Uterine Prolapse-what is it and how is it treated

Uterine Prolapse

What is Uterine Prolapse

Every now and then, I will have clients consulting me about their symptoms and if my team of therapists can help. Of course, I always tell them to see their doctors first for a proper diagnosis and treatment. Unfortunately, despite knowing their diagnosis — uterine prolapse — there is no treatment the doctor can directly help them with, unless it gets worse. But even with mild prolapse, it affects their daily activities, quality of life and sex life. 

Uterine prolapse is a common phenomenon that happens to women at any time. It can occur due to the weakening of the ligaments and muscles in the pelvic area which supports the uterus. Whenever this support structure begins to fail, the uterus will descend and sag down. In other words, I describe it as the womb has fallen out of place.

This condition can happen at any time to any woman. However, it seems to happen more commonly to women as they age, and especially if they had vaginal deliveries. It is also common for women who have just given birth, especialy if they had multiple births to experience a mild form of uterine prolapse. 

The Uterus

The uterus is part of the female reproductive system. It looks like an upside-down pear and located in between the bladder and the rectum. A layer of supporting ligaments and muscles holds the womb in position above the inside of the vagina. When the support weakens, the uterus can sag downward. When this happens, it may result in a vaginal bulge. Additionally, in worse cases, the lump can appear or protrude at the vaginal opening if the uterus has sagged far enough.

womb prolapse

Diagnosing Severity of Uterine Prolapse

In Western medicine, uterine prolapse is explained in terms of stages, which indicates how far the uterus has descended into the vagina.

The following are the four stages:

  • 1st: This stage is described as the uterus descending in the upper part of the vagina.
  • 2nd: This stage is described as the uterus descending nearly towards the vaginal opening
  • 3rd: This stage is described as the uterus protruding out of the vagina. 
  • 4rth: This stage is described as the most severe and characterized by the entire uterus protruding completely out of the vagina

However, in the Malay Traditional Medicine, there are other stages before Stage 1 of uterine prolapse. According to Malay midwifery, the uterus is nestled in its sarang, nest (i.e location in the pelvic bowl). So if the uterus is slightly lowered and out of position, it is called rahim rendah⁠ or low womb. If it has fallen out of its nest and is resting on the cervix or vagina, but not yet descended into the vagina, this is called rahim jatuh, fallen womb.

Uterine Prolapse

Signs and Symptoms to Watch Out For

So, how can you tell if your uterus has prolapsed? Here are the signs and symptoms that you should watch out for:

  • Pain in the pelvic area, lower abdomen, lower back, groin, or vagina. Most women who have uterine prolapse describe the discomfort as a sore feeling or pulling pressure in the vaginal area. The pain often worsens during sexual intercourse or during the menstrual period. In some women, the discomfort is associated as if something is falling out of the vagina.
  • A bulging tissue protruding out of the vagina. This bulging tissue may be the uterus. The exposed part of the uterus can become irritated, itchy and develop small sores that can bleed.
  • Urinary symptoms like urinary incontinence and frequency can also be experienced. The urinary leakage can also worsen when a woman coughs, sneezes laughs, or lifts heavy objects.
  • Difficulty in having a bowel movement. This can happen because the uterus can put pressure on the rectum which ultimately blocks it.
  • Moist discharges are also present when you have uterine prolapse.

Who is at Risk for Uterine Prolapse?

This condition is most likely to happen in women who have one or more vaginal deliveries and those who have family members who have had a history of uterine prolapse. Also, this condition is associated with natural aging, and post-menopausal women are likely to develop the condition.

Menopause occurs when a woman’s ovaries stop producing essential hormones that are responsible for regulating the monthly menstrual cycle. One of the hormones that are produced less during menopause is estrogen. One of the major functions of estrogen is to keep the pelvic muscles strong. With decreased production of estrogen, you are at a higher risk of developing uterine prolapse.

Health experts estimate that most women who have gone through childbirth, experience uterus prolapse to some extent. While this may be true, in most cases this condition remains undiagnosed and untreated.

In fact, only about 10 percent to 20 percent of women with such conditions seek medical consultation for the symptoms they experience. Early diagnosis is critical to this condition so that early treatment can be initiated. Also, the uterus is not the only organ that can prolapse into your vagina. In fact, your rectum or bladder can also sag and prolapse into your vagina.


Risk Factors and Possible Causes of Uterine Prolapse

While it is determined that childbirth can contribute to the weakening of the pelvic muscles and ligaments, other factors can increase the risk of uterine prolapse. These factors are the following:

  • Chronic constipation
  • Obesity
  • Chronic cough
  • Repeated heavy lifting
  • Menopause
  • Hormonal imbalance
  • Family history

Diagnosis of Uterine Prolapse

In my experience working with medical imaging, it is not very straightforward in detecting or diagnosing a mild prolapse. Depending on the severity, an experienced primary healthcare provider can make the diagnosis through a pelvic examination. In some cases, to validate the diagnosis, an MRI may be required.  

But if the prolapse is in stage 1 or milder, it is harder to diagnose because you can’t detect it through pelvic examination or medical imaging. This is because most tests are done laying down where the womb will be free-floating in the pelvic bowl. The symptoms of uterine prolapse are most often seen or felt when in an upright position when gravity pulls it down.


Treatment of Uterine Prolapse

In Western medicine, the treatment for uterine prolapse will depend on the severity of the case. Mild to moderate cases may not need treatment as long as it does not cause any significant medical implications. However, advanced or severe uterine prolapse typically requires surgery to correct the problem and prevent complications like vaginal ulceration, urinary problems, bowel problems, and sexual dysfunction.

In some cases, pessary support may also be prescribed depending on the severity of the condition. Pessary support is a prosthetic device that may be inserted into the vagina to support the internal vaginal structure.

Treatment of Uterine Prolapse in Malay Midwifery Method

Sengkak, Deep Abdominal ‘Lifting Massage’

A skilled midwife or massage therapist can assess the position of prolapse with a deep tissue abdominal massage. If the womb is low, misaligned, displaced, or fallen out of place the midwife or massage therapist will perform a series of treatments to correct this issue. 

One of the treatments is called sengkak. Sengkak is a womb lifting massage technique to reposition the womb back into its original location. It is a deep tissue massage manipulation, using herb-infused oils. Sometimes, the buttocks will be lifted up to make use of reversed gravity to push the womb back into position. 

Dos and Don’ts 

The Malay midwifery methods will also advise on the do’s and don’ts in their daily activity (such as not to carry heavy objects, prevent being constipated so you don’t use too much abdominal pressure when passing motion), and to regularly perform senaman kemutan, pelvic floor exercise among others. They will also be advised to perform other treatments such as the use of herbs, vaginal steaming, and womb heat therapy to help in the pelvic floor strengthening.

If the woman who just gave birth is experiencing uterine prolapse, bengkung belly binding can help. 

 How Bengkung belly binding can help with uterine prolapse 

Bengkung belly binding has many health, postural and slimming benefits. However, it is particularly beneficial for women who have given birth, especially if she is experiencing milder stages of uterine prolapse. If the bengkung belly bind is put on properly, it starts low in the abdomen – right above the pubic bone. As the bengkung belly bind is wrapped around the body, it helps in lifting up the abdominal organs. The bengkung belly bind becomes a compression garment that provides external support to relieve pressure off the pelvic floor. This allows the pelvic floor to recover and strengthen. This is usually done with the other treatments for maximum benefits. 


Prevention of uterine prolapse using abdominal binding

Even if a new mother does not have a prolapse, women who have given birth are susceptible to uterine prolapse. The bengkung belly bind is a preventive measure from this happening. According to Malay Midwifery, following the pantang during the confinement period, can prevent prolapse and other health problems especially in their old age. The paintings include all the taboos and restrictions you shouldn’t do in your 44 days of confinement, as well as following through the other treatment rituals and having a healthy diet and lifestyle. 

If you have any questions about natural methods to prevent or treat uterine prolapse, feel free to comment and ask me a question!

Better Health. (2020, July 20.) Bladder Prolapse. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/bladder-prolapse 
Harvard Health Publishing.(2012, April). Treating Organ Pelvic Prolapse. https://www.health.harvard.edu/womens-health/treating-pelvic-organ-prolapse
SRC Health.(2020, September 24). Uterine Prolapse – What Every Every Woman Needs to Know and What Can Be Done About it.  https://srchealth.com/blogs/news/uterine-prolapse-what-every-woman-needs-to-know-and-what-can-be-done-about-it

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I hope you have learned something new about bengkung belly binding. If you have a comment or have any questions, I will be happy to personally answer any questions.

With Love & Light, 
Salwa Salim

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