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Uterine Prolapse Surgery

Uterine prolapse is a condition in which the uterus falls by gravity through the vagina, telescoping itself until it falls through the vaginal opening. Other pelvic organs, such as the bladder, can fall through the vagina in a similar way to the uterus but the uterus is most common. There can be exercises or the use of a donut-shaped pessary in the vagina but many women turn to surgery to treat uterine or other pelvic organ prolapse.

There are several surgical choices you can choose from to correct pelvic organ prolapse. These surgeries include:

• Prolapse bladder repair or urethral repair. This tacks up these organs so they are suspended and no longer fall into the vagina.
• Hysterectomy. This is a removal of the uterus but usually spares the fallopian tubes and ovaries. It completely takes care of the uterine problem and usually helps the urinary tract issues.
• Repair of the rectum. This is done if a woman has a rectocele which usually comes from pregnancy. A woman can also have an enterocele, which is a prolapse of the small bowel. This can be treated by repairing the small bowel segment.
• Vaginal vault suspension. This involves the repair of the wall of the vagina.
• Vaginal obliteration. This involves closing up the vagina completely.

The doctor will often do an exam while you are wearing a pessary to see if there is a change in the ability to urinate without incontinence. If incontinence exists as well as uterine prolapse, the doctor can fix both problems at the same time in a dual surgery. If you have prolapse surgery to a part of the pelvic area, another area can develop prolapse at a later date. This means you’ll have to have two separate surgeries.

You can have pelvic organ prolapse surgery and develop the same symptoms after you have the problem treated. This is why things like Kegel exercises are so important to do even after you have had surgery.

Because these types of organ prolapse are so strongly connected to having a vaginal delivery, it might be wise to delay surgery until after you have had all the children you want to have.

Symptoms of a uterine prolapse involve having the feeling of fullness in the pelvis. It comes on gradually in most cases. Eventually, there is protrusion of the uterus (or other organ in the pelvis) through the vagina. This is considered severe prolapse and surgery is indicated.

In other cases, there can be pelvic pain or lower abdominal pain indicating the presence of prolapse and the need for surgical evaluation. Not all cases of pelvic organ prolapse need surgery, especially if the symptoms are mild and the pelvic organ has not protruded through the vagina. Still other symptoms include frequent bladder infection symptoms and urinary frequency or urgency.

There are complications of pelvic organ prolapse surgery that can be prevented with good surgical technique. These complications include:

• Infection. This can happen at the suture area inside the vagina. This is the most common complication of uterine prolapse surgery. It is especially common when hygiene is not taken care of.
• Suture disruption. This happens when sutures break down after surgery. If surgery has been through the abdomen, it might cause a bursting open of the abdomen and need to be sutured again.
• Vault prolapse. This involves a prolapse of the vaginal stump left behind following surgery. The internal sutures need to be placed properly in order to avoid this complication.
• Incontinence. The bladder structure and related tissues have been placed out of whack as part of the prolapse surgery. Patients can get stress incontinence and urge incontinence, which can be embarrassing.
• Early menopause. This symptom can occur even if the ovaries are intact after the surgery. This can lead to early menopause and related cardiovascular and bone complications later in life.