10 Warning Signs and Symptoms of Uterine Prolapse You Should Know

Uterine prolapse is a common yet often misunderstood condition that affects many women, particularly those who have gone through childbirth or menopause. This condition occurs when the pelvic floor muscles and ligaments stretch and weaken, causing the uterus to slip down into or protrude out of the vagina. While mild cases may not cause noticeable symptoms, moderate to severe uterine prolapse can significantly impact a woman’s quality of life.

Understanding the warning signs of a prolapsed uterus is crucial for early detection and proper management. Many women may feel embarrassed to discuss these symptoms, but recognizing them early can help prevent the condition from worsening and lead to more effective treatment options. In this comprehensive guide, we’ll explore the ten most common symptoms of uterine prolapse, their underlying causes, and practical prevention strategies.

1. Pelvic Pressure and Heaviness

One of the earliest and most common symptoms of uterine prolapse is a persistent feeling of pressure or heaviness in the pelvic region. Women often describe this sensation as if something is “falling out” or “sitting on a ball.” This discomfort typically worsens as the day progresses, especially after prolonged standing or physical activity.

The pressure occurs because the weakened pelvic floor muscles can no longer adequately support the uterus in its normal position. As gravity pulls the uterus downward, it creates tension on surrounding tissues and nerves. Many women find that lying down provides temporary relief, as this position reduces gravitational stress on the pelvic organs. This symptom can range from mild discomfort to severe pain that interferes with daily activities.

2. Tissue Protruding Through the Vaginal Opening

In more advanced cases of uterine prolapse, women may notice actual tissue bulging through the vaginal opening. This is perhaps the most alarming symptom and often prompts immediate medical attention. The protruding tissue may appear pink or red and can feel soft or firm to the touch.

Initially, this protrusion may only be noticeable during certain activities like straining during bowel movements, heavy lifting, or coughing. However, as the prolapse progresses, the tissue may remain visible even during rest. Some women discover this symptom while bathing or using the bathroom. The exposed tissue can become irritated, dry, or even develop sores due to friction against underwear or from exposure to air. It’s important to seek medical evaluation if you notice any tissue protruding from the vaginal opening.

3. Lower Back Pain and Discomfort

Chronic lower back pain is a frequently overlooked symptom of uterine prolapse. The pain typically occurs in the lower lumbar region and may radiate to the hips and upper thighs. Unlike typical back pain from muscle strain, prolapse-related back pain often improves when lying down and worsens with prolonged standing or sitting.

This pain develops because the displaced uterus alters the normal alignment of pelvic structures, creating abnormal stress on the lower spine and surrounding muscles. The body attempts to compensate for this misalignment, leading to muscle tension and fatigue in the back. Additionally, the stretched ligaments that normally support the uterus share nerve pathways with the lower back, which can contribute to pain perception in this area. Many women report that this back pain feels different from ordinary backaches and may be accompanied by a pulling sensation in the pelvis.

4. Urinary Incontinence and Bladder Problems

Bladder dysfunction is one of the most troublesome symptoms associated with uterine prolapse. Women may experience various urinary issues, including stress incontinence (leaking urine when coughing, sneezing, laughing, or exercising), difficulty starting urination, frequent urination, or the persistent feeling of incomplete bladder emptying.

These problems occur because the prolapsed uterus can compress or displace the bladder and urethra, disrupting their normal function. The bladder may kink or fold abnormally, preventing complete emptying and increasing the risk of urinary tract infections. Some women find they need to change positions or manually push the prolapse back to fully empty their bladder. In severe cases, the bladder itself may also prolapse (a condition called cystocele), compounding these urinary symptoms. These bladder issues can be particularly embarrassing and may cause women to limit social activities or exercise.

5. Difficulty with Bowel Movements

Constipation and difficulty with bowel movements are common but less discussed symptoms of uterine prolapse. Women may experience straining during defecation, a feeling of incomplete evacuation, or the need to apply manual pressure to the vaginal wall or perineum to complete a bowel movement.

The prolapsed uterus can push against the rectum, creating an obstruction or abnormal angle that makes it difficult for stool to pass normally. This can lead to chronic constipation, which ironically can worsen the prolapse due to the increased straining required. Some women develop a rectocele (bulging of the rectum into the vagina) alongside uterine prolapse, which further complicates bowel function. The cycle of constipation and straining can create a frustrating situation that progressively worsens both the bowel symptoms and the prolapse itself.

6. Painful or Uncomfortable Sexual Intercourse

Many women with uterine prolapse experience pain, discomfort, or decreased sensation during sexual intercourse, medically known as dyspareunia. This can range from mild discomfort to severe pain that makes sexual activity impossible or undesirable.

The displaced uterus can create abnormal pressure during penetration, and the stretched, weakened vaginal tissues may be more sensitive or prone to irritation. Some women report a sensation of their partner “hitting something” during intercourse, which can be painful. Additionally, if tissue is protruding from the vaginal opening, it may become further irritated during sexual activity. The emotional and psychological impact of these symptoms can also affect intimacy and relationships. Many women feel embarrassed to discuss these issues with their partners or healthcare providers, but open communication is essential for finding solutions and maintaining quality of life.

7. Vaginal Bleeding or Unusual Discharge

Abnormal vaginal bleeding or increased discharge can occur with uterine prolapse, particularly in more advanced stages. Women may notice spotting between periods, bleeding after intercourse, or unusual discharge that may be clear, white, or blood-tinged.

This symptom develops when the prolapsed tissue becomes irritated or ulcerated due to exposure, friction, or dryness. The cervix and uterine tissue that protrude beyond the vaginal opening are not designed to be exposed to air and external elements, making them vulnerable to irritation and minor trauma. The constant rubbing against clothing or during physical activity can cause the delicate tissue to bleed. Increased discharge may represent the body’s attempt to keep the exposed tissue moist and protected. While bleeding can be related to prolapse, it’s crucial to have any abnormal vaginal bleeding evaluated by a healthcare provider to rule out other serious conditions.

8. Frequent Urinary Tract Infections

Women with uterine prolapse often experience recurrent urinary tract infections (UTIs), sometimes having multiple infections within a year. Symptoms of UTIs include burning during urination, frequent urge to urinate, cloudy or strong-smelling urine, and pelvic discomfort.

The link between prolapse and UTIs occurs because the displaced uterus and bladder create pockets where urine can pool and stagnate rather than being completely expelled during urination. Bacteria thrive in this stagnant urine, leading to infection. Additionally, the difficulty in completely emptying the bladder means that bacteria are not effectively flushed out with each urination. The structural changes in the urinary tract can also make it easier for bacteria to travel from the urethra to the bladder. Women who notice they’re getting UTIs more frequently than usual should discuss this pattern with their doctor, as it may indicate an underlying pelvic support problem.

9. Sensation of Something Falling Out

Many women with uterine prolapse describe a distinctive sensation that “something is falling out” of the vagina. This feeling can be constant or intermittent, often worsening during physical activity, at the end of the day, or during bowel movements or urination.

This unsettling symptom reflects the actual descent of the uterus within the pelvic cavity. As the supporting structures weaken, the uterus gradually moves downward, creating this sensation of displacement. Women may instinctively check to see if anything is actually protruding or may unconsciously change their posture or movements to alleviate the feeling. Some describe it as similar to the sensation of a tampon that isn’t properly inserted. This symptom can be particularly distressing psychologically, as it creates constant awareness of the condition and may limit physical activities and confidence in movement.

10. Increased Pelvic Discomfort During Physical Activity

Women with uterine prolapse frequently notice that their symptoms significantly worsen during or after physical activity, exercise, lifting, or prolonged standing. Activities that increase intra-abdominal pressure, such as running, jumping, heavy lifting, or even intense coughing, can exacerbate the discomfort.

This occurs because physical activity and increased abdominal pressure push the already-displaced uterus further downward, intensifying all prolapse-related symptoms. The weakened pelvic floor muscles become fatigued more quickly during activity, reducing their ability to support the pelvic organs. Many women find themselves avoiding exercise or limiting their activities, which can lead to weight gain and decreased overall fitness—factors that can ironically worsen the prolapse over time. Understanding that symptoms may fluctuate with activity level is important, and women should work with healthcare providers to develop safe exercise strategies that strengthen rather than worsen their condition.

Main Causes of Uterine Prolapse

Understanding what causes uterine prolapse can help women identify their risk factors and take preventive measures. The condition results from weakening of the pelvic floor muscles and connective tissues that normally hold the uterus in place. Several factors contribute to this weakening:

Pregnancy and Childbirth: This is the most significant risk factor for uterine prolapse. Vaginal delivery, especially of large babies, multiple pregnancies, or prolonged labor can stretch and damage the pelvic floor muscles and ligaments. The risk increases with each vaginal delivery.

Aging and Menopause: As women age, particularly after menopause, decreasing estrogen levels lead to weakening of the pelvic support structures. Estrogen helps maintain the strength and elasticity of muscles and connective tissues throughout the body, including the pelvic floor.

Chronic Straining: Conditions that cause repeated increases in abdominal pressure can progressively weaken pelvic support. These include chronic constipation, chronic coughing (from conditions like bronchitis or asthma), and frequent heavy lifting.

Obesity: Excess body weight creates constant downward pressure on the pelvic floor, gradually stretching and weakening the supporting structures over time.

Previous Pelvic Surgery: Surgical procedures in the pelvic area, including hysterectomy, can sometimes damage or weaken the support structures, increasing the risk of prolapse.

Genetic Factors: Some women are born with naturally weaker connective tissue, making them more susceptible to developing prolapse. Family history of prolapse can indicate increased risk.

Prevention Strategies

While not all cases of uterine prolapse can be prevented, especially when genetic factors are involved, there are several strategies that can significantly reduce risk or prevent the condition from worsening:

Perform Regular Pelvic Floor Exercises: Kegel exercises strengthen the pelvic floor muscles and are one of the most effective preventive measures. These exercises involve repeatedly contracting and relaxing the muscles that control urination. Performing Kegels regularly, especially during and after pregnancy, can help maintain pelvic floor strength.

Maintain a Healthy Weight: Keeping your body weight within a healthy range reduces constant pressure on the pelvic floor. If you’re overweight, gradual weight loss through balanced diet and appropriate exercise can help prevent or improve prolapse symptoms.

Prevent and Treat Constipation: Eating a high-fiber diet, drinking adequate water, and staying physically active can help prevent constipation and reduce straining during bowel movements. Address chronic constipation promptly with your healthcare provider.

Avoid Heavy Lifting: When lifting is necessary, use proper technique—bend at the knees rather than the waist, keep objects close to your body, and avoid holding your breath while lifting. Consider asking for help with particularly heavy items.

Treat Chronic Cough: If you have a persistent cough due to smoking, allergies, or respiratory conditions, seek appropriate treatment. Chronic coughing repeatedly increases abdominal pressure and strains pelvic support structures.

Quit Smoking: Smoking contributes to chronic cough and may also affect the strength of connective tissues throughout the body, including those supporting pelvic organs.

Practice Good Posture: Maintaining proper posture and body alignment helps distribute weight evenly and reduces strain on the pelvic floor.

Frequently Asked Questions

Can uterine prolapse go away on its own?
No, uterine prolapse does not resolve on its own. However, mild cases may remain stable or improve with pelvic floor exercises and lifestyle modifications. Without intervention, prolapse typically remains the same or gradually worsens over time.

Is uterine prolapse dangerous or life-threatening?
Uterine prolapse itself is not life-threatening, but it can significantly impact quality of life. Severe cases can lead to complications such as ulceration of protruding tissue, urinary retention, recurrent infections, or kidney problems if urinary flow is obstructed.

At what age does uterine prolapse typically occur?
While uterine prolapse can occur at any age, it’s most common in women over 50, particularly those who are postmenopausal. However, it can also affect younger women, especially those who have had multiple vaginal deliveries or have other risk factors.

Can I still get pregnant if I have uterine prolapse?
Pregnancy is possible with uterine prolapse, though it may be more challenging to conceive. Pregnancy can worsen the prolapse, and there may be increased risks during pregnancy and delivery. Women with prolapse who wish to become pregnant should discuss this with their healthcare provider.

Will I need surgery for uterine prolapse?
Not all women with uterine prolapse require surgery. Treatment depends on the severity of symptoms, the degree of prolapse, age, overall health, and whether you plan future pregnancies. Mild to moderate cases may be managed with pelvic floor exercises, lifestyle changes, or a pessary device. Surgery is typically considered when conservative treatments don’t provide adequate relief.

Can men or women without a uterus get prolapse?
Women who have had a hysterectomy can still experience pelvic organ prolapse involving the vaginal vault, bladder, or rectum. Men do not get uterine prolapse but can experience other types of pelvic floor disorders.

How is uterine prolapse diagnosed?
Diagnosis typically involves a pelvic examination where your doctor can see and feel the prolapse. You may be asked to bear down as if having a bowel movement to see the full extent of the prolapse. Additional tests might include urodynamic testing to assess bladder function or imaging studies in certain cases.

Can exercise make uterine prolapse worse?
High-impact exercises or activities that significantly increase abdominal pressure can worsen prolapse symptoms. However, appropriate exercise, particularly pelvic floor strengthening, is beneficial. Low-impact activities like walking, swimming, and specific strengthening exercises are generally safe and recommended. Consult with a healthcare provider or pelvic floor physical therapist about safe exercise options.

References:

• Mayo Clinic – Uterine Prolapse
• NHS – Pelvic Organ Prolapse
• American College of Obstetricians and Gynecologists – Pelvic Support Problems
• Johns Hopkins Medicine – Vaginal Prolapse
• Cleveland Clinic – Uterine Prolapse