Uterine prolapse - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Uterine prolapse is caused by the 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.

Total uterovaginal prolapse (procidentia) POPQ stage IV

From the collection of Prof L. Brubaker and Dr L. Lowenstein; used with permission

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Apical prolapse POPQ stage III
Total uterovaginal prolapse (procidentia) POPQ stage IV

Citations

Key Articles

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]
Hagen S, Stark D, Glazener C, et al; POPPY Trial Collaborators. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet. 2014 Mar 1;383(9919):796-806.[Abstract][Full Text]
Continence Foundation of Australia. Guidelines for the use of support pessaries in the management of pelvic organ prolapse. Jul 2012 [internet publication].[Full Text]
Robert M, Schulz JA, Harvey MA, et al; Urogynaecology Committee. Technical update on pessary use. J Obstet Gynaecol Can. 2013 Jul;35(7):664-74.[Abstract]
Maher C, Feiner B, Baessler K, et al. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016 Nov 30;(11):CD004014.[Abstract][Full Text]
Sung VW, Rogers RG, Schaffer JI, et al; Society of Gynecologic Surgeons Systematic Review Group. Graft use in transvaginal pelvic organ prolapse repair: a systematic review. Obstet Gynecol. 2008 Nov;112(5):1131-42.[Abstract]
Maher C, Feiner B, Baessler K, et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016 Feb 9;(2):CD012079.[Abstract][Full Text]
Schimpf MO, Abed H, Sanses T, et al. Graft and mesh use in transvaginal prolapse repair: a systematic review. Obstet Gynecol. 2016 Jul;128(1):81-91.[Abstract]
Ugianskiene A, Davila GW, Su TH, et al. FIGO review of statements on use of synthetic mesh for pelvic organ prolapse and stress urinary incontinence. Int J Gynaecol Obstet. 2019 Nov;147(2):147-55.[Abstract][Full Text]
National Institute for Health and Care Excellence. Transvaginal mesh repair of anterior or posterior vaginal wall prolapse. Dec 2017 [internet publication].[Full Text]
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.[Abstract][Full Text]

Referenced Articles

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26. National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. Jun 2019 [internet publication].[Full Text]
27. European Association of Urology. Non-neurogenic female LUTS. Mar 2023 [internet publication].[Full Text]
28. de Boer TA, Salvatore S, Cardozo L, et al. Pelvic organ prolapse and overactive bladder. Neurourol Urodyn. 2010;29(1):30-9.[Abstract][Full Text]
29. Patil A, Duckett JR. Effect of prolapse repair on voiding and bladder overactivity. Curr Opin Obstet Gynecol. 2010 Oct;22(5):399-403.[Abstract]
30. Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996 Jul;175(1):10-7.[Abstract]
31. Baden WF, Walker T. Fundamentals, symptoms and classification. In: Baden WF, Walker T, eds. Surgical repair of vaginal defects. Philadelphia, PA: JB Lippincott; 1992:14.
32. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD003882.[Abstract][Full Text]
33. Hagen S, Stark D, Glazener C, et al; POPPY Trial Collaborators. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet. 2014 Mar 1;383(9919):796-806.[Abstract][Full Text]
34. Panman C, Wiegersma M, Kollen BJ, et al. Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care. BJOG. 2017 Feb;124(3):511-20.[Abstract][Full Text]
35. Fitz FF, Resende AP, Stüpp L, et al. Biofeedback for the treatment of female pelvic floor muscle dysfunction: a systematic review and meta-analysis. Int Urogynecol J. 2012 Nov;23(11):1495-516.[Abstract]
36. Bø K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol. 2012 Aug;30(4):437-43.[Abstract]
37. Continence Foundation of Australia. Guidelines for the use of support pessaries in the management of pelvic organ prolapse. Jul 2012 [internet publication].[Full Text]
38. Bugge C, Adams EJ, Gopinath D, et al Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD004010.[Abstract][Full Text]
39. Robert M, Schulz JA, Harvey MA, et al; Urogynaecology Committee. Technical update on pessary use. J Obstet Gynaecol Can. 2013 Jul;35(7):664-74.[Abstract]
40. Abed H, Rahn DD, Lowenstein L, et al. Incidence and management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systematic review. Int Urogynecol J. 2011 Jul;22(7):789-98.[Abstract]
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44. Barber MD, Brubaker L, Burgio KL, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014 Mar 12;311(10):1023-34.[Abstract][Full Text]
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52. Maher C, Feiner B, Baessler K, et al. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016 Nov 30;(11):CD004014.[Abstract][Full Text]
53. Benson JT, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol. 1996 Dec;175(6):1418-21.[Abstract]
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55. Shah HN, Badlani GH. Mesh complications in female pelvic floor reconstructive surgery and their management: a systematic review. Indian J Urol. 2012 Apr;28(2):129-53.[Abstract][Full Text]
56. Maher C, Feiner B, Baessler K, et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016 Feb 9;(2):CD012079.[Abstract][Full Text]
57. Schimpf MO, Abed H, Sanses T, et al. Graft and mesh use in transvaginal prolapse repair: a systematic review. Obstet Gynecol. 2016 Jul;128(1):81-91.[Abstract]
58. Ugianskiene A, Davila GW, Su TH, et al. FIGO review of statements on use of synthetic mesh for pelvic organ prolapse and stress urinary incontinence. Int J Gynaecol Obstet. 2019 Nov;147(2):147-55.[Abstract][Full Text]
59. U.S. Food and Drug Administration. FDA takes action to protect women's health, orders manufacturers of surgical mesh intended for transvaginal repair of pelvic organ prolapse to stop selling all devices. Apr 2019 [internet publication].[Full Text]
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