Uterine (Pelvic) Prolapse Treatment in Delhi, India

Pelvic (uterine) prolapse, also known as uterine prolapse, is a condition in which the uterus descends or sags into the vaginal canal. This can occur when the muscles and tissues that support the uterus weaken, leading to a displacement of the organ from its normal position within the pelvis. Uterine prolapse is a type of pelvic organ prolapse, where one or more pelvic organs, such as the bladder, rectum, or uterus, can shift downward into the vaginal space.

Uterine prolapse can be attributed to various causes and risk factors. Some of the key ones include:

• Pregnancy and Childbirth: The strain placed on pelvic muscles and tissues during pregnancy and childbirth can weaken the support structures of the uterus, increasing the likelihood of prolapse.
• Ageing: As women age, hormonal changes and the natural weakening of connective tissues can lead to a higher susceptibility to uterine prolapse.
• Weakening of Pelvic Muscles: Conditions such as obesity, chronic coughing, or straining during bowel movements can weaken the pelvic muscles, making the uterus more prone to prolapse.
• Menopause: The hormonal changes associated with menopause can contribute to the weakening of pelvic tissues, increasing the risk of uterine prolapse.
• Hysterectomy: Surgical removal of the uterus, particularly if it involves the removal of supporting structures, can elevate the risk of vault prolapse.
• Genetic Factors: Some women may have a genetic predisposition to weaker pelvic tissues, which can contribute to the development of uterine prolapse.
• Chronic Constipation: Straining during bowel movements due to chronic constipation can put added pressure on the pelvic region, potentially leading to uterine prolapse.
• Heavy Lifting: Regularly engaging in heavy lifting without proper support or technique can strain pelvic muscles and contribute to the risk of uterine prolapse.
• Chronic Coughing: Conditions such as chronic bronchitis or persistent coughing can lead to increased abdominal pressure, potentially impacting the pelvic floor and contributing to uterine prolapse.

It's important to note that multiple factors often interact to cause uterine prolapse, and individual experiences may vary. Consultation with a healthcare professional is recommended for a thorough assessment and personalised guidance based on specific circumstances.

Uterine prolapse can manifest with various symptoms, and the severity of these symptoms may vary from person to person. Common signs of uterine prolapse include:

• Feeling of Pelvic Pressure: A noticeable sensation of fullness or pressure in the pelvic area, often described as a heaviness or discomfort.
• Protrusion or Bulging: A protrusion or bulging of the uterus or other pelvic organs into the vaginal canal may be felt or observed.
• Discomfort or Pain: Pelvic pain or discomfort, especially during activities such as standing or walking, can be indicative of uterine prolapse.
• Backache: Persistent lower back pain, particularly in the pelvic region, can be associated with uterine prolapse.
• Urinary Issues: Problems such as urinary incontinence, difficulty emptying the bladder completely, or recurrent urinary tract infections may be linked to uterine prolapse.
• Bowel Changes: Constipation or difficulty with bowel movements may be experienced due to the impact of uterine prolapse on the surrounding pelvic structures.
• Sexual Discomfort: Pain or discomfort during sexual intercourse, as well as a sense of looseness in the vaginal area, may be reported by individuals with uterine prolapse.
• Vaginal Bleeding or Discharge: In some cases, abnormal vaginal bleeding or an increase in vaginal discharge may be associated with uterine prolapse.
• Difficulty Retaining a Tampon: Women with uterine prolapse may find it challenging to keep a tampon in place.

It's essential to recognize that symptoms can vary in intensity, and not everyone with uterine prolapse will experience all of these signs. Additionally, symptoms may worsen with activities that increase abdominal pressure, such as heavy lifting or straining during bowel movements.

Diagnosing uterine prolapse typically involves a comprehensive assessment by a healthcare professional. The process commonly includes:

• Medical History: Gathering information about the patient's medical history, including any symptoms related to uterine prolapse, pregnancies, childbirth, surgeries, and overall health.
• Physical Examination: A pelvic examination is conducted to assess the extent of uterine prolapse. The healthcare provider may ask the patient to perform specific movements or bear down to observe the prolapse's severity.
• Imaging Tests: In some cases, imaging studies like ultrasound, MRI, or CT scans may be recommended to provide a more detailed view of the pelvic organs and the extent of the prolapse.
• Urodynamic Testing: If urinary symptoms are present, urodynamic tests may be conducted to evaluate bladder function and identify any associated issues.
• Cystourethroscopy: This involves using a thin, flexible tube with a camera (cystoscope) to examine the inside of the urethra and bladder for any abnormalities.

It's essential for individuals experiencing symptoms of uterine prolapse, such as pelvic pressure, discomfort, or urinary and bowel changes, to seek prompt medical attention. A healthcare professional can conduct a thorough evaluation, determine the extent of the prolapse, and recommend appropriate treatment options based on the individual's specific situation.

The treatment approach for uterine prolapse depends on the severity of the condition and the individual's symptoms. Common methods include:

Pelvic Floor Exercises (Kegel exercises)

Strengthening the pelvic floor muscles can provide support to the uterus and improve symptoms. A healthcare provider or physical therapist may guide patients in performing these exercises correctly.

Lifestyle Modifications

Advising lifestyle changes such as weight management, avoiding heavy lifting, and addressing constipation to reduce strain on pelvic muscles.

Pessary Use

A pessary, a device inserted into the vagina to support the uterus, can help alleviate symptoms. It is a non-surgical option and comes in various shapes and sizes.

Hormone Replacement Therapy (HRT)

In postmenopausal women, hormonal support through HRT may help strengthen pelvic tissues.

Physical Therapy

A physical therapist with expertise in pelvic floor rehabilitation can provide specific exercises and techniques to address muscle weakness and improve pelvic support.

Surgical Interventions:

• Vaginal Reconstruction: Surgical procedures may involve repairing and reinforcing the pelvic floor, ligaments, and vaginal walls.
• Hysterectomy: In severe cases, a hysterectomy (removal of the uterus) may be considered, especially if the woman has completed childbearing.

Laparoscopic Approaches

Minimally invasive surgeries, such as laparoscopic sacrocolpopexy, may be performed to correct uterine prolapse, providing a shorter recovery time compared to traditional open surgeries.

While not all cases of uterine prolapse can be prevented, there are steps that women can take to reduce the risk and potentially minimise the severity of the condition. Here are some preventive measures:

• Pelvic Floor Exercises (Kegel exercises): Strengthening the pelvic floor muscles through regular exercises can provide support to the uterus and surrounding structures. Consult a healthcare provider or a physical therapist for guidance on proper technique.
• Maintain a Healthy Weight: Excess body weight can contribute to the weakening of pelvic floor muscles. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce this risk.
• Regular Exercise: Engaging in overall physical activity, including aerobic exercises and strength training, contributes to overall health and may help support pelvic floor muscles.
• Proper Lifting Technique: When lifting heavy objects, use proper lifting techniques to avoid putting excessive strain on the pelvic floor. Bend your knees, keep your back straight, and lift with your legs rather than your back.
• Prevent and Treat Constipation: Chronic constipation can strain pelvic floor muscles. Maintain a diet high in fibre, stay hydrated, and seek prompt treatment for constipation to reduce the risk of uterine prolapse.
• Avoid Heavy Lifting: Limit heavy lifting, especially during pregnancy and postpartum. If lifting is necessary, use proper techniques and seek assistance when needed.
• Regular Check-ups: Attend regular gynaecological check-ups, especially during and after pregnancy. Discuss any symptoms or concerns with your healthcare provider promptly.
• Proper Prenatal Care: Receive proper prenatal care during pregnancy to address factors that may contribute to uterine prolapse, especially if you have multiple pregnancies or a history of difficult childbirth.
• Manage Chronic Coughing: Address conditions that cause chronic coughing, as persistent coughing can increase abdominal pressure and strain pelvic floor muscles.
• Quit Smoking: Smoking can contribute to a chronic cough and may weaken connective tissues, so quitting smoking can have multiple health benefits, including reducing the risk of uterine prolapse.

How common is uterine prolapse?

Uterine prolapse is relatively common, especially in women who have experienced childbirth and menopause. The prevalence increases with age, and factors like multiple pregnancies and vaginal deliveries can contribute.

How serious is a prolapsed uterus?

The severity of a prolapsed uterus can vary. While it may cause discomfort and affect quality of life, it is not life-threatening in most cases. However, severe prolapse can lead to complications such as urinary and bowel issues.

Can a prolapsed uterus be treated at home?

Some mild cases may benefit from lifestyle changes and pelvic floor exercises. However, it's crucial to consult with a healthcare professional for a proper diagnosis and personalised treatment plan.

Can I push my prolapsed uterus back up?

Attempting self-correction is not recommended. It is essential to consult a healthcare provider for proper assessment and guidance on suitable treatment options.

How to reduce the risk of uterine prolapse?

Maintaining a healthy weight, practising pelvic floor exercises, avoiding heavy lifting, treating constipation promptly, and seeking proper prenatal care during pregnancy can help reduce the risk of uterine prolapse.

Can uterine prolapse recur?

Yes, uterine prolapse can recur, especially if underlying risk factors are not addressed. Following recommended lifestyle changes and maintaining pelvic floor health can help minimise the risk of recurrence.

What is the prognosis/outlook for uterine prolapse?

With appropriate management, the prognosis for uterine prolapse is generally favourable. Non-surgical interventions, such as pelvic exercises and lifestyle modifications, can provide relief. Surgical options are effective for more severe cases, with a high success rate in correcting the condition. Regular follow-up care is essential for monitoring and managing any potential recurrence.

What are the different stages of uterine prolapse?

Stage I: The descent of the uterus occurs in the upper portion of the vagina.

Stage II: In this stage the uterus descends into the lower segment of the vagina.

Stage III: When the uterus protrudes from the vagina.

Stage IV: This is the last stage when the entire uterus slips outside of the vagina.

What are some associated conditions commonly linked with a prolapsed uterus?

Prolapsed uterus is often accompanied by the following conditions that impact the supporting muscles:

• Cystocele: This occurs when the upper front vaginal wall bulges, causing a section of the bladder to protrude into the vagina. Also termed a prolapsed bladder, it can result in urinary issues such as frequency, urgency, retention, and incontinence.
• Enterocele: Characterised by the upper rear vaginal wall herniating, allowing a portion of the small bowel to bulge into the vagina. Standing may cause a pulling sensation and backache, which is relieved upon lying down.
• Rectocele: Involves the lower rear vaginal wall herniating, causing the rectum to bulge into the vagina. This condition can make bowel movements challenging, often requiring internal pressure on the vagina for effective bowel emptying.

Reviewed by Dr. Parinita Kalita, Associate Director - Obstetrics And Gynaecology, Robotic Surgery, Gynaecologic Laparoscopy on 16-Apr-2024.