Uterine prolapse: causes, what the grades mean and what you can do

Do you know that feeling when something presses down in your pelvis in the evening, as though something is sagging downwards, as if something is no longer where it belongs – and you simply can't work out what's going on? There are moments in life when you lose trust in your own body, and this is one of them. But you aren't imagining it. And it's nothing to feel ashamed of either. Over time, the muscles and ligaments that hold the womb in place can slacken – and the womb can descend into the vaginal canal. This is known as a prolapsed womb or uterine prolapse, and in this article you'll find everything you need to know about it.

• A prolapsed womb is common, but only rarely dangerous.
• There are four degrees of severity, from 1 to 4, depending on how far the womb has descended.
• With mild forms, pelvic floor exercises and a few adjustments to daily life are often enough to ease symptoms.
• A pessary is a genuine alternative to surgery – not a consolation prize for women who don't want or can't have an operation.
• The diagnosis is made by your doctor during a simple gynaecological examination, with no need for elaborate tests.

Looking for particular information about prolapsed womb? Have a look at the contents below and jump straight to the section you need:

1. What a prolapsed womb is – explained clearly
2. How common a prolapsed womb actually is
3. Symptoms of a prolapsed womb
4. The degrees of uterine prolapse: what 1, 2, 3 and 4 mean
5. Why a prolapsed womb develops: causes and risk factors
6. How to tell at home whether you have a prolapse
7. What happens during the examination and how the diagnosis is made
8. Treatment for a prolapsed womb
9. What does NOT help with a prolapse: "natural remedies" and forum tips
10. Everyday life with a prolapse
11. Uterine prolapse, pregnancy and fertility
12. How to lower your risk of prolapse and of it worsening
13. Frequently asked questions

What a prolapsed womb is – explained clearly

To help you understand exactly what a prolapsed womb is, let's first take a closer look at the anatomy of the vagina, the pelvis and the structures that support the pelvic organs.

Picture a kind of hammock made of muscle and connective tissue. That's roughly what your pelvic floor looks like – it supports the organs in the lower abdomen: the womb, the bladder and the rectum. When you walk, cough, lift something heavy or exert yourself, this "hammock" helps your organs stay in their natural position. Over time, however, it slackens.

With age, and particularly after vaginal births, the pelvic floor muscles and ligaments become stretched or weaker. The "hammock" can then no longer provide the same support, and one or more organs begin to descend. This phenomenon is called pelvic organ prolapse. When it affects the womb, it's known as uterine prolapse, or a prolapsed womb.

Despite the colloquial expression "dropped womb", the womb doesn't detach and it doesn't literally fall out. It simply descends gradually along the vagina, which is a muscular canal rather than an empty cavity. That's why many women describe a sensation of heaviness or pressure rather than actual pain.

And while we're on the subject of mix-ups: many women confuse a prolapsed womb with a retroverted womb, although the latter is something entirely different. Retroversion is simply a normal anatomical variant found in many women – the womb is tilted backwards. It is neither an illness nor a disorder.

Prolapsed womb, genital prolapse, cystocele, rectocele – what's the difference?

One of the reasons there's so much confusion around prolapsed womb is that the same condition goes by different names. Doctors often use the term genital prolapse as an umbrella term for the descent of one or more pelvic organs. So if you're given a diagnosis of "genital prolapse" and then search at home for "prolapsed womb" or "vaginal prolapse", you might get the impression these are completely different things.

So, briefly, here are the various forms and how they differ:

• Uterine prolapse (prolapsed womb): the womb descends into the vaginal canal.
• Cystocele (bladder prolapse): the bladder descends and bulges into the front vaginal wall.
• Rectocele: the rectum descends and presses against the back vaginal wall.
• Vaginal vault prolapse: usually occurs after a hysterectomy, when the upper part of the vagina loses its support and descends.

It's also true that several forms of prolapse can occur at the same time. You might have both a prolapsed womb and a cystocele, for example. That doesn't automatically mean the condition is more serious – your doctor assesses each area of the pelvic floor separately and chooses treatment based on your symptoms.

How common a prolapsed womb actually is

Changes in the position of the pelvic organs, including the womb, become increasingly common with age. You may already have come across alarming figures online – such as the claim that almost 50% of women aged between 50 and 79 have a prolapsed womb. Statistics like these can be misleading, however, as a study of 270 women with an average age of 68 shows.

In fact, only 2.3% of the 270 participants had completely intact pelvic floor support on examination. That said, 33% were at stage I and 62.9% at stage II. In other words, although a degree of descent of the pelvic organs is very common at a certain age, the leading edge of the prolapse reached the hymenal ring or beyond in only about one in four women – that is, the threshold at which symptoms usually begin.

Put differently: if your doctor finds a degree of descent during an examination, that by no means implies you have a problem and need treatment. What's more, the lifetime risk of needing surgery for prolapse is estimated at around 11–13%. So there's really no reason to panic just because your doctor has found a mild prolapse.

But is a prolapse, which is more common in older women, linked to the menopause? Well, age is one of the factors associated with prolapse – but the menopause doesn't automatically mean you'll develop the problem. A prolapse is the result of slackened muscles and ligaments, not of hormonal changes in themselves.

Symptoms of a prolapsed womb

When the womb descends only slightly, a prolapse may be completely symptom-free. So you can have a prolapsed womb without feeling anything at all. Many women only find out by chance during a routine gynaecological check-up.

When symptoms do occur, they're often milder in the morning after a night's rest and intensify towards the evening – after several hours on your feet, after physical exertion or after lifting something heavy. There's a good chance you have a prolapsed womb, and you should book a gynaecology appointment promptly, if you notice the following symptoms:

• You feel a sensation of heaviness, pressure or fullness in your pelvis
• You have the impression that something is "slipping down" or "coming out"
• You can feel or see a bulge at the vaginal opening, especially after standing for a long time
• You have a dull ache in the lower back
• You notice a sensation of tightness in your lower back
• You feel discomfort or numbness during sex
• You experience urinary incontinence, leaking urine when you cough, sneeze, laugh or exert yourself, for example
• You feel as though you can't empty your bladder completely, have difficulty passing urine or need to urinate frequently
• You suffer from constipation or the feeling that you can't fully empty your bowels
• You notice unusual discharge
• You have difficulty inserting a tampon or feel that it doesn't sit properly.

The degrees of uterine prolapse: what 1, 2, 3 and 4 mean

The stage of a prolapsed womb is described using degrees from 1 to 4. These four degrees show how advanced the prolapse is, in other words how far the womb has descended into the vagina. The higher the degree, the closer the womb is to the vaginal opening, or the further it has already emerged.

• Uterine prolapse, degree 1: the womb has descended into the upper part of the vagina but doesn't come close to the vaginal opening.
  • Usually you either have no symptoms at all or feel only slight pressure.
• Uterine prolapse, degree 2: the womb has descended close to the vaginal opening.
  • You may feel pressure, heaviness or a small bulge when washing or touching yourself.
• Uterine prolapse, degree 3: part of the womb protrudes beyond the vaginal opening and may become visible.
  • Symptoms are noticeably stronger when standing, coughing or exerting yourself.
• Uterine prolapse, degree 4: the womb has emerged completely through the vaginal opening. This form is also known as total prolapse or procidentia uteri.

In clinical practice, the POP-Q system is also frequently used. It describes prolapse on the basis of precise measurements in five stages, from 0 to IV. That's why "degree 2" and "stage II" may be used in different contexts and don't correspond exactly in terms of definition.

It's also important to note that the degree alone determines neither the severity nor the best treatment. Why? Because a degree 2 prolapse that causes pressure, pain or bladder problems and interferes with your everyday life may need more attention than a more advanced degree 3 prolapse that you barely notice. Treatment therefore isn't based solely on the number in your medical notes. What matters most is your symptoms, how much they bother you and how strongly they affect your daily life.

Why a prolapsed womb develops: causes and risk factors

A prolapsed womb usually develops over a long period of time. When the tissues and muscles supporting the pelvic organs lose their firmness, the womb begins to descend. Most often this is the result of several factors working together, rather than a single cause.

A prolapse doesn't develop because you lifted something heavy once, or because you did too few Kegel exercises after giving birth. It develops because the muscles and ligaments in the pelvic region slacken over the course of your life. Several pregnancies and vaginal births, getting older, hormonal changes, repeated pressure on the pelvic floor – all of these can, over time, affect the pelvic floor's ability to support your organs.

Pregnancy, birth and the postnatal period

Pregnancy and childbirth, particularly vaginal birth, are among the most significant risk factors for a prolapsed womb. The risk increases with the number of births and may be higher after delivering a particularly large baby, after a difficult birth or an instrumental delivery. And while a caesarean section may lower the risk, it can't eliminate it entirely.

Whether vaginal or by caesarean, pregnancy itself remains a major risk factor, because the growing baby and the womb press continuously on the pelvic floor, and pregnancy hormones loosen tissues and ligaments, which can then be stretched further or torn during a vaginal birth.

There's good news too, however: just because you feel a sensation of descent or pressure in the first weeks after giving birth doesn't mean you'll be left with a permanent prolapse. During the postnatal period, the tissues go through a recovery process and symptoms may improve over time. A symptom at six weeks is by no means a long-term verdict.

If this worries you – and especially if you have symptoms – you can ask for an assessment of your pelvic floor at your postnatal check. This isn't automatically part of recovery after a vaginal birth, but it's worth raising with your doctor if you're concerned.

The menopause and falling oestrogen levels

A prolapsed womb during the menopause can be encouraged by the hormonal changes of this stage of life.

Oestrogen keeps the vaginal and pelvic tissues elastic and thick. When levels fall during the menopause, these supporting structures become more vulnerable and give way more easily. That explains why symptoms can become noticeable or intensify around the menopause, even though the weakening of the pelvic floor began years earlier – after pregnancies and births. Incidentally, the hormonal changes can begin as early as perimenopause, before periods stop for good.

Falling oestrogen levels also contribute to vaginal atrophy, which can worsen dryness, irritation and discomfort. Although both problems can occur at the same time, they're not one and the same thing.

Other factors: weight, constipation, chronic cough, genetics

Aside from pregnancy and hormonal changes, which are natural stages in a woman's life, there are other factors that can repeatedly increase pressure on the pelvic floor.

• Being overweight
• Chronic constipation
• Repeated straining when opening your bowels
• A persistent cough, including one linked to smoking or asthma
• Frequently lifting heavy loads, at work or at the gym
• Advancing age and the progressive slackening of the supporting tissues.

But take note: don't confuse a risk factor with a direct cause. Factors you can influence – such as weight and physical strain – are more like levers for reducing risk, not causes to blame yourself for. The truth is that you can't control all the causes of a prolapse, and there usually isn't one single thing you did wrong or too much of. So there's no point in reproaching yourself.

A previous hysterectomy can also alter your anatomy and the support of the pelvic organs. That's why some women later develop a vaginal vault prolapse.

And there's an inherited component: connective tissue disorders can increase the risk of pelvic organ prolapse – including at a younger age and even without previous births:

• Marfan syndrome
• Ehlers-Danlos syndromes
• Joint hypermobility syndrome

How to tell at home whether you have a prolapse

A great many women end up in forums and on social media, searching for pictures of a prolapsed womb and trying to work out whether they're affected and what signs to look for. Are you asking yourself the same questions? We'll tell you right away what to look out for.

First, though, an important distinction: observing and making sense of your symptoms is one thing. Diagnosing yourself is something else entirely. Recognising the signs of a prolapsed womb is important and useful, so that you know when it's time to see a doctor. Because that's exactly the point of checking at home: to show you when it's time for a gynaecological examination.

What a self-check at home can't tell you is anything about severity or the treatment needed. You can't work out for yourself whether it's a uterine prolapse, a cystocele or a rectocele, you can't determine the correct degree, and you can't rule out other causes such as a vaginal cyst or other tissue changes. So don't try to diagnose yourself.

You don't even need to be certain you have a prolapse to ask for an assessment. Simply noticing unusual signs is reason enough to see your gynaecologist. With that said, these signs may point to a possible prolapsed womb:

• You can feel a bulge in the vagina or a soft lump near the vaginal opening.
• The signs become stronger when you're standing and after a long day, and are less noticeable in the morning, when lying down or after resting.
• A sensation of descent or pressure that increases when you cough, strain or exert yourself.

If you'd like to feel what the area is like, do so gently, without pressing or straining the tissue. You also don't need to repeat the check several times to be "sure".

What happens during the examination and how the diagnosis is made

A prolapsed womb is usually diagnosed during a gynaecological examination on the basis of clinical findings – generally with no invasive procedures at all. So if you're nervous about the appointment, there's really very little reason to be. In most cases the appointment simply consists of a conversation in which you describe your symptoms, followed by the examination itself.

Here's how the examination usually goes, step by step:

1. Your doctor asks about your symptoms. When do they occur? Do they change after exertion, after standing for a long time or over the course of the day?
2. Next comes the gynaecological examination, including with a speculum. The doctor assesses the position of the cervix and the vaginal walls.
3. You may be asked to cough or strain, so the doctor can see how far the tissue descends.
4. In some cases you'll be examined not only lying down but also standing, since gravity can make a prolapse more apparent.

Depending on your symptoms and the findings, your doctor may then recommend further investigations, such as an ultrasound scan, urodynamic testing or an MRI. As a rule, however, a prolapse can usually be identified without extensive diagnostic tests.

If you still feel uneasy, it may reassure you to know that you have the right to have another person in the room during the examination. And if it helps, you can also ask to be examined by a female doctor.

And if you're worried you'll be so overwhelmed during the appointment that you forget all your questions, here are a few suggestions to note down on your phone:

• What type of prolapse do I have and which organs are affected?
• What stage or degree is the prolapse at?
• Do I need to do something now, or can we simply monitor it for the time being?
• Which treatment options are suitable for me?

• Which symptoms should prompt me to come back for a check sooner?

  

Treatment for a prolapsed womb

Treatment for a prolapsed womb is always decided together with your doctor, who will take into account your age, the severity of your symptoms, the degree of prolapse, your sex life, whether you want children and any other health problems.

Because so many factors play a role, there can be no standard treatment that suits every patient. It's always individual – tailored to what your doctor observes during the examination and to the conversations you have together.

And although no treatment can guarantee that the prolapse will disappear completely, there are many options, and overall the chances of your symptoms improving and of you leading a normal life are good.

When "nothing for now" is the medically right decision

A degree 1 prolapse that doesn't bother you, in which the womb has descended only slightly and causes no symptoms, doesn't necessarily need treating.

Your doctor may advise simply monitoring the prolapse at your regular check-ups and taking a few measures to reduce pressure on the pelvic floor:

• Eat a nutrient-rich, high-fibre diet to avoid constipation and straining when opening your bowels.
• Get a chronic cough treated.
• Avoid lifting heavy loads if this brings on symptoms.

A prolapse doesn't inevitably progress to more severe forms – ACOG points out that in some women it can remain stable or even improve over time. Longitudinal studies have shown that spontaneous resolution is particularly common in mild forms.

Kegel exercises and pelvic floor physiotherapy

Exercises play an important role in treating a prolapsed womb, particularly in mild forms. ACOG recommends a simple protocol that can effectively relieve symptoms – provided you do it correctly.

How should you do Kegel exercises step by step to strengthen your pelvic floor?

1. Tighten the muscles you'd use to stop the flow of urine.
2. Hold for 3 seconds.
3. Relax for 3 seconds.
4. Repeat 10 times, 3 times a day.
5. Each week, increase the hold by one second until you reach 10 seconds.

With Kegel exercises it's particularly important to know not only what you should do, but also what you should not do:

• Don't tighten your abdomen.
• Don't squeeze your thighs together.
• Don't clench your buttocks.
• Don't hold your breath.

The aim is to train the pelvic floor muscles and not to compensate with other muscle groups. The first changes appear over weeks, not days – so consistency is key.

You should be aware that, even when done correctly, Kegel exercises for a prolapsed womb can relieve symptoms and slow progression, but they can't lift an already well-descended womb back into position on their own. With advanced prolapse, exercises alone aren't enough as a treatment.

There's also an important exception: if the pelvic floor is hypertonic – that is, the muscles are already excessively tense and unable to relax properly – repeated contractions can worsen pain, bladder problems or discomfort during sex. In that case, Kegel exercises won't help you. What's needed is a proper assessment and a programme that takes the muscles' ability to relax into account.

The vaginal pessary (ring for prolapse)

For many women, a vaginal pessary is the best alternative to surgery for a prolapsed womb. ACOG lists it among the first-line non-surgical treatment options, and many women notice relief from their symptoms immediately after it's fitted.

This pessary is essentially a device inserted into the vagina to support prolapsed pelvic organs. It comes in numerous shapes and sizes, including the ring pessary, and it can be worn either temporarily or long term.

Depending on the type of prolapse and your anatomy, your doctor will select the right model for you in the clinic. A well-fitting pessary shouldn't hurt and, ideally, shouldn't be noticeable at all during everyday activities. If you're constantly aware of it, if it bothers you, slips out or causes discharge and irritation, you may need a different size or a different model. If such problems arise, your doctor will usually adjust the pessary rather than abandoning the idea altogether.

Caring for the pessary – including during your period – also depends on the model, on how easily it can be removed and on your doctor's instructions. Some pessaries you can remove, clean and reinsert yourself. Others require check-up appointments and cleaning at the clinic. Sex is also possible with some models, while others need to be removed beforehand.

If you're going through the menopause and have a pessary fitted, your doctor may also recommend topical oestrogen to improve the condition of the vaginal tissue and how well you tolerate the pessary.

Topical oestrogen

Topical oestrogen may be prescribed as a cream, pessary or vaginal ring, and it's helpful when falling oestrogen levels are affecting your tissues. Your doctor will decide on the type and dose; these products are available on prescription only. If you have a history of cancer or other relevant health problems, be sure to tell your doctor before using topical oestrogen.

This approach is particularly relevant for a prolapsed womb during the menopause, which can occur alongside atrophic vaginitis. Oestrogen can improve tissue quality, reduce dryness and irritation, and make wearing a pessary more comfortable.

Like the other methods discussed so far, however, oestrogen doesn't lift the womb back up and doesn't cure the prolapse.

Surgery: what the options are and what you should know about mesh

If your symptoms are affecting your quality of life and non-surgical treatments aren't helping enough, there are two main directions your doctor may recommend:

• Reconstructive surgery, which aims to restore support and bring the organs back as close as possible to their normal position.
  • This category also includes uterus-preserving options such as certain forms of hysteropexy or sacrohysteropexy.
• Obliterative surgery, in which the vaginal canal is shortened, narrowed or closed to provide more support.
  • After this procedure, penetrative vaginal intercourse is no longer possible. This option is therefore only suitable for women who no longer wish to have such intercourse and for whom it is medically appropriate.

In any case, removing the womb isn't the only solution, as many women believe. Yes, hysterectomy is one of the options, but it isn't inevitably used for every patient with a prolapse. The right approach depends on your anatomy, your symptoms, your age, whether you may want children, your general state of health and your own wishes.

Vaginal mesh is another device that was increasingly used in the treatment of genital prolapse. Because of the high risk of complications – including mesh erosion, pain, infection and injury to the bladder or bowel – the NHS in the UK notes that procedures using transvaginal mesh are now only carried out when there's no alternative. That doesn't mean all mesh is banned in prolapse surgery: certain abdominal reconstructive procedures still use mesh. It simply means you needn't worry about it, because the decision is always made by weighing up the individual benefits and risks.

If you're also wondering about the cost of prolapse surgery, there's no single price. Costs depend on the type of procedure, the length of hospital stay and, of course, the hospital you choose – whether public or private. If you opt for the public system, it's worth asking the medical team which costs are covered, as some procedures may be funded.

None of these procedures guarantees that all symptoms will disappear. What's more, new problems may arise, such as pain during intercourse, pelvic pain or urinary incontinence. And even after successful surgery, there's a risk of recurrence. According to ACOG, this risk is higher in patients under 60, in those who are overweight, or where the prolapse was more advanced before surgery.

What does NOT help with a prolapse: "natural remedies" and forum tips

If you're afraid of surgery or reluctant to see a doctor, you may already have considered natural treatment for a prolapsed womb. But it's important to stay realistic and think things through soberly.

No tea, ointment, tincture, supplement, herbal bath or massage said to lift the womb can restore overstretched supporting structures. There's no evidence whatsoever that any of these work – and mechanically it simply isn't possible. A tea or a supplement can't rebuild the ligaments and tissues that support your pelvic organs.

The risks you take, on the other hand, are very real. Not because the remedies themselves are harmful, but because you lose time. In trying to solve the problem at home, months or years can pass during which symptoms worsen to the point where gentle, non-invasive treatments become less effective.

Some natural approaches do genuinely work, and gentle solutions do exist – but they aren't teas and tinctures. They're the preventive measures recommended by doctors:

• Exercise suited to your physical condition
• Kegel exercises for the pelvic floor (where appropriate)
• A nutrient-rich diet to prevent constipation
• Stopping smoking
• Adjusting physical strain

The difference between these measures and the drinks or herbs generally regarded as natural remedies is this: the former reduce the factors that put pressure on the pelvic floor – even if they don't directly correct the prolapse.

Everyday life with a prolapse

A diagnosis of prolapsed womb can knock you sideways at first. When you learn that your womb has descended, it's completely normal for one question after another to race through your mind: can I still have sex? Can I keep going to the gym? Can I still use tampons during my period?

Good news! In most cases, the answer is by no means that you have to give up your lifestyle. Yes, a prolapse may change a few things in your daily life – but it doesn't turn your life and daily activities upside down.

Sex

You can still have sex with a prolapsed womb. Penetration doesn't push the womb further down and doesn't make the prolapse progress. Some women do feel pressure, dryness, discomfort or dyspareunia – that is, pain during intercourse – particularly if there's vaginal atrophy as well, but there are solutions. You can use a lubricant, choose positions that put less pressure on the pelvis, or use the topical oestrogen prescribed by your doctor.

Don't neglect the emotional side either, because that can also affect your sex life when you receive the diagnosis. You may worry that your partner will notice something. You may feel ashamed because your body no longer looks and works the way it once did. These insecurities are normal and don't mean you've developed a sexual dysfunction – they simply show that you need patience and understanding with yourself.

Exercise and weightlifting

A diagnosis of prolapse doesn't mean you have to give up exercise, never set foot in a gym again and avoid all exertion.

You simply need to listen to your body and make adjustments when it tells you to. Some activities and exercises are better tolerated with a prolapsed womb than others – your job is to find the ones that suit you.

Long-distance running, jumping, trampolining, very heavy weights and exercises done while holding your breath can increase intra-abdominal pressure and worsen your symptoms. Walking, swimming, cycling, Pilates and strength training with good breathing technique, by contrast, are often well tolerated. Simply breathe out on the effort and avoid holding your breath.

The most useful rule is very simple: if a sensation of heaviness or pressure in the pelvis appears during the exercise or in the hours afterwards, that's a sign to reduce the load or modify the movement. It certainly doesn't mean you automatically have to stop training.

Periods, tampons and menstrual cups

A prolapse can also change how internal period products feel. ACOG mentions that some women have difficulty inserting a tampon or find it hard to keep it in place. That's because the position and shape of the vaginal canal change.

The tampon may shift, be harder to position or feel more noticeable. Likewise, a menstrual cup can be harder to position and less comfortable, especially if you also wear a pessary. For these reasons, some women prefer to switch to pads.

If this sounds like you, choose products with a top layer of 100% organic cotton for the gentlest possible period care. They won't treat or prevent a prolapsed womb, but they can give you a little extra comfort during your period.

If you wear a pessary and would like to use a menstrual cup or other internal products, be sure to speak to your doctor first. How you manage the pessary during your period depends on the model and on your doctor's advice.

Uterine prolapse, pregnancy and fertility

Mild forms of uterine prolapse generally don't affect fertility. In most cases you can still have children after this diagnosis. An advanced prolapse can, however, alter the anatomy of the vagina and cervix and make conception more difficult.

If you'd like to become pregnant, the best thing to do is to be examined by your gynaecologist and discuss your situation and the available options together.

Your position on whether you may want children is also particularly important in choosing treatment. If your symptoms allow, non-invasive solutions such as pelvic floor physiotherapy or a pessary will most likely be preferred. With more pronounced prolapse, however, a later pregnancy can compromise the outcome of reconstructive pelvic floor surgery – and a hysterectomy, of course, rules pregnancy out.

That's why you should tell your doctor clearly at your very first consultation whether you'd like children in the future – whether in a year or in ten. Because that information can fundamentally change the treatment strategy chosen.

How to lower your risk of prolapse and of it worsening

There's no guaranteed way to prevent a prolapsed womb, and you can't eliminate all the risk factors. But that doesn't mean there's nothing you can do.

With a few simple measures you can significantly reduce the repeated pressure on your pelvic floor and better protect your supporting tissues:

• Regular pelvic floor training: Kegel exercises can improve the support provided by the pelvic floor muscles.
• Preventing constipation: fibre, plenty of fluids and exercise help you avoid heavy straining when opening your bowels.
• Maintaining a weight you feel comfortable at: this can reduce chronic pressure on the pelvic floor.
• Treating a chronic cough and giving up smoking: repeated coughing raises intra-abdominal pressure and strains the pelvic floor.
• Lifting weights with good technique: avoid very heavy loads and don't hold your breath during the effort.
• A postnatal check: to identify muscle weakness and choose the right exercises.

These same measures can also bring relief if you already have a prolapse. They won't cure it in the sense of returning the womb to its position, but they can reduce the factors that make symptoms worse. And regular gynaecological check-ups can pick up a prolapse before symptoms worsen, giving you the chance to discuss monitoring and treatment options early on.

Frequently asked questions

Looking for quick answers to your questions about prolapsed womb? If you want to understand as much as possible in as little time as possible, below you'll find concrete answers to the questions we've come across most often in forums and on social media – the places where women share their fears about prolapsed womb and try to make sense of the diagnosis and the next steps.

Can a prolapsed womb resolve on its own?

Yes, some mild forms of prolapsed womb can improve or even resolve without intervention, particularly in the early stages. A prolapse doesn't inevitably progress to more severe forms. If symptoms are minimal, your doctor may recommend simply monitoring it.

How long does recovery take after prolapse surgery?

Recovery usually takes a few weeks. The exact timeframe depends on the type of procedure and your state of health. During this period, your surgeon may temporarily advise you to limit strenuous activity, heavy lifting and sexual intercourse.

How much does prolapse surgery cost?

There's no single price for surgery for a prolapsed womb. Costs depend on the procedure chosen, the hospital, the type of anaesthetic and what's included. In the public health system, some procedures may be funded.

Is a prolapsed womb dangerous?

A prolapsed womb is generally not a life-threatening condition. The symptoms can, however, affect urination, bowel movements, your sex life and even your emotional wellbeing, and can cause considerable discomfort. Severe, untreated forms can also lead to local complications.

Can a prolapsed womb get worse after the menopause?

Yes, a prolapsed womb can worsen after the menopause, as falling oestrogen levels can affect the supporting tissues. Some prolapses do remain stable, however, or even improve over time.

What shouldn't you do if you have a prolapsed womb?

You don't wake up the next morning with a list of forbidden activities just because you have a prolapsed womb. You simply need to listen to your body. If you notice that an exercise, heavy lifting or any other activity increases the pressure or heaviness in your pelvis, you should reduce the intensity and speak to your doctor.

Can I get pregnant with a prolapsed womb?

Yes, you can get pregnant with a prolapsed womb, particularly with mild forms. With advanced forms there may be mechanical difficulties. If you'd like children, be sure to tell your doctor before choosing a treatment.

Does prolapse come back after surgery?

Yes, a prolapse can recur after surgery, because the operation repairs the existing support but doesn't remove all the factors that contributed to it developing. The risk of recurrence varies according to the procedure and each patient's individual circumstances.

Can I use tampons or a menstrual cup with a prolapsed womb?

Some women can continue to use tampons, but a prolapse can make insertion or retention more difficult. A menstrual cup can also become uncomfortable for some women. If you wear a pessary, it's important to speak to your doctor before using internal products.

How quickly do Kegel exercises work?

The first improvements from Kegel exercises generally appear after a few weeks of regular, correct practice, not after a few days. Results depend on your technique, your consistency and the condition of your pelvic floor. If your muscles are already too tense, speak to your doctor – Kegel exercises may not be suitable in that case.

Sources

1. NHS — Pelvic organ prolapse — https://www.nhs.uk/conditions/pelvic-organ-prolapse/
2. ACOG (American College of Obstetricians and Gynecologists) — Pelvic Support Problems (FAQ012) — https://www.acog.org/womens-health/faqs/pelvic-support-problems
3. Mayo Clinic — Uterine prolapse — Symptoms and causes — https://www.mayoclinic.org/diseases-conditions/uterine-prolapse/symptoms-causes/syc-20353458
4. Cleveland Clinic — Uterine Prolapse: Stages, Symptoms, Treatment & Surgery — https://my.clevelandclinic.org/health/diseases/16030-uterine-prolapse
5. Nygaard I., Bradley C., Brandt D. (Women's Health Initiative), Obstetrics & Gynecology, 2004 — Pelvic organ prolapse in older women: prevalence and risk factors — https://pubmed.ncbi.nlm.nih.gov/15339758/
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7. Johns Hopkins Medicine — Uterine Prolapse — https://www.hopkinsmedicine.org/health/conditions-and-diseases/uterine-prolapse

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