Uterine Prolapse

Populations and Risk Factors

Women with history of vaginal deliveries — particularly multiple births, large infants, prolonged second stage, forceps use
Post-menopausal women — estrogen decline reduces connective tissue quality and pelvic floor tone
Chronic increases in intra-abdominal pressure: obesity, chronic cough (COPD, asthma), constipation, heavy lifting occupations
Prior pelvic surgery that disrupts supportive structures
Connective tissue disorders (Ehlers-Danlos syndrome, Marfan syndrome)

Pelvic support anatomy: The uterus is supported by the cardinal ligaments, uterosacral ligaments, round ligaments, and pelvic floor musculature (levator ani)
Progressive failure: Obstetric trauma, estrogen loss, and repetitive straining cause progressive ligamentous laxity and muscle atrophy. As support fails, gravity and intra-abdominal pressure displace the uterus inferiorly
Grading (Baden-Walker system): Grade 1 — uterus in upper vagina. Grade 2 — at the introitus. Grade 3 — partial protrusion beyond opening. Grade 4 — complete procidentia
Associated prolapse: Cystocele (anterior vaginal wall/bladder) and rectocele (posterior vaginal wall/rectum) frequently accompany uterine prolapse

Pelvic pressure or heaviness: Sensation of "something falling out" — worse with prolonged standing or activity. Relieved supine
Low back pain and pelvic discomfort from traction on supporting structures
Urinary symptoms: stress incontinence, urgency, incomplete emptying, recurrent UTIs
Bowel symptoms: difficulty defecating, incomplete emptying
Visible or palpable protrusion in Grade 3-4
Dyspareunia (painful intercourse)
Red flags: New urinary retention or inability to void suggests severe prolapse with urethral kinking — urgent referral

Uterine prolapse is a pelvic floor dysfunction condition — frequently co-occurs with stress urinary incontinence
Prone positioning is generally inappropriate for significant prolapse (Grade 2+) — increases intra-abdominal pressure and worsens symptoms
Abdominal massage is not indicated — deep pressure increases intra-abdominal pressure and aggravates prolapse
Pelvic floor physiotherapy is the primary conservative treatment — MT complements by addressing hip flexors, posterior pelvic musculature, and lumbar region

No systemic contraindication: Prolapse does not prevent treatment of other body regions
Positioning: Supine is generally comfortable. Avoid prolonged prone (increases intra-abdominal pressure). Side-lying or semi-reclined preferred
Abdominal massage: Avoid deep abdominal pressure in any grade of active prolapse. Superficial techniques may be used with caution and client communication
Lumbopelvic work: Appropriate and beneficial — hip flexor lengthening, posterior pelvic and gluteal release, sacral work reduce pelvic mechanical strain
Pessary users: Clients wearing a vaginal pessary should not be positioned in ways that dislodge or create discomfort — ask about comfort
Psychological sensitivity: Prolapse carries significant body image concerns — use neutral, clinical language during intake

Uterine prolapse is descent of the uterus due to pelvic floor and ligamentous failure — graded 1-4 by degree
Primary risk factors: multiple vaginal deliveries, menopause, chronic straining
Avoid prone positioning and deep abdominal massage — both increase intra-abdominal pressure and worsen symptoms
Lumbopelvic soft tissue work is appropriate and complements pelvic floor physiotherapy
Approach the condition with clinical sensitivity — use professional, neutral language