Uterine prolapse is a condition in which the uterus sags down from its normal position and moves into the vagina and furtherly out of the vagina. This condition occurs as a result of weakening of the pelvic floor muscles and connective tissues. Uterine prolapse is a health problem that can significantly affect the quality of life in women and limit daily activities.
The main cause of uterine prolapse is the weakening of the pelvic floor muscles and connective tissues that hold the uterus in its normal place. This weakening can develop due to many factors. Vaginal births, especially difficult births, large babies, or multiple births are the risk factors for uterine prolapse. Aging and the decrease in estrogen hormone after menopause also contribute to the weakening of the pelvic floor muscles.
Chronic constipation and constant straining, chronic cough (due to smoking or lung diseases), constantly carrying heavy loads, obesity and being overweight can also cause uterine prolapse. In addition, genetic factors such as a family history of uterine prolapse and previous gynecological surgeries are also among the risk factors.
The symptoms of uterine prolapse vary depending on the degree of prolapse. While there may be no symptoms in mild prolapse, various symptoms may be seen in advanced prolapse. The feeling of vaginal fullness, feeling like there is something in the vagina, is one of the most common symptoms. Lower abdominal pain and discomfort in the groin area are also common symptoms.
Urinary problems, frequent urination, incontinence or inability to urinate are also among the symptoms of uterine prolapse especially together with cystocele. Constipation and difficulty defecating, pain during sexual activity, vaginal bleeding (especially as a result of friction), and pain in the lower back area may also occur. In advanced cases of prolapse, vaginal tissues may also protrude.
Uterine prolapse is divided into four degrees according to the severity of the prolapse. In first-degree prolapse, the cervix is close to the entrance of the vagina but has not yet come out. In second-degree prolapse, the cervix has come out of the entrance of the vagina.
In third-degree prolapse, the cervix is outside the vagina and the uterine body is inside the vagina. In fourth-degree prolapse, the entire uterus is outside the vagina, which is called complete prolapse. The degree of prolapse is an important factor in treatment planning.
Uterine prolapse is diagnosed with a detailed gynecological examination. During the examination, the patient's complaints are listened to in detail and a gynecological examination is performed. The degree of prolapse is assessed with the Valsalva maneuver (pushing) and the position of the uterus is examined with pelvic ultrasonography.
Urodynamic tests can also be performed if necessary. These tests are important to understand whether urinary problems are due to uterine prolapse. In the diagnosis process, detailed evaluation of the symptoms that affect the patient's quality of life is also of great importance.
Treatment for uterine prolapse is planned according to the degree of prolapse, the patient's age, general health status and desire to have children. Treatment options are divided into two main groups: conservative (non-surgical) and surgical treatment.
Conservative treatment options include pelvic floor exercises (Kegel exercises). These exercises are important for strengthening the pelvic muscles. Pessaries are used to support the uterus with a silicone ring placed inside the vagina. Estrogen therapy may also be beneficial for postmenopausal women. However, this therapy requires attention because of systemic effects of estrogens.
Lifestyle changes are also an important part of conservative treatment. Measures such as losing weight, quitting smoking and avoiding heavy lifting can slow the progression of uterine prolapse.
Surgical treatment is preferred in cases where conservative treatment is inadequate or in cases of advanced prolapse. Vaginal hysterectomy is the removal of the uterus through the vagina. Pelvic floor repair is performed to fix the prolapsed organs in place.
The use of mesh (net) is used to support the pelvic floor with synthetic material. Laparoscopic surgery is a closed surgery and offers a less invasive approach. The choice of surgical treatment is determined by the patient's condition and the degree of prolapse. Today, there are excellent surgical treatment modalities for the treatment of uterine prolapse. Abdominal sacrocolpopexy together with anti incontinence surgery serve a lifetime treatment chance for patients. Both open (laparotomy) and laparoscopically these operations can be realized with minimal complication and failure risk.
There are precautions that can be taken to prevent uterine prolapse. Regular pelvic floor exercises are one of the most important preventive measures to strengthen the pelvic muscles. Avoiding chronic constipation and avoiding heavy lifting are also important in preventing uterine prolapse.
Not smoking, maintaining a healthy weight, and receiving treatment for chronic cough are also preventive measures. Regular gynecological examinations are of great importance in the early diagnosis and prevention of uterine prolapse.
In the following cases, a gynecologist should definitely be consulted. Symptoms such as a feeling of vaginal fullness, urinary incontinence or inability to urinate may be signs of uterine prolapse. Lower abdominal pain and pain during intercourse are also among the symptoms to watch out for.
Symptoms such as vaginal bleeding and vaginal tissue protrusion may also be advanced symptoms of uterine prolapse. In these cases, it is important to consult a specialist for early diagnosis and treatment.
Uterine prolapse is a condition that can be successfully managed with early diagnosis and appropriate treatment. Regular gynecological examinations and attention to pelvic floor health are important in preventing and early diagnosis of this problem.
