About Uterine Prolapse

Uterine prolapse is a common pelvic floor disorder, especially in women who have given birth. It occurs when the uterus descends into or outside the vaginal canal due to weakened pelvic muscles and ligaments.

• General Prevalence:
  Studies estimate that up to 50% of women who have had children may have some degree of pelvic organ prolapse (including uterine prolapse), although not all are symptomatic.

What is Uterine Prolapse?

Uterine prolapse is a common condition as women age. When the muscles and tissues in the pelvis become weak after menopause or damaged due to multiple vaginal childbirths, the uterus can sag into the vagina. The severity of the condition depends on how weakened the supporting muscles and ligaments around the uterus are.
 
Stages of uterine prolapse

• Stage I: The uterus is in the upper part of the vagina.
• Stage II: The uterus descends to the lower part of the vagina. 
• Stage III: The uterus protrudes out of the vagina.
• Stage IV: The whole uterus is outside of the vagina.

It is possible for other organs in the pelvis to stretch out and prolapse, causing cystocele (prolapsed bladder), enterocele (prolapsed small intestine), and rectocele (bulging rectum).

Signs and Symptoms

In mild cases, the symptoms may not be obvious. Once the condition progresses, you can develop the following symptoms:

• Pressure in the pelvis.
• Pelvic, abdominal, and lower back pain. 
• Painful intercourse.
• Uterine tissue drops out of the vaginal opening.
• Constipation.
• Urinary incontinence and urinary frequency.

Causes of Uterine Prolapse

Uterine prolapse happens when the pelvic floor muscles and ligaments become weakened or stretched, no longer able to support the uterus effectively. This allows the uterus to drop into or bulge out of the vaginal canal. The primary causes include:

• Childbirth Trauma: Vaginal deliveries, especially those involving prolonged labor, large babies, multiple births, or the use of forceps, can weaken or injure the pelvic floor muscles and nerves.
• Hormonal Changes After Menopause: A drop in estrogen levels leads to decreased strength and elasticity of pelvic tissues.
• Chronic Intra-Abdominal Pressure: Conditions like persistent coughing, constipation, obesity, or regular heavy lifting place excessive pressure on pelvic organs.
• Pelvic Surgery: Procedures such as hysterectomy or other gynecologic surgeries can compromise the supportive structures of the uterus and vagina.
• Connective Tissue Weakness: Genetic conditions such as Ehlers-Danlos or Marfan syndrome can cause early degeneration of pelvic support due to weak connective tissue.

Risk Factors for Uterine Prolapse

Several risk factors make a woman more susceptible to developing uterine prolapse, including:

• Multiple vaginal births
• Postmenopausal age
• Obesity or chronic weight-bearing strain
• Smoking (due to chronic cough and poor tissue healing)
• Chronic constipation or straining during bowel movements
• Previous pelvic or abdominal surgeries
• Family history of pelvic organ prolapse
• Connective tissue disorders (e.g., Ehlers-Danlos syndrome)
• Low levels of estrogen
• Advancing age and weakened muscle tone

Complications of Uterine Prolapse

If left untreated, especially in more advanced stages (like Stage III or IV), uterine prolapse can lead to a range of complications that affect both physical and emotional well-being:

1. Ulceration and Vaginal Bleeding

In severe prolapse (Stage IV), the uterus or vaginal walls may protrude outside the body, leading to constant friction against clothing or surfaces. This can cause ulceration, irritation, and even bleeding of the exposed tissues, increasing the risk of infection.

2. Urinary Problems

Prolapse can distort the normal position of the bladder and urethra, resulting in urinary obstruction, difficulty emptying the bladder completely, urinary retention, or recurrent urinary tract infections (UTIs). Some women may also experience stress urinary incontinence, especially during activities like coughing, sneezing, or lifting.

3. Bowel Issues

In some cases, the prolapse may affect the rectum or bowel, leading to bowel obstruction, constipation, or fecal incontinence. Straining during bowel movements may further worsen the prolapse or contribute to discomfort.

4. Emotional and Sexual Distress

Chronic pelvic discomfort, pain, and embarrassment from visible prolapse can cause significant emotional distress. Many women experience low self-esteem, anxiety, or depression, especially if the condition affects sexual function, causes pain during intercourse (dyspareunia), or limits daily activities.

Uterine Prolapse Diagnosis

• Pelvic exam: to check the position of your uterus. The doctor will place a speculum to see inside your vagina. Your doctor will feel any bulges in your vaginal canal. You may be asked to cough or strain like you are holding your urine to evaluate the degree of your pelvic muscles weakness.
• Imaging: MRI or ultrasound to evaluate pelvic structures.
• Pessary test: Temporary insertion of a device to confirm prolapse impact

Uterine Prolapse Treatment

Non-Surgical Options

• Pessary: A silicone device inserted to support the uterus.
• Lifestyle changes: Weight loss, Kegel exercises, and avoiding heavy lifting.
• Hormone therapy: Vaginal estrogen to strengthen tissues.

Note: Medications are only advisable under doctor's consideration.

• Minimal Invasive options.

3D Laparoscopic Repair of Pelvic Prolapse

Also known as pelvic floor reconstruction, this advanced, minimally invasive procedure uses 3D laparoscopic technology to repair and restore support to prolapsed pelvic organs, such as the uterus, bladder (cystocele), or rectum (rectocele). The enhanced 3D view allows for precise dissection and suturing, helping to lift and secure pelvic structures using native tissues or mesh, depending on the case. Benefits include smaller incisions, less blood loss, quicker recovery, and better cosmetic results. It is ideal for women seeking durable repair with minimal downtime, especially those experiencing symptoms like vaginal bulge, urinary incontinence, or pressure.

Vaginal Hysterectomy

A vaginal hysterectomy involves the removal of the uterus through the vagina, without external incisions. It is commonly performed for uterine prolapse, fibroids, or abnormal bleeding. This approach offers several advantages, such as faster healing, shorter hospital stay, and reduced postoperative pain compared to abdominal hysterectomy. When combined with pelvic floor repair procedures, it provides a comprehensive solution for prolapse while minimizing surgical trauma.

Prevention  

• Kegel exercises: Strengthen pelvic floor muscles.
• Manage chronic conditions: Address obesity, coughing, or constipation.
• Avoid smoking and heavy straining.

Early intervention improves outcomes and quality of life