What is Uterine Prolapse?



478

Uterine prolapse is a disorder where uterine slips down from its area. Mostly the uterus does not slip alone. This is accompanied by the bladder in front of the womb and the last part of the large intestine. In the genital area, the organs within the pubic area have only limited mobility with the various bonds that secure them. As the woman’s age progresses and the number of births increases, the bonds that secure them can lose their ability. This causes the genital organs to slips out into or out of the vagina over time. In some women this prolapse is very evident. The woman may feel this prolapse by smelling opening of the vagina with her hand. This is called partial uterus prolapse. In some women, the uterus may prolapse out completely. This is called total prolapse. Genital prolapse occurs in different degrees in more than half of women who have given birth. Severe prolapse is seen in one in ten women and seriously affects the quality of life of women. If uterine prolapse is less, it causes urine incontinence, if it is severe, it causes inability to urinate and defecate. Some women even push their bladder or last part of large intestines from vagina, so that they can defecate.

What are Causes of Uterine Prolapse?

Pelvic organ prolapse is caused by

  • High number of delivery
  • Difficult delivery (prolonged delivery, large baby delivery)
  • Invasive delivery (vacuum, forceps)
  • Menopause
  • Obesity
  • Genetic predisposition
  • Heavy work
  • Constipation
  • Chronic cough (asthma, chronic bronchitis).

Pelvic floor defects caused by damage to the muscles and connective tissues, which provide the formation of the pelvic floor leads to the pelvic organs such as the uterus, bladder, anal canal to protrude out of the vagina. Delivery and pregnancy are the two major factors that cause damage to the pelvic muscles and connective tissues. The more a woman experience vaginal delivery, the more likely she will encounter pelvic organ prolapse. The possibility of pelvic organ prolapse increases by 4 to 11 times in a woman with a high number of vaginal deliveries. The problem of pelvic organ prolapse gradually becomes severe and gradually increases. Cystocele is a medical condition in which the bladder adjacent to the anterior wall of the vagina protrudes into or out of vagina. It may be caused by some condition causing increase in intra-abdominal pressure such as coughing, sneezing, heavy lifting.

Pelvic organ prolapse and looseness are common problems encountered by gynecologists. Each of these problems reduces the quality of life of women and requires treatment.

 Uterine prolapse can also be seen in young people. The most important reason for the uterus prolapse is mostly vaginal birth and rarely genetic predisposition. Uterine prolapse usually manifests itself in menopause and post-menopausal stages. This is caused by the decrease in the amount of hormones in women and the progression of age, therefore it weakens the bonds and increases slack.

If bladder prolapse (cystocele) is severe, some disorders can be seen for example bladder can not be fully emptied or urinary tract infections often recurrent.
 Rectocele refers to the herniation of the last part of the large intestine (rectum) into the vaginal cavity. Due to the haustrum, defecation may be difficult.

 Enterocele is rectocele. The part called Douglas behind the uterus is herniated into the vaginal space through the posterior wall of the vagina. The herniated part usually contains small intestine. Laxity in all these pelvic structure ligaments can be easily understood by examination, except in small exceptional cases, treatments can be performed with operations.

Degrees of Uterine Prolapse

Uterine Prolapse is classified. 1st degree is the lightest form of prolapse. The 4th degree prolapse refers to the stages where the uterus is completely out. 

Complications are problems such as hemorrhages, protruding uterus, wounds and infections around the uterus, urinary tract infections, discharge, flow through the kidney collecting ducts, and expansion of the kidneys. Very neglected cases may face problems that may lead to renal failure. Generally, patients with uterine sagging consult the doctor with the complaints of the feeling of fullness, the feeling of compression, palpable mass in the vagina, frequent urination and incontinence problems. 
 The vaginal vault prolapse may also be seen following hysterectomy.

Tears caused by the birth trauma may be occur in the vaginal access and the perineum near the pulp. The perineum gets thinner and loosens. Therefore, the pelvic floor muscles lose their function, and the vaginal entrance expands. Sometimes these tears may be small. Sometimes it can cause ruptures, including arse muscles. These reasons can cause gas and fecal incontinence in women. These women often have sexual dysfunction and their partners are not satisfied. Correcting the tears to fit with the pelvic floor anatomy and reconstructing and tightening the vagina is the only treatment of all these problems.

Support can be provided to the pelvic floor by means of silicone rings placed in the vagina called pessary. 

Pessaries may be applied in women in advanced age who are at risk for surgery and anesthesia, in patients who reject surgical procedures and to pre-operative preparation period for the purpose of providing treatment for wounds in mild and moderate sagging wounds or in sagging uterus for a period of time. If it is used after menopause, it should be applied together with estrogen creams. Other measures that the patient can take include weight loss, improved cardiovascular or lung problems, and an to quit smoking.

Uterine Prolapse Surgeries

The method to be preferred in uterus prolapse are cystocele and rectoselin correction without hysterectomy if there is not any anomaly in uterus.

 The purpose of prolapse surgery is to restore the anterior wall, back wall and top of the vagina. If one of them is neglected, the operation will fail. In the operation, the patient’s own tissue is hung vaginally or in the pelvic ligaments, or the glands are placed on the anterior and posterior walls of the vagina with mesh. If the patient’s own tissue is used, the success is over 90%, in mash operation success rate is 60%. Another successful method for uterus prolapse is the robotic surgery and the closure of the uterus by closed surgery. The success of this surgery is over 90%.

In case of recurrence of prolapse operations, the second operations are more difficult and the success rate decreases. Therefore, these operations should be done by urogynecologists who specialized in this field.