Uterine Prolapse

It is a condition where the uterus slips down into or protrudes entirely out of the vagina as a result of the tearing, weakening, or stretching of the strong ligaments and muscle hammocks that suspend the uterus in the pelvic cavity.

Difficult and prolonged normal vaginal deliveries of large babies, advancing age, weakening of tissues along with menopause, chronic cough (asthma), obesity, and constant heavy lifting are the primary causes that tear the supporting ligaments.

A constant pulling or heavy sensation in the groin, lower back, and vagina. Patients may feel a round, fleshy mass (the uterus itself) protruding at the vaginal opening when wiping after using the toilet.

Usually, the uterus does not prolapse alone. The adjacent urinary bladder (Cystocele) and the end portion of the bowel (Rectocele) also herniate into the vagina. Therefore, it is often accompanied by urinary incontinence when laughing or sneezing, or severe constipation.

For mild prolapses, Kegel exercises (pelvic floor tightening) are beneficial. In elderly or high-risk patients who cannot undergo surgery, plastic rings (Pessaries) placed inside the vagina to hold the uterus up are used to mechanically relieve symptoms.

If the woman does not plan to have children, the prolapsed uterus is removed vaginally (without abdominal incisions) (Vaginal Hysterectomy), and the prolapsed bladder is sutured and tightened. In young women who wish to preserve their uterus, minimally invasive surgery is performed to lift and suspend the uterus to the tailbone using special synthetic meshes (Sacrocolpopexy).