Uterine prolapse

Alternative names:

pelvic floor hernia; pudendal hernia

Definition:

Falling or sliding of the uterus from its normal position in the pelvic cavity into the vaginal canal.

Causes, incidence, and risk factors:

The uterus is normally supported by pelvic connective tissue and the pubococcygeus muscle, and held in position by special ligaments. Weakening of these tissues allows the uterus to descend into the vaginal canal. Tissue trauma sustained during childbirth, especially with large babies or very rapid labor and delivery, is typically the cause of muscle weakness. The loss of muscle tone and the relaxation of muscles, which are both associated with normal aging and a reduction in the female hormone estrogen, are also thought to play an important role in the development of uterine prolapse. Descent can also be caused by a pelvic tumor, however, this is fairly rare.

There is a rare, congenital type of uterine prolapse which may be noted in newborns after rigorous crying or vomiting. It occurs most commonly in multiparous births (multiple deliveries), and in Caucasian women.

There are a number of conditions associated with an increased risk of developing problems with the supportive tissues of the uterus. Obesity places additional strain on the supportive muscles of the pelvis as does excessive coughing caused by lung conditions such as chronic bronchitis and asthma. Chronic constipation and the bearing-down associated with it causes weakness in these muscles. Large uterine fibroids also contribute to muscle strain.