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, uterine prolapse may occur. This condition — also known as pelvic organ prolapse — is a disorder in which the uterus or parts of the vagina drop from their normal position.
The pelvic muscles may become weak for a variety of reasons — including a loss of estrogen, damage during pregnancy and delivery, or simply 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.
Uterine prolapse can be 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 severity, determined by how far the uterus has descended.
There are other types of pelvic organ prolapse aside from just the uterus:
- Vaginal vault prolapse — The top of the vagina may prolapse after a hysterectomy.
- Cystocele — Prolapse of the anterior (front) vaginal wall and bladder.
- Rectocele — Prolapse of the back wall of the vagina and the rectum.
- Enterocele — Prolapse of the pocket of tissue between the back wall of the uterus and the rectum, usually involving part of the small intestine.
What are uterine prolapse symptoms?
While a mild case of a prolapsed organ 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 urinary tract 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
How is uterine prolapse diagnosed?
If your gynecologist suspects that you have a prolapsed uterus, you will first have a pelvic exam. If you also have urinary incontinence or feel like you can’t completely empty your bladder, we 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 to get a better look at your kidneys and pelvic organs.
Can uterine prolapse be treated without surgery?
Mild uterine prolapse can be addressed with nonsurgical treatments. The first non-surgical option is a vaginal 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 healthcare provider can recommend the right type of pessary based on your condition, and can insert it for you in the office.
Another treatment (and prevention!) option is Kegel exercises. These exercises are 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. Stronger pelvic floor muscles can more easily hold your pelvic organs in place (and can also improve sexual function).
Uterine prolapse surgical procedures
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 surgery. You will certainly want to consider if you have future plans for pregnancy as carrying a baby puts a lot of strain on your uterine muscles. If you have prolapse repair 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 younger patients should considering if they’re 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.
Your gynecological surgeon will choose the best prolapse surgery for you based on the type and severity of the prolapse, your health history, and any existing medical conditions you may have.
Some patients — especially older women — may elect to have obliterative surgery to treat uterine prolapse. This procedure permanently closes off the vaginal canal to keep prolapsed organs from descending. The procedure is very effective at treating uterine prolapse and is less risky than reconstructive surgery, but it prohibits vaginal penetration during sexual intercourse.
If you’re finished having children and want to ensure your uterine prolapse won’t reoccur, a hysterectomy may be your solution. Your options include a minimally-invasive surgery (laparoscopy with small incisions), open surgery (a large abdominal incision), or a vaginal hysterectomy (the uterus is removed via the vagina).
Hysterectomy for prolapse will often also include strengthening and supporting the surrounding ligaments. After a hysterectomy, there is a risk of apical prolapse (descent of the vaginal vault).
As with any medical procedure, reconstructive surgery for uterine prolapse carries some risk of complications, including painful intercourse, chronic pelvic pain, and urinary incontinence.
Reconstructive surgery aims to correct the muscles, tissues, and ligaments to lift your pelvic organs back into their natural positions. There are different types of reconstructive surgery based on what your body needs.
The uterosacral ligaments support the uterus and keep it in place. Repairing these ligaments or supporting them with medical mesh helps keep the uterus naturally in place.
For bladder prolapse, you need cystocele repair (also called anterior repair or anterior colporrhaphy). This prolapse repair elevates the anterior vaginal wall to provide support for the bladder.
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.
How long is recovery from uterine prolapse surgery?
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.
With a minimally invasive surgery you can often return to normal activities (showering, walking, working) the next day.
Worried about uterine prolapse? Talk to Dr. Aliabadi!
As one of the nation’s leading OB/GYNs, Dr. Thaïs Aliabadi offers the very best in women’s health and well-being. Together with her warm professional team, Dr. Aliabadi provides compassionate care for women through all phases of life. She fosters a special one-on-one relationship between patient and doctor.
Highly-trained and honored by the medical community, Dr. Thais Aliabadi is board-certified and a Diplomat of the American College of Obstetrics and Gynecology. She implements the most advanced, state-of-the-art technology and treatment options. Dr. Aliabadi specializes in up-to-date, minimally invasive surgical techniques, promising her patients shorter recovery times, reduced pain, and the least interruption to their daily lives.
We also invite you to establish care with Dr. Aliabadi. Please make an appointment online or call us at (844) 863- 6700.
The Beverly Hills gynecology practice of Dr. Thais Aliabadi is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.