Uterine Prolapse

Many factors are implicated in pelvic organ prolapse.

The main ones are:

• Childbirth and Pregnancy
  Vaginal delivery is the most significant risk factor. During delivery, the muscles and ligaments of the pelvic floor are stretched and may sustain damage. Multiple pregnancies and difficult deliveries increase the risk.
• Age and Menopause
  Over time, tissues lose their elasticity. The decrease in estrogen during menopause contributes to the weakening of supporting structures.
• Genetic Factors
  Some women have genetically weaker ligaments, collagen, and muscles, making them more susceptible to prolapse.

Contributing Factors

• Obesity
  Extra weight puts pressure on the pelvic organs, worsening the condition.
• Chronic Constipation
  Continuous pressure during defecation can weaken the pelvic floor muscles.
• Chronic Cough
  Conditions like asthma or chronic obstructive pulmonary disease that cause persistent coughing chronically increase pressure in the pelvis, resulting in increased risk of prolapse.
• Chronic Heavy Lifting
  Frequent lifting of heavy objects can worsen the condition.

Early Signs

The initial symptoms of uterine prolapse may be mild and misinterpreted. Women often report:

• Feeling of heaviness or discomfort in the vagina, abdomen, or pelvis
• Discomfort during sex
• Difficulty urinating, frequency, incontinence, or urinary infections
• Back pain

Advanced Symptoms

As the condition worsens, symptoms become more pronounced:

• Visible Protrusion: The uterus may become visible or palpable at the vaginal opening.
• Urination Problems: Difficulty with normal urination, feeling of incomplete bladder emptying, or conversely, urinary incontinence.
• Sexual Problems: Pain during intercourse, decreased satisfaction, or complete inability for sexual activity.
• Bowel Problems: Difficulty with defecation, feeling of incomplete emptying, or necessary manual adjustment for defecation.

Clinical Examination

The diagnosis of uterine prolapse is made through clinical examination by an experienced gynecologist (urogynecologist).

The examination includes:

• Gynecological Examination: The doctor examines the position of the uterus and assesses the severity of the prolapse.
• Valsalva Examination: The patient is asked to cough during the examination to assess the degree of prolapse.

Additional Tests

• Ultrasound: To evaluate the position of the pelvic organs and diagnose possibly coexisting conditions.
• Urodynamic Study: Essential examination especially if the patient desires surgical repair of the prolapse
• Magnetic Resonance Imaging: In selected cases for detailed evaluation.

Conservative Treatment

• Kegel Exercises: Pelvic floor strengthening exercises are the first line of treatment for very mild cases of prolapse.
• Lifestyle Changes: Weight loss, avoiding constipation, and treating chronic cough can help prevent worsening of the prolapse degree.
• Vaginal Ring (Pessary): This is a medical device placed in the vagina to support the uterus. It is an excellent option for women who cannot or do not wish to undergo surgery.

Surgical Techniques for Uterine Prolapse Repair: Modern Therapeutic Approaches

Surgical techniques for uterine prolapse repair have evolved significantly in recent years, offering effective solutions for managing this condition. These are specialized surgeries performed by certified urogynecologists.

Main Surgical Methods

1. Vaginal Hysterectomy with Repair
   Vaginal hysterectomy is one of the most widespread surgical techniques. During this procedure, the uterus is removed through the vagina, while simultaneously repairing the pelvic supporting structures.
2. Sacrospinous Fixation with or without Uterine Preservation
   Sacrospinous fixation is an effective technique that involves attaching the vaginal vault to the sacrospinous ligament. This repair method provides excellent long-term support.
3. Endoscopic Techniques with or without Uterine Preservation
   Minimally invasive surgical techniques (laparoscopic or robotic), such as laparoscopic sacrocolpopexy, offer many advantages. These include less surgical trauma, rapid recovery, and reduced risk of complications.

Advantages of Modern Techniques

Modern surgical methods for uterine prolapse offer:

• High success rates
• Improved quality of life immediately after surgery
• Short hospital stay
• Rapid return to daily activities

Selection of the Appropriate Technique

The selection of the optimal surgical technique depends on various factors:

• The degree of prolapse
• The results of urodynamic testing
• The patient's age and general health status
• The desire to preserve fertility or not

Post-operative monitoring is critical for long-term success. Surgical techniques for uterine prolapse repair have reached a high level of development, offering effective solutions that significantly improve women's quality of life. The correct choice of surgical method, combined with specialized medical care from a certified urogynecologist, ensures optimal results for each patient.

Prevention of uterine prolapse includes:

• Regular pelvic floor exercise
• Maintaining healthy weight
• Managing chronic constipation
• Avoiding heavy physical labor

It is important to seek medical help when:

• You feel something protruding from the vagina
• You have pain or discomfort in the vagina or pelvis
• You experience urination or defecation problems
• Your sexual life is affected

Uterine prolapse is a common gynecological condition that can significantly affect a woman's quality of life. However, with proper diagnosis and appropriate treatment, all women can return to a normal life. Early diagnosis and appropriate treatment are key to optimal management of the condition.

Kostis Nikolopoulos has experience in pelvic floor repair with safe methods.

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