What is uterine prolapse?
When the muscles and ligaments of the pelvis become weak and can no longer support your organs in their normal position, what may occur is uterine prolapse. This condition, also known as pelvic organ prolapse, is a type of disorder in which the uterus or parts of the vagina drop from their normal position. Uterine prolapse is a relatively common condition in which the uterus drops when the pelvic muscles become too weak to support it.
The pelvic muscles may become weak for a variety of reasons, including a loss of estrogen, damage during pregnancy and delivery, or simply several years of stress and gravity. Risk factors of uterine prolapse include multiple vaginal deliveries, giving birth to a large baby, repetitive heavy lifting, or previous pelvic surgeries. Having a high body mass index, postmenopausal, and chronic cough can also be a risk of uterine prolapse.
Uterine prolapse can be categorized as incomplete or complete:
- Incomplete uterine prolapse: The uterus is partially displaced into the vagina but does not protrude.
- Complete uterine prolapse: A portion of the uterus protrudes from the vaginal opening.
The condition is graded by its severity, determined by how far the uterus has descended.
Along with the uterus, the surrounding organs may also be affected by a prolapse, such as:
Vaginal Vault Prolapse
The top of the vagina may prolapse in women who have had a hysterectomy
Prolapse of the front wall of the vagina and the bladder
Prolapse of the back wall of the vagina and the rectum
Prolapse of the pocket of tissue between the back wall of the uterus and the rectum, usually involving part of the small intestine
Symptoms of Uterine Prolapse
In mild cases, there may be no symptoms. While a mild case of uterine prolapse may not present with any symptoms, severe cases of prolapse might cause:
- Pelvic heaviness or pulling
- Vaginal bleeding or an increase in vaginal discharge
- Difficulties with sexual intercourse
- Urinary leakage, retention or bladder infections
- Bowel movement difficulties, chronic constipation
- Lower back pain
- Uterine protrusion from the vaginal opening
- Sensations of sitting on a ball or that something is falling out of the vagina
- Weak vaginal tissue
Diagnosis of Uterine Prolapse
If your healthcare provider suspects that you have a prolapsed uterus, the doctor will do a pelvic exam. If you also have urinary incontinence or feel like you can’t completely empty your bladder, the healthcare provider may also perform a procedure called a cystoscopy to examine your bladder and urethra.
A test such as an MRI or CT scan might be performed as well. The MRI procedure uses a magnet and radio waves to create images. A CT scan uses X-rays to make the image. This will allow your healthcare provider to get a good look at your kidneys and other pelvic organs.
Treatment of Uterine Prolapse
Mild uterine prolapses that cause no symptoms may not need treatment. For more serious prolapses, you and your doctor can discuss both surgical and non-surgical options.
Non-Surgical Treatment for Uterine Prolapse
Non-surgical options include the insertion of a pessary. A pessary is a removable device that can be inserted into the vagina to support the prolapsing muscles and organs. There are three types of pessaries: inflatable, doughnut, and Gellhorn. Your doctor can recommend the right type for you depending on your condition, and can insert it for you in the office.
Your doctor may also recommend Kegel exercises. These are exercises designed to strengthen your pelvic floor muscles and can be performed easily anywhere – at home, while watching TV, in the car, or even at the office.
Lastly, women who are overweight or obese might find relief from their symptoms if they lose some excess weight. Weight loss can reduce pressure in the pelvis and relieve strain on their pelvic muscles.
Surgical Treatment for Uterine Prolapse
Before having surgery to treat your prolapse, you should have a discussion with your OB-GYN about the implications and risks of this type of surgical treatment. You will certainly want to consider if you have future plans for pregnancy. Carrying a baby puts a lot of strain on your uterine muscles. If you have corrective surgery and then get pregnant, you may risk another prolapse after childbirth.
You’ll also want to consider your age. Recurring prolapse is not uncommon even after surgery, so young women may want to consider if they are willing to risk more surgery in the future. On the other hand, older women, women with heath problems, and women who have had previous pelvic surgeries may have special circumstances that the surgeon will need to work around to have a successful procedure.
Some women, especially elderly women, may elect to have obliterative surgery to treat uterine prolapse. This procedure permanently closes off the vaginal canal in order to keep prolapse organs from descending. The procedure is very effective at treating uterine prolapse and is less risky than reconstructive surgery, but it prohibits sexual intercourse. Obliterative surgery is only recommended for women who no longer desire sexual intercourse.
As with any medical procedure, reconstructive surgery for uterine prolapse carries some risk for certain complications, including painful intercourse, chronic pelvic pain, and urinary incontinence.
There are several different types of reconstructive surgery for the treatment of uterine prolapse. Basically, reconstructive surgery aims to correct the muscles, tissues, and ligaments to lift your pelvic organs back into their natural positions.
Surgery may be performed through the vaginal opening or through an incision in the abdomen. The surgeon may or may not use a laparoscope (a thin, flexible, lighted camera) to guide the procedure. Depending on your condition, your surgeon may graft your own tissue onto the weakened areas, use tissue from a donor, or replace your tissue with synthetic mesh.
Reconstructive Surgery Recovery
Reconstructive surgery is a very intensive procedure. You will need a few weeks of rest to recover, and we recommend you take this time off work. Avoid heavy lifting, exercise, or sexual activity for 6-8 weeks after surgery.