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Question from a patient: I have pressure in the uterus area, which seems less after urinating. Could I be dealing with a fallen uterus?

A fallen uterus (also called uterine prolapse) can occur when the normal suspensory ligaments that support the uterus weaken. These ligaments, the uterosacral ligaments can be stretched with vaginal childbirth, weaken with age or be stretched with conditions that put excessive pressure on the ligaments (chronic coughing, chronic heavy lifting, etc.). As the uterus begins to drop into the vaginal canal symptoms can arise. A sense of heaviness or fullness in the pelvis can be felt, a bulge may be felt in the vaginal opening, a sense of pulling or discomfort in the lower pelvis may be felt and pressure may be felt on the bladder. However, many women will be asymptomatic from prolapse until the prolapse begins to protrude through the opening of the vagina.

Uterine prolapse is not uncommon but conditions that cause bladder symptoms are not uncommon either. The bladder and uterus are right next to each other in the pelvis so concurrent conditions may be perceived by one symptom. A gynecologic examination can assess the suspensory ligaments that support the uterus. Further testing on the bladder may be required to see if the fallen uterus is contributing to your bladder symptoms or if you are dealing with a fallen uterus and a separate bladder condition.

Treatment for a fallen uterus can be non surgical or surgical. Non surgical options can include pelvic floor therapy or a pessary. Pelvic floor therapy can strengthen the muscles in the vagina to help support the weakened suspensory ligaments of the uterus. A pessary is a small rubber device placed in the vagina to support the uterus and weakened vaginal walls. Surgical treatments for a fallen uterus include laparoscopic, robotic and vaginal approaches that may not require removal of the uterus (also called a hysterectomy). Seeking out a physician who can treat a fallen uterus as well as bladder conditions will give you the best options in terms of treatment.

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