Treatment of Uterine Prolapse

Stages of Uterine Prolapse

Four stages of uterine prolapse are commonly defined:

• Stage I of uterine prolapse is defined as descent of the uterus to any point in the vagina above the hymen (or hymenal remnants).
• Stage II of uterine prolapse is defined as descent to the hymen.
• Stage III of uterine prolapse is defined as descent beyond the hymen.
• Stage IV of uterine prolapse is defined as total eversion or procidentia.¹

Uterine prolapse always is accompanied by some degree of vaginal vault prolapse.

Screening & Diagnosis

Diagnosing uterine prolapse requires a pelvic examination. You may be referred to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist). The doctor will ask about your medical history, including how many pregnancies and vaginal deliveries you've had. He or she will perform a complete pelvic examination to check for signs of uterine prolapse. You may be examined while lying down and also while standing. Sometimes imaging tests, such as ultrasound or magnetic resonance imaging (MRI), might be performed to further evaluate the uterine prolapse.²

Treatment

Losing weight, stopping smoking and getting proper treatment for contributing medical problems, such as lung disease, may slow the progression of uterine prolapse.

If you have very mild uterine prolapse, either without symptoms or with symptoms that aren't highly bothersome, no treatment is necessary. However, without treatment, you may continue to lose uterine support, which could require future treatment.

Non-Surgical Options

Exercise

Special exercises, called Kegel exercises, can help strengthen the pelvic floor muscles. This may be the only treatment needed in mild cases of uterine prolapse. To do Kegel exercises, tighten your pelvic muscles as if you are trying to hold back urine. Hold the muscles tight for a few seconds and then release. Repeat. You may do these exercises anywhere and at any time. To see results, it is recommended that you repeat the exercise four times daily.

Vaginal Pessary

A pessary is a rubber or plastic doughnut-shaped device that fits around or under the lower part of the uterus (cervix), helping to prop up the uterus and hold it in place. A health care provider will fit and insert the pessary, which must be cleaned frequently and removed before sex.

Estrogen replacement therapy (ERT)

ERT refers to a woman taking supplements of hormones such as estrogen alone or estrogen with another hormone called progesterone (progestin in its synthetic form).  ERT replaces hormones that a woman’s body should be making or used to make.³ Taking estrogen may help to limit further weakness of the muscles and other connective tissues that support the uterus. However, there are some drawbacks to taking estrogen, such as an increased risk of blood clots, gallbladder disease and breast cancer. The decision to use ERT must be made with your doctor after carefully weighing all of the risks and benefits.

Surgical Options

Hysterectomy

Uterine prolapse may be treated by removing the uterus in a surgical procedure called hysterectomy. This may be done through an incision made in the vagina (vaginal hysterectomy) or through the abdomen (abdominal hysterectomy). Hysterectomy is major surgery, and removing the uterus means pregnancy is no longer possible.

Sacrocolpopexy

Sacrocolpopexy is a procedure to surgically correct vaginal vault prolapse where mesh is used to hold the vagina in the correct anatomical position. This procedure can also be performed following a hysterectomy to treat uterine prolapse to provide long-term support of the vagina.
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Uterine Suspension

Uterine suspension is a procedure that involves putting the uterus back into its normal position. This may be done by reattaching the pelvic ligaments to the lower part of the uterus to hold it in place. Another technique uses a special material that acts like a sling to support the uterus in its proper position. Recent advances include performing uterine suspension with minimally invasive techniques and laparoscopically (through small band aid-sized incisions) that decrease post-operative pain and speed recovery.⁴

Vaginal vs. Abdominal Surgery

Doctors generally prefer to perform the surgical repair vaginally because it's associated with less pain after surgery, faster healing and a better cosmetic result. However, vaginal surgery may not provide as lasting a fix as abdominal surgery. And if you didn't have your uterus removed during surgery, prolapse can recur.

Laparoscopic Techniques

Laparoscopic and robotic operating techniques use smaller abdominal incisions, a lighted camera-type device (laparoscope) and specialized surgical instruments to offer a minimally invasive approach to abdominal surgery.

Robotic Surgery

Robot-assisted laparoscopic surgery (da Vinci Sacrocolpopexy)is an effective alternative to traditional surgery for treatment of vaginal vault prolapse, U.S. researchers report.

In da Vinci Sacrocolpopexy, the surgeon uses the da Vinci System to provide improved precision, visualization and control, all of which help with technically difficult aspects of vaginal vault prolapse surgery. A recent Mayo Clinic study of 30 women who had robot-assisted laparoscopic repair (da Vinci Sacrocolpopexy) concluded that this method has the following advantages over traditional open surgical repair.⁵

• Less overall recovery time.
• An overnight hospital stay, rather than two to four days.
• Potentially lower risk of post-surgery bleeding.
• Much less pain. Fifty percent of laparoscopic surgery patients are discharged from hospital with only over-the-counter painkillers.
• Women who, due to health issues, may not be able to tolerate the open surgery may be candidates for this approach.

To find a surgeon who performs robotic surgery to treat uterine prolapse, use our surgeon locator.

Prevention

General Guidelines

• Maintain a healthy body weight.
• Exercise regularly (for 20 to 30 minutes, three to five times per week), including Kegel exercises (up to four times a day).
• Eat a healthy diet balanced in protein, fat and carbohydrates and high in dietary fiber (such as whole grain cereals, legumes and vegetables), and limit your daily fat intake to 25 to 30 grams. Using the Food Guide Pyramid (visit the web site: mypyramid.gov) is a good way to help ensure that you are meeting your nutrition needs.
• Stop smoking. Smoking cessation reduces the risk of developing a chronic cough, which can put extra strain on the pelvic muscles.
• Consider estrogen replacement therapy after menopause.
• Use correct lifting techniques.

Tips on Lifting

• To pick up an object that is lower than the level of your waist, keep your back straight, and bend at your knees and hips. Do not bend forward at the waist with your knees straight.
• Stand with a wide stance close to the object you are trying to pick up, and keep your feet firm on the ground. Tighten your stomach muscles and lift the object using your leg muscles.
• Straighten your knees in a steady motion. Do not jerk the object up to your body. Stand completely upright without twisting. Always move your feet forward when lifting an object.
• If you are lifting an object from a table, slide it to the edge to the table so that you can hold it close to your body. Bend your knees so that you are close to the object. Use your legs to lift the object and come to a standing position.
• Hold packages close to your body with your arms bent. Keep your stomach muscles tight.
• Take small steps and go slowly.
• To lower the object, place your feet as you did to lift, tighten stomach muscles and bend your hips and knees.⁶

Kegel Exercises

Kegel exercises were originally developed as a method of controlling incontinence in women following childbirth. These Kegel exercises are now recommended for women with urinary stress incontinence. The principle behind Kegel exercises is to strengthen the muscles of the pelvic floor, thereby improving the urethra and/or rectal sphincter function.⁷

Some people have difficulty identifying and isolating the muscles of the pelvic floor. Care must be taken to learn to contract the correct muscles. Typically, most people contract the abdominal or thigh muscles, while not even working the pelvic floor muscles.