Dr Ting Hua Sieng
Obstetrician & Gynaecologist
A uterine prolapse is when the uterus drops into the vaginal canal because the pelvic muscle, tissue and ligaments are unable to support its weight. This can also affect other organs such as the bladder or rectum. Collectively, this is known as pelvic organ prolapse.
Muscle weakness or relaxation may allow the uterus to sag or completely come out of the body in various stages:
Uterine prolapse is a common condition. The risk of developing the condition increases with age, due to the natural loss of the hormone oestrogen. Multiple vaginal deliveries during childbirth also increases the risk of having a uterine prolapse.
Risk factors for uterine prolapse include:
Uterine prolapse is often associated with prolapse of other pelvic organs. These include:
Severe uterine prolapse can displace part of the vaginal lining, causing it to protrude outside the body. When vaginal tissue rubs against clothing, vaginal sores or ulcers can occur.
While uterine prolapse cannot be definitively prevented, although lifestyle changes can help you reduce the risks. These include:
Prolapse occurs in stages. In mild cases, the uterus may have only dropped slightly and may not require treatment. In severe cases, the uterus has dropped significantly or may be protruding from the vagina. Some women experience no symptoms while others may notice the following:
Uterine prolapse happen when the group of muscles and ligaments that hold the uterus in place weaken, resulting in the uterus dropping into the vagina. Uterine prolapse is more likely to happen to women who have:
To check if you have uterine prolapse, a doctor will perform a pelvic examination. You may also be asked to bear down or exert pressure as though you are trying to perform a bowel movement or to tighten your pelvic muscles as though you are trying to stop the flow of urine.
Additional tests may be required such as a cystoscopy to check the bladder and urethra or a magnetic resonance imaging (MRI) of the kidneys, uterus and other pelvic organs. These will help the doctor to determine if you have a uterine prolapse and how mild or severe it is.
Depending on your condition, your doctor may recommend one of the following:
These procedures may be minimally invasive, such as laparoscopy, while others that take place through the vagina or abdomen are not. Here are some of the likely treatment options your specialist may advise.
In a vaginal hysterectomy, the uterus is removed through the vagina without the need for an abdominal incision. This procedure generally has fewer complications and a shorter healing period, making it a preferred choice whenever possible. However, it may not be suitable for all women.
A laparoscopic hysterectomy requires several small incisions in the abdomen. Through these incisions, a laparoscope (a small camera) can be inserted so the surgeon can view the pelvic organs and concurrently remove the affected part of the uterus using the same scope. It has a lower risk of infection compared to an abdominal hysterectomy and requires a shorter hospital stay. However, the procedure may take longer to perform and can pose an increased risk of injury to other surrounding organs.
An abdominal hysterectomy means that the uterus is removed through an incision in the lower abdomen. Compared to a laparoscopic or vaginal hysterectomy, there is a greater risk of complications, with a longer healing time.
Pain, bleeding, vaginal discharge and constipation are commonly experienced after a hysterectomy. Other side effects a person may experience depends on the type of hysterectomy they have.
This procedure does not involve ovary removal but may still affect the ovaries. Research indicates that the onset of menopause may be sped up as a result of the surgery. However, more research needs to be done to confirm the long-term effects and impact of hysterectomies on ovarian function.
This procedure involves the removal of both the uterus and the ovaries. The ovaries produce the female hormones oestrogen and progesterone. Without these organs, a woman would experience menopause symptoms such as hot flashes, night sweats, vaginal dryness, difficulty sleeping, mood swings, weight gain, hair loss and dry skin.
The duration of these symptoms will vary from person to person. Your doctor may recommend hormone replacement therapy to manage these symptoms.
You will receive specific instructions from your healthcare provider on how you should prepare for the surgery. Generally, the instructions would include:
Your stay in the hospital and subsequent recovery will vary according to the type of procedure, the extent of surgery and your overall health. Pain will be experienced for the first few days, with vaginal bleeding and discharge. You will also be asked to walk about as soon as you are able, as it will help prevent blood clots from forming in the operated area. You may also receive medication to relieve pain and prevent clots.
During your recovery, you should aim to get plenty of rest in between moving around as often as possible, such as taking short walks and gradually increasing the distance. You should avoid lifting anything heavy until your doctor says you are able to. In the first 6 weeks, do not place any object in the vagina such as douches or tampons, and avoid sexual intercourse.
It's important to follow your doctor's instructions regarding post-operative care, and this includes medications to take, diet to observe and physical activity. You should also keep up with routine gynaecological check-ups to detect any other potential or long-term complications.
A uterine prolapse, left untreated, may worsen to the point where it causes pain or affects other organs, and interfere with bowel and/or bladder function. If you experience any of the symptoms above or suspect any abnormality, please seek advice from a gynaecologist to discuss your treatment options.