11.AUG.2020 5 MIN READ | 5 MIN READ

Above 50 and feeling an uncomfortable weight, pressure or bulging sensation from the vagina? These could be signs of uterine prolapse.

What is uterine prolapse?

A uterine prolapse is when the uterus drops into the vaginal canal because the pelvic muscle, tissue and ligaments are unable to support its weight. This can also affect other organs such as the bladder or rectum. Collectively, this is known as pelvic organ prolapse.

Who gets affected?

Women of any age can be affected, but it is more commonly experienced by older women. Nearly half of all women between 50 – 79 years old experience some form of pelvic organ prolapse.

How would you know if you are at risk?

Uterine prolapse risks
Risk factors for uterine prolapse include:

  • Natural (vaginal) childbirth
  • Obesity
  • Chronic constipation
  • Age
  • Family history

Can it be prevented?

While uterine prolapse cannot be definitively prevented, although lifestyle changes can help you reduce the risks. These include:

  • Maintaining a healthy body weight
  • Eating a fibre-rich diet to avoid constipation
  • Quitting smoking
  • Performing pelvic floor exercises to strengthen the pelvic muscles
  • Avoiding activities that place extra pressure on your pelvic organs such as heavy lifting

What are the symptoms?

Prolapse occurs in stages. In mild cases, the uterus may have only dropped slightly and may not require treatment. In severe cases, the uterus has dropped significantly or may be protruding from the vagina. Some women experience no symptoms while others may notice the following:

  • Leakage of urine (urinary incontinence)
  • Being unable to completely empty the bladder
  • Constipation
  • Feeling weight or pressure in the pelvis or vagina
  • Bulging in the vagina or protruding tissue from the vagina
  • Lower back pain

How is it diagnosed?

Uterine prolapse diagnosis
To check if you have uterine prolapse, a doctor will perform a pelvic examination. You may also be asked to bear down or exert pressure as though you are trying to perform a bowel movement or to tighten your pelvic muscles as though you are trying to stop the flow of urine.

Additional tests may be required such as a cystoscopy to check the bladder and urethra or an MRI (magnetic resonance imaging) of the kidneys, uterus and other pelvic organs. These will help the doctor to determine if you have a uterine prolapse and how mild or severe it is.

What can be done if you have uterine prolapse?

Apart from the lifestyle modifications listed above, which can help to relieve the symptoms, a non-surgical option is to have a pessary inserted. A vaginal pessary is a plastic or rubber ring that is inserted into the vagina to support the tissue. Do note that it must be removed regularly for cleaning.

Surgical options may involve surgery to repair the weakened pelvic muscles, a procedure that involves grafting tissue or a synthetic material onto pelvic floor structures to provide support.

Another surgical procedure for uterine prolapse is a hysterectomy, which removes the entire uterus. For women who are still of child-bearing age, they will no longer be able to bear children.

What happens during a hysterectomy?

Depending on your condition, your doctor may recommend one of the following:

  • Partial hysterectomy (also known as a supracervical or subtotal hysterectomy) which removes the upper part of the uterus and leaves the cervix in place
  • Total hysterectomy which removes the entire uterus including the cervix
  • Radical hysterectomy which removes the uterus and all the surrounding structures

These procedures may be minimally invasive, such as laparoscopy, while others that take place through the vagina or abdomen are not. Here are some of the likely treatment options your specialist may advise.

In a vaginal hysterectomy, the uterus is removed through the vagina without the need for an abdominal incision. This procedure generally has fewer complications and a shorter healing period, making it a preferred choice whenever possible. However, it may not be suitable for all women.

A laparoscopic hysterectomy requires several small incisions in the abdomen. Through these incisions, a laparoscope (a small camera) can be inserted so the surgeon can view the pelvic organs and concurrently remove the affected part of the uterus using the same scope. It has a lower risk of infection compared to an abdominal hysterectomy and requires a shorter hospital stay. However, the procedure may take longer to perform and can pose an increased risk of injury to other surrounding organs.

An abdominal hysterectomy means that the uterus is removed through an incision in the lower abdomen. Compared to a laparoscopic or vaginal hysterectomy, there is a greater risk of complications, with a longer healing time.

What happens after surgery?

Surgery recovery
Your stay in the hospital and subsequent recovery will vary according to the type of procedure, the extent of surgery and your overall health. Pain will be experienced for the first few days, with vaginal bleeding and discharge. You will also be asked to walk about as soon as you are able, as it will help prevent blood clots from forming in the operated area. You may also receive medication to relieve pain and prevent clots.

During your recovery, you should aim to get plenty of rest in between moving around as often as possible, such as taking short walks and gradually increasing the distance. You should avoid lifting anything heavy until your doctor says you are able to. In the first 6 weeks, do not place any object in the vagina such as douches or tampons, and avoid sexual intercourse.

It’s important to follow your doctor’s instructions regarding post-operative care, and this includes medications to take, diet to observe and physical activity. You should also keep up with routine gynaecological check-ups to detect any other potential or long-term complications.

Who can you see for more information?

A uterine prolapse, left untreated, may worsen to the point where it causes pain or affects other organs, and interfere with bowel and/or bladder function. If you experience any of the symptoms above or suspect any abnormality, please seek advice from a gynaecologist to discuss your treatment options.

 

Article reviewed by Dr Ting Hua Sieng, gynaecologist at Parkway East Hospital

References

(n.d.) Uterine Prolapse. Retrieved on 2 July 2020 from https://www.hopkinsmedicine.org/health/conditions-and-diseases/uterine-prolapse

(November 2012) Pelvic organ prolapse. Retrieved on 2 July 2020 from https://www.acog.org/patient-resources/videos/pelvic-organ-prolapse#:~:text=Pelvic%20organ%20prolapse%20is%20a,and%20childbirth%2C%20especially%20vaginal%20childbirth.

(1 June 2019) Uterine Prolapse. Retrieved on 2 July 2020 from https://www.mayoclinic.org/diseases-conditions/uterine-prolapse/symptoms-causes/syc-20353458

(1 June 2019) Uterine Prolapse. Retrieved on 2 July 2020 from https://www.mayoclinic.org/diseases-conditions/uterine-prolapse/diagnosis-treatment/drc-20353464

(n.d.) Hysterectomy. Retrieved on 2 July 2020 from https://www.acog.org/patient-resources/faqs/special-procedures/hysterectomy

(23 November 2019) Different Types of Hysterectomies. Retrieved on 2 July 2020 from https://www.verywellhealth.com/what-are-the-types-of-hysterectomy-3522467

(30 December 2019) Uterine Prolapse: Management and Treatment. Retrieved on 3 July 2020 from https://my.clevelandclinic.org/health/diseases/16030-uterine-prolapse/management-and-treatment

11.AUG.2020
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Ting Hua Sieng
Obstetrician & Gynaecologist
Parkway East Hospital

Dr Ting Hua Sieng is an obstetrics and gynaecology (O&G) specialist practising at Parkway East Hospital, Singapore.