About Cervical Prolapse
Cervical prolapse occurs when the cervix descends into the vaginal canal due to weakened pelvic floor muscles and ligaments. In severe cases, the cervix may protrude outside the vaginal opening. Unlike uterine prolapse, which involves the entire uterus shifting downward, cervical prolapse primarily affects the cervix while the uterus remains in place. Symptoms may include a bulging sensation in the vagina, pressure or discomfort in the pelvic area, difficulty inserting tampons, urinary issues such as leakage or difficulty urinating, and bowel problems like constipation.
Treatment options vary based on severity. Pelvic floor exercises, such as Kegels, may help strengthen the muscles and provide relief. In some cases, a pessary, a small supportive device inserted into the vagina, can help keep the cervix in place. For more severe cases, surgical intervention may be necessary. If symptoms worsen or interfere with daily activities, consulting a healthcare professional is important to determine the best course of treatment.
Cervical prolapse, also known as cervical descent, can be caused by factors or conditions that increase pressure on or weaken the pelvic muscle and supportive tissues, leading to the descent of the cervix into the vaginal canal. Some causes include:
- Vaginal delivery, especially multiple vaginal deliveries
- Difficult labor and delivery
- Delivering a large baby
- Being overweight
- Being post-menopause
- Chronic constipation
- Chronic cough
- Frequent heavy lifting
Risk factors for cervical prolapse include:
- Multiple vaginal deliveries: Repeated childbirth through the vaginal canal can weaken pelvic support structures.
- Older age at first pregnancy: Giving birth for the first time at an older age may increase the risk due to decreased tissue elasticity.
- Prior pelvic surgery: Surgeries like hysterectomy or procedures affecting the pelvic floor may weaken support structures.
- Smoking: Increases the risk by contributing to chronic coughing, which puts repeated strain on the pelvic floor.
It is important to note that having risk factors does not always lead to cervical prolapse, and some people experience cervical prolapse without know risk factors. If you have concerns about cervical prolapse or its risk factors, it is recommended to consult with your healthcare professional for personalized advice.
Mild cervical prolapse may not cause symptoms.
Early symptoms of cervical prolapse:
- Feeling of pressure or heaviness in the pelvic area
- Discomfort or pain during sexual intercourse
- Vaginal bleeding or spotting (not related to menstruation)
Other symptoms in later stages or higher severity of cervical prolapse:
- Increased urinary frequency and urgency
- Difficulty emptying the bladder completely
- Recurrent urinary tract infections (UTIs)
- Bowel movement difficulties, such as constipation or straining
- Lower back pain or pelvic pain that worsens with activity
- Vaginal bulging or protrusion, where the cervix may be visible outside the vagina
It's important to note that these symptoms can vary from person to person, and some individuals may not experience any symptoms at all. If you are experiencing any of these symptoms, it is recommended to consult with a healthcare professional for an accurate diagnosis and appropriate treatment options.
To diagnose cervical prolapse, healthcare professionals commonly perform the following examinations, tests, and procedures:
- Pelvic examination: A healthcare professional examines the pelvic area to assess the position of the cervix and uterus. The patient may be asked to bear down (as if having a bowel movement) or tighten pelvic muscles to evaluate the severity of the prolapse.
- Pelvic Organ Prolapse Quantitation (POP-Q): This assessment tool is used to measure the degree of prolapse.
- Imaging studies: An ultrasound or MRI (magnetic resonance imaging) scan may be recommended in cases where additional visualization of the pelvic organs is needed.
It's important to follow up with your health care provider if any symptoms worsen or change after the initial physical exam. They may recommend further diagnostic procedures to help determine a diagnosis. Remember to consult with your doctor about which specific examinations, tests, and procedures are appropriate for your individual situation.
The goals of treatment for cervical prolapse are to relieve symptoms, improve quality of life, and prevent the condition from worsening. The appropriate treatment depends on the severity of symptoms and the individual’s overall health and preferences. Here are the different treatment options and how they work to achieve these goals:
- Medications:
- There are no medications that reverse cervical prolapse, but hormone therapy (such as vaginal estrogen) may help strengthen vaginal tissue in postmenopausal individuals. Pain or bladder control medications may be prescribed to manage associated symptoms like discomfort or urinary incontinence.
- Therapies:
- Pelvic floor exercises (Kegels): Strengthening pelvic muscles may help support the cervix and reduce mild symptoms. They can improve symptoms and prevent further prolapse.
- Physical therapy: A pelvic floor physical therapist can guide you through exercises and techniques to strengthen your pelvic floor muscles and provide symptom relief.
- Therapeutic procedures:
- Pessary: A pessary is a small device inserted into the vagina to support the cervix and relieve symptoms. It is a non-surgical option that can be effective for some women.
- Surgical repair: If the prolapse is severe or causes significant symptoms, surgery may be needed to repair or reinforce weakened tissues and muscles supporting the cervix. The type of surgery depends on the severity of prolapse and whether future pregnancies are planned.
- Health behavior changes:
- Lifestyle modifications: Maintaining a healthy weight, avoiding heavy lifting or straining, and practicing good bowel habits can help prevent further progression of cervical prolapse.
It's important to note that treatment options may vary depending on the severity of the prolapse and individual factors. It is recommended to consult with your healthcare professional to determine the most appropriate treatment plan for you.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.