A dropped uterus, or uterine prolapse, is caused by weakened pelvic floor muscles and can lead to vaginal eversion and descent of the uterus. Causes include childbirth, nerve damage, and medical conditions. Treatment options include pelvic exercises, vaginal support devices, and surgery. Severity of symptoms and patient choice are important considerations.
A dropped uterus, also known as a prolapsed uterus or uterine prolapse, is a condition in which a woman’s uterus is displaced downward and the vagina is everted out. Causes of a dropped uterus include childbirth and pelvic floor damage during labor, impaired nerve transmission to the pelvic floor muscles, genital atrophy, lack of estrogen or hypoestrogenism, and other medical conditions that increase intra- abdominal or decrease the elasticity of collagen . This condition can cause impaired function and is usually treated surgically.
Together with the upper part of the vagina, a healthy uterus is supported by a muscle called the levator ani and fibrous structures collectively called the endopelvic fascia. The levator muscles and endopelvic fascia are also called the pelvic floor because they support the pelvic and abdominal contents. A woman with a dropped uterus has a weakening of this support system and a defect in the upper part of the vagina, leading to vaginal eversion and a drop or descent of the uterus through the vaginal canal.
There are various causes of a dropped uterus. Women who have given birth multiple times are at increased risk because delivery loosens or tears the levator muscle, endopelvic fascia, or perineal body. A problem with the pudendal nerve and associated nerves can cause impaired nerve transmission, leading to pelvic floor weakness and subsequent uterine prolapse. Women who have chronic lung disease leading to excessive coughing, constipation, and obesity may also suffer from uterine drop due to increased intra-abdominal pressure that weakens the pelvic floor. Connective tissue diseases, such as Marfan syndrome, also predispose women to having a dropped uterus.
The need to treat a dropped uterus usually depends on the degree of prolapse. In first-degree prolapse, the uterus descends into the upper part of the vagina but cannot be seen externally, while in second-degree prolapse, the cervix is already near or outside the vagina. A third-degree or total prolapse is a condition in which the entire uterus is already outside the vagina. While minimal or first-degree uterine prolapse may not cause symptoms, the effects of a second- or third-degree dropped uterus include vaginal fullness, back pain, spotting, ulceration, pain or difficulty with intercourse, and incontinence or urinary retention or fecal . Women who have mild uterine prolapse without symptoms don’t need treatment.
Important considerations in treatment include the patient’s age, desire to conceive, degree of prolapse, severity of symptoms, other medical conditions, presence or absence of nerve problems, previous surgical history, and patient choice . If the patient decides that her reproductive function must be preserved, ultrasound and endometrial biopsy are recommended. Pelvic exercises, vaginal support devices such as pessaries, and topical estrogen are considered conservative medical treatment. Severe cases are best treated with surgical procedures, such as colpectomy, colpocleisis, abdominal sacral colpopexy, sacral uteropexy, sacrospinous ligament fixation, iliococcygeal band suspension, and uterosacral ligament fixation. A Pap test is recommended before surgery.
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