Uterine Prolapse

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  2. Uterine Prolapse

Uterine prolapse (vaginal hysterectomy)

Loss of anatomical support for the uterus.

Late-stage prolapse usually presents as a palpable protruding cervix with vaginal tissue, which is often noticed by the patient.

Symptoms include sensation of vaginal bulging, pelvic pressure, urinary frequency or incontinence, incomplete bladder emptying, defecatory dysfunction, and dyspareunia.

Diagnosis is made by vaginal examination during resting and straining.

Conservative management encompasses observation, physiotherapy, and use of pessaries.

Surgical intervention is by either a vaginal or an abdominal approach, with or without augmenting graft material.

Vaginal bleeding, abnormal discharge, dyspareunia, urinary retention, and pelvic pain are possible complications of therapy.

How successful is the operation?

In our experience this operation has a more favourable outcome compared with vaginal hysterectomy, as strong uterine support can be achieved with a lower risk of recurrence. The recurrence of uterine prolapse has been as low as 2% in small studies.

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What is Appendix?

The appendix is a narrow, small, finger-shaped portion of the large intestine that is generally situated near junction of small and large intestine (Cecum) on lower right side of the abdomen.

Appendicitis

Appendicitis is a sudden inflammation of the appendix. Although the appendix does not seem to serve any purpose, it can become diseased and, if untreated, can burst, causing infection and could be even fatal.

Symptoms of Uterine Prolapse

The symptoms of prolapse can vary according to which organ becomes displaced into the vagina or outside.

Uterine prolapse: involves the descent of the uterus and cervix down the vaginal canal due to weak or damaged pelvic support structures.

Cystocoele: involves the descent of the bladder and can be noted as a bulge over the anterior vaginal wall.

Rectocoele: involves the descent of the rectum and can be noted as a bulge over the posterior vaginal wall.

Vaginal vault prolapse: this happens in women who have had a hysterectomy and no longer have the uterus. The top of the vagina descends into the vaginal canal.

Treatment for Uterine Prolapse

Prolapse is not a life threatening disease but can cause significant discomfort especially if associated with leakage of urine or difficulty emptying the bowel.

Treatment options include:
  • Weight loss and pelvic floor exercises can significantly help to reduce the symptoms.
  • Vaginal ring pessaries can be very effective at reducing symptoms. It is recommended as a temporary measure for women waiting for surgery or as an alternative for women who cannot or do not want to undergo surgical treatment.
Surgical treatment : Vaginal or Laparoscopic

Some women may decide that the best treatment for them is an operation. Usually this can be performed through the vagina but more recently better results have been obtained through laparoscopic Keyhole surgery without the use of any mesh and reattaching the torn ligaments.

There has been a lot of recent publicity about patients having problems after mesh surgery for prolapse. Not all mesh is bad but it has to be for a very specific purpose and preferably not in the vagina.

What is the success rate of surgical treatment?

The success rate can vary depending on many factors such as degree of prolapse and the age of the patient. Generally about 1 in 10 women will need further surgery at a later time.