Uterine Prolapse Surgery

What Is Uterine Prolapse Surgery?

UTERINE PROLAPSE occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus.

The uterus then slips down into or protrudes out of the vagina.

Uterine prolapse can happen to women of any age, but it often affects postmenopausal women who've had one or more vaginal deliveries.

Weakening of the pelvic muscles that leads to uterine prolapse can be caused by:

• Damage to supportive tissues during pregnancy and childbirth
• Effects of gravity
• Loss of estrogen
• Repeated straining over the years

If you have mild uterine prolapse, treatment usually is not needed. But if uterine prolapse makes you uncomfortable or disrupts your normal life, you might benefit from treatment.

Uterine prolapse varies in severity. You may have mild uterine prolapse and experience no signs or symptoms. If you have moderate to severe uterine prolapse, you may experience:

• Sensation of heaviness or pulling in your pelvis
• Tissue protruding from your vagina
• Urinary problems, such as urine leakage or urine retention
• Trouble having a bowel movement
• Low back pain
• Feeling as if you're sitting on a small ball or as if something is falling out of your vagina
• Sexual concerns, such as a sensation of looseness in the tone of your vaginal tissue
• Symptoms that are less bothersome in the morning and worsen as the day goes on

Weakening of pelvic muscles and supportive tissues contribute to uterine prolapse. This may happen as a result of:

• Pregnancy
• Trauma during childbirth
• Delivery of a large baby
• Difficult labor and delivery
• Loss of muscle tone
• Less circulating estrogen after menopause

Some conditions — such as obesity, chronic constipation and chronic obstructive pulmonary disease (COPD) — can place a strain on the muscles and connective tissue in your pelvis and may play a role in the development of uterine prolapse.

Risks

Possible complications of uterine prolapse include:

Ulcers.

In severe cases of uterine prolapse, part of the vaginal lining may be displaced by the fallen uterus and protrude outside your body, rubbing on underwear. The friction may lead to vaginal sores (ulcers). In rare cases, the sores could become infected.

Prolapse of other pelvic organs.

If you experience uterine prolapse, you might also have prolapse of other pelvic organs, including your bladder and rectum. A prolapsed bladder (cystocele) bulges into the front part of your vagina, which can lead to difficulty in urinating and increased risk of urinary tract infections. Weakness of connective tissue overlying the rectum may result in a prolapsed rectum (rectocele), which may lead to difficulty having bowel movements.

 

THE PROCEDURE

To repair damaged or weakened pelvic floor tissues, your surgeon may perform the procedure through your vagina, although sometimes an abdominal surgery is needed.

Surgical repair of your prolapse may involve grafting your own tissue, donor tissue or some synthetic material onto weakened pelvic floor structures to support your pelvic organs. Your surgeon may recommend a hysterectomy, which removes your uterus.

In some cases, minimally invasive (laparoscopic) surgery is a possibility. This procedure involves smaller abdominal incisions, special surgical instruments and a lighted camera-type device (laparoscope) to guide the surgeon.

Which surgery and surgical approach your doctor recommends depends on your individual needs and circumstances. Each procedure has pros and cons that you'll need to discuss with your surgeon.

If you plan future pregnancies, you might not be a good candidate for surgery to repair uterine prolapse. Pregnancy and delivery of a baby put strain on the supportive tissues of the uterus and can undo the benefits of surgical repair.