The quality of life in a woman can be substantially affected by uterine prolapse. As surgical intervention is often considered a treatment option, it is important to thoroughly assess the risks and benefits associated with uterine prolapse surgery. This article aims to explore the details of uterine prolapse, including its causes and symptoms, and the risks and benefits of uterine prolapse surgery to help you make better decisions for your health and well-being.

Understanding Uterine Prolapse

Uterine prolapse is a medical condition prevalently affecting women, characterized by the descent or displacement of the uterus from its normal position within the pelvic cavity. This condition occurs when the supportive tissues and ligaments in the pelvic floor weaken, leading to the protrusion of the uterus into the vaginal canal or, in severe cases, outside the body.

Causes and risk factors

Uterine prolapse frequently develops because of the following factors:

• Multiple childbirths
• Vaginal delivery
• Late age first pregnancy
• Giving birth to a large baby
• Advancing age (menopause)
• Obesity
• Prior pelvic surgery
• Weak connective tissues
• Weakness of pelvic floor muscles
• Chronic coughing and constipation

Symptoms and impact on women's health

Here are several indicators of uterine prolapse that it's important to recognize and monitor:

• A sensation of pressure or weight in the pelvic region
• Lower back discomfort
• Perception of something protruding from the vaginal area
• Pain during sexual intercourse
• Difficulty with urination or bowel movements
• Unease while walking
• Urinary leakage

Non-Surgical Treatments for Uterine Prolapse

Pelvic floor exercises and physical therapy: Strengthening the pelvic muscles through targeted exercises and guided physical therapy can help improve support for the uterus, reducing symptoms of uterine prolapse and promoting overall pelvic health.

Pessaries: Pessaries, available in various shapes and sizes, are silicone prosthetics inserted into the vagina to support the uterus. Their proper selection and fitting by a healthcare professional can offer effective non-surgical management for uterine prolapse.

Hormone therapy: Hormone therapy, carefully prescribed by a healthcare provider, may be beneficial for menopausal women with uterine prolapse. Estrogen supplementation can help maintain pelvic tissue integrity, potentially reducing prolapse severity and associated discomfort. 

Support braces: There are many pelvic support braces and garments on the markets for women who are dealing with pelvic organ prolapse and they can be especially helpful postpartum. FemiCushion is a supporter that offers prolapse support with a unique silicone cushion. This one of a kind prolapse brace not only eliminates painful symptoms but also prevents the prolapse from worsening over time.

Indications for Uterine Prolapse Surgery

The healthcare provider may advise surgical intervention for correcting uterine prolapse depending on the severity of the prolapse and individual factors such as age, overall health, and the desire for future childbearing. They may perform a thorough assessment to determine the most suitable treatment approach.

Your doctor may also consider surgery to address uterine prolapse if non-surgical treatments like pelvic floor exercises, pessaries, braces, have been ineffective in alleviating symptoms and improving the condition.

As a patient, it is important to carefully evaluate several factors, like the impact of symptoms on daily life, the risks associated with the procedure, recovery time, and long-term outcomes, and discuss them with your healthcare provider while considering uterine prolapse surgery.

But is surgery the ultimate answer for uterine prolapse? It is important to understand that while uterine prolapse surgery can significantly improve symptoms and restore the uterus to its proper position, complete symptom relief may not always be guaranteed, and results of surgery is not always permanent. Some women may experience post-surgery prolapse with the same organ or a different pelvic organ. We recommend discussing your apprehensions and expectations with the surgeon to understand the potential outcomes of the procedure.

Surgical Approaches for Uterine Prolapse

Hysterectomy: This procedure involves surgically removing the uterus through the vagina.

• Total Hysterectomy: Complete removal of the uterus and cervix, often chosen for extensive uterine prolapse or certain medical conditions.
• Subtotal Hysterectomy: Removal of the upper part of the uterus, preserving the cervix, suitable for specific cases and potential future reproductive options. 

Uterine suspension techniques: Uterine suspension techniques, such as sacrospinous ligament fixation and uterosacral ligament suspension, can effectively restore the uterus to its proper position and provide pelvic support. These techniques focuses on reattaching the uterus to surrounding pelvic structures for support and prevent prolapse from reoccurring.

Vaginal or abdominal approach options: Vaginal approaches rectify prolapsed organs and reinforce the pelvic floor using methods like anterior/posterior colporrhaphy. On the other hand, abdominal sacrocolpopexy helps address complex cases of uterine prolapse through abdominal incisions and helps with complex cases of pelvic organ prolapse.

Minimally Invasive Uterine Prolapse Surgery

Minimally invasive surgeries for uterine prolapse are advanced surgical methods that offer less invasive approaches compared to traditional open surgery. These procedures aim to treat uterine prolapse while minimizing tissue damage, reducing recovery time, and promoting better cosmetic outcomes.

Two common types of minimally invasive surgeries for uterine prolapse are laparoscopic procedures and robotic-assisted surgery. 

• Laparoscopic procedures: In laparoscopic surgery, several small incisions are made in the abdomen, through which a laparoscope (a thin, flexible tube with a camera) and specialized surgical instruments are inserted. The surgeon uses the camera to view the internal organs and performs the necessary repairs to correct the uterine prolapse. The benefits of this procedure include smaller incisions, reduced scarring, less pain, shorter hospital stays, and quicker recovery times.

• Robotic-assisted surgery: Robotic-assisted surgery is a variation of laparoscopic surgery that utilizes robotic arms to enhance the surgeon's precision and control. The surgeon controls the robotic arms equipped with surgical instruments for increased dexterity, allowing for more complex and delicate maneuvers. Like laparoscopic procedures, robotic-assisted surgery offers the advantages of smaller incisions, minimal scarring, and faster recovery.

Open Abdominal Uterine Prolapse Surgery

Open abdominal uterine prolapse surgery is considered when minimally invasive approaches are not suitable due to the severity of the prolapse, the involvement of multiple pelvic floor issues, or prior surgeries that limit access to the pelvic area. 

• Traditional abdominal hysterectomy: This procedure involves a larger abdominal incision to remove the uterus and repair the pelvic floor to address prolapse.

• Abdominal sacrocolpopexy: It is a surgical procedure done through an open abdominal incision where the vagina is attached to the sacrum (lower spine) using surgical mesh or other materials. This provides additional support to address uterine or vaginal vault prolapse.

Recovery and Aftercare

Recovery after uterine prolapse surgery typically involves a hospital stay of 1-3 days. During this time, you would receive postoperative care, including pain management, wound monitoring, and guidance on mobility and self-care.

Your healthcare provider would also prescribe pain medications and advise you to use hot/cold packs to alleviate discomfort. You must follow the surgeon's instructions on medication use and activity restrictions for a smooth recovery.

Recovery timelines may vary for everyone, but most women can gradually resume light daily activities within a few weeks. However, you will have to avoid strenuous activities and exercise for about 6-8 weeks to allow proper healing of surgical incisions and pelvic tissues.

Potential Complications and Risks

Common complications and risks associated with uterine prolapse surgery may include bleeding, infection, damage to surrounding organs or tissues, urinary or bowel problems, and adverse reactions to anesthesia. There is also a possibility of recurrence of uterine prolapse or the development of new pelvic floor issues. 

Preoperative evaluations, proper surgical technique, and adherence to postoperative instructions can help minimize risks. Close monitoring during the recovery period and early reporting of any unusual symptoms to the healthcare provider is crucial in preventing and managing potential complications.

Long-Term Outcomes and Success Rates

Surgical intervention for addressing uterine prolapse has demonstrated notable effectiveness in most patients. However, the success of uterine prolapse surgery is influenced by several critical factors, such as the patient's overall health status, including age and medical history, adequate pre-operative evaluation, and the surgical technique employed by the medical team.

Adherence to postoperative care and recommended guidelines significantly influences long-term outcomes, while surgeon expertise and experience enhance the chances of achieving successful results.

Alternative and Complementary Therapies

Holistic approaches encompassing pelvic floor exercises, herbal remedies, yoga, acupuncture, and lifestyle adjustments can also be effective in preventing and relieving symptoms of uterine prolapse. Integrating these practices alongside conventional treatments can contribute to a more comprehensive and well-rounded approach to addressing uterine prolapse.

Conclusion

When deciding on uterine prolapse surgery, it's really important to know both pros and cons of it. With women's health and well-being taking center stage, making well-informed choices becomes a big deal. Therefore, it's crucial for women to actively seek professional medical guidance to make sure they're on the right track to optimal health and quality of life.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.