Uterine Prolapse

Background 

Uterine prolapse occurs when uterus slips from its normal position. The uterus is a muscular organ that’s is held in its place by pelvic muscles and ligament. If the muscles of these ligaments stretch or become weak then they are no longer able to hold the uterus causing a prolapse. 

The prolapse may be complete or incomplete. Incomplete or partial prolapse occurs when uterus is only partly sagging into the vagina. In complete prolapse the uterus falls down so far that some tissues protrude outside the vagina. 

Causes of uterine prolapse 

Several factors contribute to the weakening of the pelvic floor muscles, thus becoming unable to hold the uterus in position.

  1. Obesity
  2. Chronic coughing and straining
  3. Chronic constipation
  4. Loss of muscle tone due to aging 
  5. Injury during childbirth, especially if you have had many babies or a large baby 
  6. Family history of uterine prolapse. 
  7. Genetic history of uterine disease 

Symptoms of uterine prolapse 

A mild case may not have any obvious symptoms. As the uterus slips further it may put pressure on other pelvic organs causing symptoms like.

  1. Pain in the pelvis, abdomen or lower back 
  2. A feeling of heaviness or pressure in the pelvis 
  3. Pain during sex
  4. Frequent bladder infections
  5. Unusual or excessive discharge from vagina
  6. Constipation
  7. Uterine tissue that falls through the opening of vagina may give extreme sense of discomfort. 
  8. Urination problem, like sudden urge to urinate, frequent urination, involuntary loss of urine. 
  9. Vaginal bleeding 

Symptoms are less bothersome in the morning and worsen during the course of the day. Also, when you stand or walk for a longer period of time symptoms are further aggravated. 

Treatment of Uterine Prolapse

Non-Surgical Treatment

  1. Losing weight to take stress off pelvic structure ( Kegel’s exercise for very early prolapse) 
  2. Wearing pessary, it is a device inserted into the vagina that fits under the cervix and helps push up and stabilise the uterus and cervix
  3. Avoiding heavy lifting
  4. Doing Kegel exercise, this is a pelvic floor exercise that help strengthen the pelvic muscles. 

Surgical Treatment

Surgical treatment remains the mainstay of the management for chronic long standing prolapse and symptomatic prolapse. Surgery Is performed according to stage of prolapse, age of the patient, reproductive life of the patient and patients preference. The surgery is focused mainly on either suspension of uterus in normal place or removal of uterus.

Uterine Suspension surgery: This procedure is preferred in young woman who are still in child bearing age and want to conceive later. In this procedure your surgeon places the uterus back into its original position by using surgical material or by reattaching or enforcing the  pelvic ligaments. Various techniques have been described to perform this surgery and minimal access surgery(laparoscopic uterine suspension surgery or laparoscopic pelvic organ prolapse surgery) . The synthetic meshes have and tapes have been used to enforce the uterus in normal position 

Hysterectomy: This is the procedure of choice who have completed the reproductive age, severe and recurrent uterine prolapse and woman who have completed there families. The gynaecologist surgeon will remove the entire uterus from the body through the abdomen or vagina. Laparoscopic hysterectomy or vaginal hysterectomy are routinely performed for removal of uterus. 

Methods to prevent Uterine Prolapse

The condition is not preventable in every situation but you can reduce the risk by doing the following things.

  • Maintaining a healthy weight
  • Getting regular exercise
  • Practising Kegel exercises
  • Seeking treatment for constipation and cough at the initial stage itself.

To consult with best team of Gynaecologist, General and minimal access cancer surgeons available at  The Surgeons House (SHL) in different global locations, please click this link for more details. 

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