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Uterine Prolapse

Obstetrics and GynaecologyReproductive Medicine Gynaecological Oncology

Uterine Prolapse refers to the partial or complete descent of the uterus from its normal position. The pelvic floor muscles and ligaments usually support the uterus. When these muscles or ligaments become damaged or weakened, the uterus may gradually descend towards the opening of the vagina, leading to what is known as uterine prolapse.

Symptoms

Mild uterine prolapse patients may not exhibit symptoms initially. Patients may gradually feel a sense of vaginal descent, and discomfort may increase with the degree of prolapse.
The following are some indications of Uterine Prolapse:

Sensation of Vaginal Foreign Body
Feeling as though there is a foreign object in the vagina or a sense of pressure.
Abdominal Discomfort or Back Pain
Pain or discomfort in the abdomen or back, especially when standing or walking.
Urinary and Bowel Issues
Uterine prolapse may exert pressure on the bladder or rectum, causing symptoms such as frequent urination, urinary incontinence, difficulty urinating, or constipation
Discomfort During Sexual Intercourse
Discomfort or pain during sexual intercourse, possibly due to uterine prolapse.
Visible or Palpable Uterus
In severe cases, it may be possible to see or touch a portion of the uterus at the vaginal opening.

Staging

The severity of uterine prolapse can be divided into different stages, and healthcare professionals typically use a grading system to assess the extent of prolapse. Generally, it can be classified into the following stages:

Stage 1 (Mild)	The uterus slightly descends to the upper part of the vagina, possibly without significant symptoms, or with only mild discomfort.
Stage 2 (Moderate)	The uterus further descends to the middle part of the vagina, accompanied by mild symptoms such as a feeling of vaginal descent, usually more noticeable when standing.
Stage 3 (Severe)	The uterus markedly descends to the lower part of the vagina, leading to noticeable discomfort and symptoms, including abdominal discomfort, back pain, and urinary and bowel issues.
Stage 4 (Extreme)	The uterus is completely prolapsed, potentially protruding outside the vagina. This is the most severe stage.

Factors

Physiologically, women have pelvic flexibility due to the requirements of pregnancy and childbirth. However, this flexibility also makes them more prone to laxity. Once the pelvic floor becomes lax, there is a possibility of prolapse involving the uterus, rectum, and bladder. Therefore, women who have been pregnant and given birth should pay special attention to the symptoms of prolapse listed above and seek medical diagnosis early.

In addition, the following factors can increase the risk of uterine prolapse:

Reproductive History: Multiple natural childbirths, delivering larger babies, or using excessive force during childbirth may increase the risk of uterine prolapse.
Age: Women's tissues and muscles lose elasticity as they age, increasing the likelihood of uterine prolapse. It is especially notable after menopause, where hormonal changes can affect the strength of supportive tissues.
Weight: Obesity can increase abdominal pressure, exerting additional pressure on the pelvic floor muscles and tissues, thereby increasing the risk of uterine prolapse.
Genetic Factors: Some women may have inherently weaker tissue structures, making them more susceptible to uterine prolapse.
Chronic Abdominal Pressure: Long-term chronic abdominal pressure, such as chronic constipation, chronic cough, or intense physical exercise, including high-intensity labour, may increase the risk of uterine prolapse.
Hormonal Changes: Drastic hormonal fluctuations, such as during pregnancy and menopause, can impact the supportive tissues.
Surgical History: Women who have undergone pelvic surgery, especially involving the uterus or pelvic area, may be at an increased risk of uterine prolapse.
Ethnicity: Some studies suggest that the incidence of uterine prolapse may be relatively higher in European and Latin American women, which may be related to genetic and cultural factors.
Smoking: Smoking can affect blood supply and tissue health, thereby increasing the risk of uterine prolapse.

Diagnosis and Treatments

Diagnosis

Doctor can typically diagnoses uterine prolapse through a clinical examination to visually assess symptoms. If necessary, ultrasound, MRI, or other imaging tests may be conducted to observe the pelvic structure further.

Treatments

Non-surgical Treatment	Pelvic Floor Muscle Exercises: Strengthening support tissues can be achieved through exercises targeting the pelvic floor muscles, with Kegel exercises specifically aimed at maintaining the correct position of pelvic organs and preventing or treating pelvic floor disorders, improving symptoms. Lifestyle Changes: This includes avoiding heavy lifting, maintaining a proper weight, and avoiding prolonged periods of standing.
Supportive Devices	In some cases, doctors may recommend using supportive devices such as intra-vaginal rings or uterine meshes.
Surgical Treatment	Traditional surgeries may involve repairing the vaginal wall to improve the degree of uterine prolapse. For patients with fertility needs or those who do not wish to have the uterus removed, procedures like vaginal stitching or vaginal suspension may be performed. However, the likelihood of recurrence remains relatively high. A newer surgical treatment involves the use of artificial mesh repair, which can be inserted through the abdomen or vagina. This procedure supports the pelvic floor organs with synthetic mesh, helping them return to their normal position. After 5 years of surgery, the success rate is over 90%, and the recurrence rate is lower than traditional surgery. In severe cases, uterine removal may be necessary.
Other Treatments	Physical Therapy: Strengthening pelvic floor muscles through physical therapy techniques such as electrical stimulation and massage. Hormone Therapy: After menopause, hormone supplementation may help maintain tissue elasticity.

Uterine prolapse may increase the risks during pregnancy and childbirth. Due to damage to the supporting structures of the uterus, pregnancy can impact the uterus and pelvic tissues. Additionally, uterine prolapse may misplace the uterus, affecting the process of childbirth. During a natural birth, the position of the uterus and compromised support structures can create additional pressure. Women should consult with a doctor for appropriate guidance and management advice before and during pregnancy to ensure the safety of both pregnancy and childbirth.

The chances of uterine prolapse recurrence vary depending on individual conditions, treatment methods, and lifestyle habits. Recurrence is possible, but the risk can be effectively reduced through suitable treatment, lifestyle adjustments, and regular medical monitoring.