetrics, Gynecology, and Reproductive Sciences

Division of Urogynecology and Pelvic Reconstructive Surgery

University of Pittsburgh

Pittsburgh

PA

Disclosures

CG 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.

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