From the Guidelines
Yes, if you have a history of rectal uterine prolapse from 20 years ago, you are at increased risk for recurrence if you strain or become constipated. According to the most recent study 1, risk factors for pelvic floor dysfunction include advanced age, menopause, vaginal multiparity, obesity, chronic straining, and conditions that result in chronic increase in intra-abdominal pressures.
Key Points to Consider
- Straining during bowel movements puts significant pressure on your pelvic floor muscles and can weaken the supportive tissues that hold pelvic organs in place 1.
- To reduce this risk, focus on preventing constipation through:
- A high-fiber diet (25-30 grams daily)
- Adequate hydration (6-8 glasses of water daily)
- Regular physical activity
- Consider using a stool softener like docusate sodium (100mg once or twice daily) if needed.
- Avoid straining during bowel movements by using proper positioning—try elevating your feet on a small stool while on the toilet to create a more natural squatting position.
- Performing regular pelvic floor exercises (Kegels) can also strengthen the muscles supporting your pelvic organs.
Importance of Early Intervention
If you notice any symptoms of prolapse returning, such as pressure, bulging, or discomfort in the vaginal or rectal area, consult with your healthcare provider promptly as early intervention can prevent worsening of the condition 1. The goal of any treatment strategy is to improve the patient’s quality of life, because the condition primarily causes morbidity but is not life threatening 1.
From the Research
Risk of Recurrence
- A history of rectal uterine prolapse 20 years ago may increase the risk of recurrence, especially if strain or constipation occurs 2, 3.
- Straining or constipation can put additional pressure on the pelvic floor, which may lead to a recurrence of prolapse 4.
- It is essential to maintain good bowel habits and avoid straining during bowel movements to reduce the risk of recurrence 4.
Management Options
- Treatment options for pelvic organ prolapse include observation, pelvic floor physical therapy, pessary use, and surgery 2, 3, 5.
- Pelvic floor physical therapy (PFPT) can improve or cure symptoms of urinary incontinence, pelvic organ prolapse, and fecal incontinence 6.
- Surgery can be performed through transvaginal, laparoscopic/robotic, or open approaches, using either the patient's own tissue or mesh augmentation 2, 3.