Retroverted uterus: What is a tilted, inverted and retroverted uterus?
By Gina Flaxman
May 24 2019
What is a retroverted uterus?
A retroverted, tipped, tilted or backwards uterus is when the uterus is tipped backwards instead of forwards at the cervix. In most women, the uterus lies over the bladder, with the top (the fundus) aimed towards the abdominal wall. In a retroverted uterus the fundus is aimed towards the rectum.
About a quarter of all women have a retroverted uterus. It shouldn’t generally cause any problems. Women are either born with it (there may be a genetic link) or it develops later on. The uterus usually moves into a forward tilt as a woman matures but sometimes this doesn’t happen.
It can also occur as a result of pregnancy. The uterus is held in place by ligaments. These bands of connective tissue can be stretched during pregnancy, causing the uterus to tilt backwards. In most cases it returns to its normal position after childbirth but occasionally it stays tilted.
The other potential causes include underlying conditions such as endometriosis, where the endometrial cells that line the uterus grow outside it and ‘glue’ the uterus to other pelvic structures; an adhesion (a band of scar tissue) as a result of pelvic surgery; and fibroids (small, non-cancerous lumps).
What are the symptoms of a retroverted uterus?
Most women will have no symptoms. The condition is usually diagnosed through a routine pelvic examination or Pap smear.
If you are having any problematic symptoms, these are usually due to one of the underlying conditions outlined above. These symptoms include pain during sex, particularly when the woman is on top; lower back pain during sex; severe period pain, particularly if the retroversion is a result of endometriosis; difficulty inserting tampons; increased urinary frequency, pressure in the bladder and mild incontinence.
A retroverted uterus in itself does not usually affect a woman’s fertility but some underlying conditions, such as endometriosis, do affect it.
Does a retroverted uterus affect pregnancy?
A tilted uterus doesn’t usually interfere with pregnancy. It can sometimes make it more difficult to locate your baby during ultrasounds so you may need to have vaginal rather than abdominal ultrasounds. During the first trimester it may place more pressure on your bladder, causing either incontinence or difficulty urinating. It can also cause back pain.
After the first trimester the expanding uterus lifts out of the pelvis and assumes the usual forward position. In a small percentage of cases the uterus doesn’t shift forward and snags on a pelvic bone, usually the sacrum. This is known as an incarcerated uterus and can occur between weeks 12 and 14.
Let your doctor know straight away if you experience pain and difficulty urinating, constipation or incontinence as there is an increased risk of miscarriage. Treatment includes hospitalisation, the insertion of a urinary catheter to empty the bladder and exercises.
What is the treatment for a retroverted uterus?
Treatment for problems associated with a retroverted uterus will depend on the underlying condition, for instance hormone therapy is often prescribed for endometriosis.
Some doctors may prescribe pelvic exercises but the medical profession is divided as to their effectiveness as in many cases, the uterus simply tips backwards again.
A pessary, a small silicone or plastic device, can be inserted into the vagina, either temporarily or permanently, to prop the uterus into a forward lean. But there is an increased risk of infection and inflammation and sex may still be painful. Laparoscopic (keyhole) surgery is also an option to reposition the uterus and is usually successful. In some cases, a hysterectomy (removal of the uterus) may be considered.
What is an inverted uterus?
Uterine inversion is a potentially life-threatening complication of childbirth where the uterus is turned inside out so it protrudes through the cervix and into or through the vagina.
It is extremely rare and occurs when the placenta remains attached and its exit pulls the uterus inside out. In most cases doctors can manually detach the placenta and push the uterus back into position while the woman is under general anaesthetic. Occasionally abdominal surgery is required.