Surgery Can Correct Uterine Prolapse

Ask The Expert Dr. Kevin M. Audlin, Mercy Medical Center

August 17, 2009

Uterine prolapse and other forms of pelvic organ prolapse affect millions of women, leading to more than 200,000 surgeries a year, writes Dr. Kevin M. Audlin of Mercy Medical Center.

* Uterine prolapse occurs when the uterus becomes downwardly displaced into the vaginal cavity, and in worst cases, is visible outside of the vagina. Uterine prolapse is usually associated with vaginal prolapse, often described as the "bladder falling," and may involve urinary leakage. The statistics show that 1 in 9 women will undergo surgery for prolapse before the age of 80.

* Uterine prolapse occurs because the support of the top of the vagina and the uterus is not normal. Ligaments, nerves and pelvic floor muscles support the uterus. The most common risk factors for prolapse are increasing number of pregnancies and menopause. It is also more common with women who deliver larger children vaginally.

* Symptoms of uterine prolapse range from subtle to obvious. A protruding vagina is confirmation of the condition; more subtle signs can be a sensation of pelvic pressure, difficulty emptying the bladder, leaking urine, pelvic pain, lower back pain, pain with having a bowel movement and pain with intercourse. The symptoms likely will worsen over time, but there is some recent evidence that this may not always be true. Since uterine prolapses usually include urinary difficulties, voiding studies should be performed on the patient to make sure that the bladder functions normally.

* Uterine prolapse is a quality-of-life disorder and should be treated when the patient's symptoms are bothersome enough to proceed with treatment. Most patients opt for surgical treatment for the prolapse, but pelvic floor exercises and weight loss can help mild prolapses and pessaries (a removable device placed in the vagina designed to support areas of pelvic organ prolapse) can be used with patients who are interested in a nonsurgical treatment of their prolapse. Surgical treatments include hysterectomy, repair of vaginal wall defects and suspension of the top of the vagina. Vaginal suspension surgeries can be performed vaginally, laparoscopically or abdominally. Most procedures performed today include non-absorbable mesh to support the vagina and secure its position in the pelvis.

* Uterine prolapse procedures are clinically challenging and complex, but have low complication rates when performed appropriately. The satisfaction rate for the patient is high since their symptoms are gone, and they can return to a normal lifestyle. My recommendation would be for any patient with pelvic organ prolapse to

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