What is Uterine Prolapse?
Uterine prolapse, also called a prolapsed uterus, is a female reproductive health disorder. It occurs when the uterus slips downward into the vagina due to the weakness of the pelvic floor muscles and ligaments, which cannot provide proper support. In some women, the uterus may protrude from the vaginal opening. Pelvic organ prolapse or POP is the collective term used to describe a prolapse of not only the uterus, but also the bladder or rectum.
Indications for Uterine Prolapse Surgery
Uterine prolapse surgery is recommended for the treatment of a prolapsed uterus when conservative treatment options have failed to improve the problem.
Pre-Surgical Preparation for Uterine Prolapse Surgery
Before scheduling your uterine prolapse surgery, your physician will perform a complete health checkup. A pelvic ultrasound or MRI may also be performed to determine the severity of the prolapse.
You will be given specific instructions to be followed until the date of surgery. You should take your medications based on your physician’s instructions. You may also have certain dietary restrictions.
Factors to Consider Before Uterine Prolapse Surgery
Your doctor will recommend surgery based on the severity of your symptoms. Other factors that may determine the success of your surgery include the following:
- Your age
- Your plans for pregnancy
- Your overall health
Surgical Treatment for Pelvic Organ Prolapse
Pelvic organ prolapse can be treated through two types of surgeries:
- Obliterative surgery
- Reconstructive surgery
Obliterative surgery involves narrowing or closing the vagina to offer support for the prolapsed organs. After this procedure, sexual intercourse is not possible.
Reconstructive surgery aims to restore the uterus and supporting organs to their original position. Some types of reconstructive surgeries are performed through an incision in the vagina. Others are performed through an incision in the abdomen (laparoscopy).
Procedure and Types of Reconstructive Surgeries
The surgery is performed under general anesthesia. There are different types of reconstructive surgeries as follows:
Uterosacral ligament suspension and sacrospinous fixation or native tissue repair: This procedure is performed through the vagina and involves suturing the prolapsed part to a muscle or a ligament in the pelvis.
Colporrhaphy: This procedure addresses a defect in the wall of the vagina and involves suturing the front (anterior) and back (posterior) walls. This strengthens the vagina so that it can support the bladder and the rectum.
Sacrocolpopexy: In this procedure, the vagina is put back into place by attaching a surgical mesh to the front and back walls, and then to the tail bone or sacrum. It can be performed through an abdominal incision or through laparoscopy.
Sacrohysteropexy: In this procedure, the uterus is put back into place by attaching a surgical mesh to the cervix and then to the sacrum.
Surgery using vaginal mesh: In this procedure, a mesh is placed into the vagina provides support to treat all types of prolapses.
Hysterectomy: In this procedure, the uterus is removed and therefore is usually reserved for women who do not wish to become pregnant. It can be performed through an incision in the abdomen - an abdominal hysterectomy, or through an incision in the vagina - a vaginal hysterectomy.
Compared to the open surgery methods mentioned above, the laparoscopic approach causes less pain, a smaller scar, lower infection risk, and a shorter hospital stay.
Post-Surgical Care for Uterine Prolapse Surgery
After surgery, you are required to stay in the hospital for a few days until you feel comfortable and are able to walk around normally. After discharge, you should avoid the following:
- Lifting heavy objects
- Having sex for a few weeks; you may resume under your doctor’s instructions
You must visit the hospital for the first few months after the surgery for a complete medical check-up.
Risk and Complications of Uterine Prolapse Surgery
Every surgical procedure carries some amount of risk. Likewise, uterine prolapse surgery may also have certain risks and complications such as the following:
- Heavy bleeding
- Pain during sexual intercourse
- Pelvic pain
- Side-effects of the anesthesia such as nausea and vomiting
- Prolapse may recur with obesity
Care and Maintenance after Uterine Prolapse Surgery
Most women experience relief after uterine prolapse surgery. It is recommended to maintain a healthy weight and to exercise daily to avoid chances of recurrence. Visit your healthcare provider to learn more about prolapse surgery.