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.
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
Other diagnostic factors
- urinary incontinence
- pelvic pain
- urinary retention
- disordered defecation
- sexual dysfunction
- lower back pain
- vaginal delivery
- older age
- high BMI
- previous surgery for prolapse
- genetic factors
- white ancestry
- increased intra-abdominal pressure
1st investigations to order
- assessment of postvoid residual urine (PVR) volume
Investigations to consider
Lior Lowenstein, MD, MS, MHA, MBA
Associate Clinical Professor and Head of Gynecology Division
Rambam Health Care Campus
Rappaport Faculty of Medicine
Technion-Israel Institute of Technology
LL declares that he has no competing interests.
Linda Brubaker, MD, MS
Dean of the Faculty of Medicine
LB has received an editorial honorarium from UpToDate.
Chiara Ghetti, MD
Department of Obstetrics, Gynecology, and Reproductive Sciences
Division of Urogynecology and Pelvic Reconstructive Surgery
University of Pittsburgh
CG declares that she has no competing interests.
Sushma Srikrishna, MRCOG
Locum Consultant Urogynaecologist and Obstetrician
Kings College Hospital
SS declares that she has no competing interests.
- Cervical elongation
- Vaginal cyst
- Pelvic organ prolapse
- Urinary incontinence and pelvic organ prolapse in women: management
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer