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What You Should Know About Tilted Uterus

What is a tilted uterus?

A tilted uterus is a uterus that curves in a backwards position at the cervix instead of a forward position. A tilted uterus may also be referred to as:

  • tipped uterus
  • retroflexed uterus
  • retroverted uterus
  • uterine retroversion
  • backward uterus
  • uterine retro displacement

Read on to learn more about this condition.

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Symptoms

Symptoms

Some women with a tilted uterus experience no symptoms. That means you may be unaware of the condition. If you do experience symptoms, they may include:

  • pain in your vagina or lower back during sexual intercourse
  • pain during menstruation
  • trouble inserting tampons
  • increased urinary frequency or feelings of pressure in the bladder
  • urinary tract infections
  • mild incontinence
  • protrusion of the lower abdomen

Fertility

Titled uterus and fertility

A tilted uterus doesn’t typically affect a woman’s ability to conceive. This condition is sometimes associated with other diagnoses which may affect fertility potential. These include:

Endometriosis and fibroids are often treatable or correctable through minor surgical procedures.

When caught early, PID can often be treated with antibiotics.

If needed, infertility treatments, such as intrauterine insemination (IUI) or in vitro fertilization (IVF), can help women with these types of diagnoses achieve pregnancy.

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Pregnancy

Tilted uterus and pregnancy

Having a tilted uterus doesn’t usually affect the viability of a pregnancy.

A tilted uterus may create more pressure on your bladder during the first trimester. That may cause either increased incontinence or difficulty urinating. It can also cause back pain for some women. Your uterus may also be harder to see via ultrasound until it begins to enlarge with pregnancy. Your doctor may need to use transvaginal ultrasounds during the first trimester to see the progression of your pregnancy.

Your uterus should expand and straighten towards the end of the first trimester, typically between weeks 10 and 12. This will cause your uterus to lift out of the pelvis and no longer tip backwards. On occasion, the uterus is not able to not make this shift. Sometimes this is caused by adhesions, which keep the uterus anchored into the pelvis. If the uterus doesn’t shift forward, your risk for miscarriage may increase. This is known as an incarcerated uterus, and it’s uncommon. When discovered early, an incarcerated uterus can be fixed, reducing or eliminating miscarriage risk.

Let your doctor know right away if you’re pregnant and experience:

  • a consistent inability to urinate
  • pain in your stomach or near your rectum
  • constipation
  • incontinence

Those symptoms may signal incarceration of the uterus. The condition can be diagnosed during a pelvic exam or an ultrasound.

Your third trimester should not be affected at all. Some women with a tilted uterus are more likely to experience labor pain in the back.

Sex

Titled uterus and sex

Having a tilted uterus doesn’t usually interfere with sexual sensation or enjoyment. It can, however, make sexual intercourse painful in some instances. This discomfort may be more pronounced when you are in certain positions. Changing sexual positions may reduce this discomfort.

The uterus sits fairly low in the pelvis, along with the ovaries. During vigorous sex, or sex with deep thrusting, the head of the penis may push against the walls of the vagina, bumping into the uterus or ovaries. This can cause pain, tears, or bruising. If you have discomfort during sex, try altering your position to see if that helps. If every sexual position causes you discomfort, with or without bleeding, discuss this with your doctor.

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Causes

Causes

A tilted uterus is a standard variation of pelvic anatomy that many women are either born with or acquire as they mature. It may be caused by genetics.

In other instances, the condition may have an underlying cause which is often associated with pelvic scarring or adhesions. These include:

  • Endometriosis. Endometrial scar tissue or adhesions can cause the uterus to stick in a backwards position, almost like gluing it in place.
  • Fibroids. Uterine fibroids can cause the uterus to become stuck, misshapen, or to tilt backwards.
  • Pelvic inflammatory disease (PID). When left untreated, PID can cause scarring, which may have a similar effect to endometriosis.
  • History of pelvic surgery. Pelvic surgery can also cause scarring.
  • History of prior pregnancy. In some instances, the ligaments holding the uterus in place become overly stretched during pregnancy and stay that way. This may allow the uterus to tip backwards.
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Diagnosis

Diagnosis

Your doctor can diagnose tilted uterus during a routine pelvic exam. If you have symptoms which concern you, discuss them with your doctor. For some women, you may first be diagnosed with a tilted uterus when pregnant. That’s because doctors can also diagnose it from an ultrasound.

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Treatment

Treatment

You may not require any treatment if you’re asymptomatic. If you do have symptoms or are concerned about the condition, discuss treatment options with your doctor. There is often no need for treatment.

Exercises

Sometimes your doctor may be able to manually manipulate your uterus and place it into an upright position. If that’s the case, certain types of exercises designed to strengthen the ligaments and tendons that hold the uterus in an upright position may be beneficial. Kegels are one example. Other exercises that may help include:

  • Knee chest. Lie on your back with both knees bent and your feet on the floor. Slowly raise one knee at a time up to your chest, gently pulling it with both hands. Hold this position for 20 seconds, release, and repeat with the other leg.
  • Pelvic contractions. These exercises work to strengthen the pelvic floor muscles. Lie on your back with your arms at your sides in a relaxed position. Inhale as you lift your buttocks off the ground. Hold and release as you exhale. Repeat 10-15 times.

These will not work if your uterus is stuck in place because of scarring or adhesions, however.

Pessary device

Pessaries are made from silicone or plastic. They are small devices that can be inserted into the vagina to prop the uterus into an upright position. Pessaries can be used on either a temporary or permanent basis. They have been associated with infection if left in long-term.

Surgical techniques

In some instances, surgery may be required to reposition the uterus, and to reduce or eliminate pain. There are several different types of procedures. They include:

  • Uterine suspension procedure. This type of surgery can be done laparoscopically, vaginally, or abdominally.
  • Uplift procedure. This is a laparoscopic procedure which takes around 10 minutes to perform.

Outlook

Outlook

Often there are no symptoms associated with a tilted uterus, although painful intercourse has been known to occur. If you do experience symptoms, there are treatments available which can help. Having a tilted uterus rarely affects fertility or pregnancy, but it may be associated with other conditions which can have adverse effects on fertility potential.

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