What is Uterine Prolapse?
Uterine prolapse, also called a dropped uterus, occurs when the uterus slips downward into the vagina due to the weakness of the pelvic floor muscles and supportive ligaments. In some women, the uterus may protrude outside of 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 such as pelvic floor (Kegel) exercises or a vaginal pessary 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 may also be performed to identify any other abnormalities in your uterus or tubes/ovaries.
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 and reproductive function
- 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. This type of surgery is only performed in women of advanced age who are not, and will not be, sexually active. This type of surgery is performed under light anesthesia in order to minimize and surgical risks. The satisfaction rating and success rate from this surgery are very high. Our center has some of the world’s largest experience with this type of surgery.
Reconstructive surgery aims to restore the uterus and supporting organs to their original position. Most reconstructive surgeries at our center are performed through an incision in the vagina. Others are performed through an incision in the abdomen (open or laparoscopy).
Procedure and Types of Reconstructive Surgeries
The surgery is performed under general or spinal anesthesia. There are different types of reconstructive surgeries as follows:
- Uterosacral ligament suspension and sacrospinous fixation: This procedure is performed through the vagina and involves suturing the prolapsed uterus and/or top of the vagina to a ligament in the pelvis. It may be performed by creating a suspensory ligament with an implant strip called an apical sling.
- Colporrhaphy: This procedure addresses a tear/defect in the wall of the vagina and involves opening the front (anterior) and/or back (posterior) walls of the vagina, identifying the connective tissue tears and fixing them with stitches. 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 graft/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 graft/mesh to the cervix and then to the sacrum.
- Hysterectomy: In this procedure, the uterus is removed and thus represents definitive treatment for prolapse of the uterus or other problems related to the uterus. Therefore, it is reserved for women who opt for that option and/or do not wish to become pregnant . It can be performed through an incision in the abdomen (abdominal hysterectomy), through an incision in the vagina (vaginal hysterectomy) or via a laparoscopic or robotic approach.. At our center, we specialize in vaginal hysterectomy as the preferred route due to its greater safety, less pain and less complications.
Compared to the open surgery methods, the vaginal and/or laparoscopic approach causes less pain, a smaller scar, lower infection risk, and a shorter hospital stay.
Post-Surgical Care for Uterine Prolapse Surgery
Most prolapse surgeries are now done as outpatient procedures, meaning you may go home the same day once you have good pain control, no nausea and you are able to walk around normally. After discharge, you should avoid the following:
- Lifting heavy objects. Nothing that weighs more than 5 lbs.
- Having sex for a 6-8 weeks; you may resume under your doctor’s instructions
You must contact our office for any post-operative problems or questions, and follow up as requested at 6-8 weeks, 6 months and 1 and 2 years after the surgery for a complete 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 or clotting
- Pain during sexual intercourse
- Pelvic pain
- Damage to internal organs
- Side-effects of the anesthesia such as nausea and vomiting
- Prolapse may recur over time
Care and Maintenance after Uterine Prolapse Surgery
Most women experience relief of their prolapse symptoms after uterine prolapse surgery. It is recommended to maintain a healthy weight and to perform pelvic floor (Kegel) exercises daily to avoid chances of recurrence. Visit your healthcare provider to learn more about prolapse surgery