The primary cause of uterine prolapse is the weakening of the pelvic floor muscles and ligaments. Several factors can contribute to this weakening:

Childbirth: Vaginal deliveries, especially multiple births, can stretch and weaken the pelvic muscles.

Aging and menopause: As women age, and particularly after menopause, estrogen levels decrease, weakening the pelvic tissues.

Chronic pressure on the abdomen: Abdominal masses, Frequent heavy lifting, long periods of standing, or chronic constipation can increase pressure on the pelvic organs.

Obesity: Being overweight puts additional pressure on the pelvic floor.

Chronic cough: Conditions like asthma or chronic bronchitis that cause frequent coughing can strain the pelvic muscles over time.

In rural parts of Sub-Saharan Africa, women who perform hard labour, such as farming or carrying heavy loads, are at higher risk for uterine prolapse. Additionally, limited access to healthcare during and after childbirth can contribute to the development of prolapse.

The symptoms of uterine prolapse can vary depending on the severity of the condition. Common signs include:

A feeling of heaviness or pressure in the pelvis or lower abdomen.

A bulge or lump protruding from the vagina, which may worsen with standing or physical activity.

Discomfort or pain during sexual intercourse.

Difficulty urinating or having bowel movements.

Feeling of incomplete emptying of the bladder. 

Lower back pain.

Recurrent urinary tract infections due to incomplete emptying of the bladder.

In severe cases, the uterus may partially or fully protrude outside the vagina, which can cause irritation and infection if untreated. Women in rural areas may delay seeking treatment due to shame or lack of awareness about the condition, but it is important to get help early to prevent complications.

If you experience any symptoms of uterine prolapse, you should visit a healthcare provider for an examination. In regions with limited access to gynecological care, a general healthcare worker or community health worker can help refer you to a specialist.

During the diagnosis, a healthcare provider may:

Perform a pelvic exam: This involves examining the uterus, vagina, and surrounding organs to assess the degree of prolapse.

Ask about your medical history: Questions about childbirth, physical activities, and other health conditions can help determine the cause and severity of prolapse.

Treatment depends on the severity of the prolapse and the woman’s overall health. Mild cases can often be managed without surgery, while more severe cases may require surgical intervention.

1. Lifestyle Changes and Non-Surgical Treatments:

Pelvic floor exercises (Kegel exercises): Strengthening the pelvic muscles can help support the uterus and relieve symptoms of mild prolapse. These exercises can be done at home and are often effective in preventing further prolapse.

Avoiding heavy lifting: Reducing physical strain can help prevent the condition from worsening. Women who perform manual labor may need to find ways to lessen the load they carry.

Weight management: Maintaining a healthy weight can reduce pressure on the pelvic floor.

Treatment for constipation and coughing: Addressing chronic constipation or a persistent cough can help reduce abdominal pressure.

Vaginal pessaries: A pessary is a small, removable device inserted into the vagina to support the uterus and hold it in place. Pessaries are an effective non-surgical option, especially in areas where access to surgery is limited.

2. Surgical Treatments:

Uterine suspension: This surgery restores the uterus to its normal position by tightening or reinforcing the pelvic ligaments.

Hysterectomy: In severe cases, the uterus may be removed entirely, especially if a woman is no longer planning to have children. After a hysterectomy, other pelvic organs may also need to be supported to prevent future prolapse.

In many parts of Sub-Saharan Africa, surgical options may not be readily available, and women may need to travel long distances to access hospitals that offer these procedures. Pessaries and lifestyle changes are more accessible in such regions.

In some communities in Sub-Saharan Africa, uterine prolapse may be stigmatized, and women might be hesitant to discuss their symptoms due to embarrassment. Cultural beliefs and taboos surrounding reproductive health can make it difficult for women to seek help, leading to delays in treatment. Additionally, healthcare infrastructure may be limited, especially in rural areas, where women may not have access to specialists.

The Role of Community Health Workers: Community health workers (CHWs) are often the first point of contact for women in rural areas. CHWs can play a critical role in:

Educating women about pelvic health and the importance of seeking treatment for conditions like uterine prolapse.

Encouraging early medical attention: Explaining that uterine prolapse is a common condition and that treatment is available can help reduce the stigma.

Providing access to non-surgical treatments like pessaries and pelvic exercises.

Referring patients to hospitals or clinics if surgery is needed.

While some risk factors for uterine prolapse, such as childbirth and aging, cannot be avoided, there are steps women can take to reduce their risk:

Perform pelvic floor exercises regularly, especially after childbirth, to strengthen the muscles that support the uterus.

Avoid heavy lifting and reduce strenuous physical labour, if possible, particularly in the months following childbirth.

Maintain a healthy weight to avoid placing extra pressure on the pelvic organs.

Seek treatment for chronic constipation or persistent coughing, both of which

Seek treatment for abdominal masses.