What Is Uterine Prolapse? How Is It Treated?
If you experience pressure in the vaginal area, a downward pulling sensation, or the feeling that “something is coming out,” the underlying cause may be uterine prolapse. This condition is particularly common among women who have given birth, entered menopause, or have long been exposed to factors that place strain on the pelvic floor. It can range from a mild anatomical change to advanced prolapse that significantly affects daily life. What matters is not only how far the uterus has descended but also how the condition affects bladder and bowel function, sexual health, and overall daily comfort.
Obstetrician and Gynecologist Prof. Dr. İsmail Mete İtil evaluates the patient’s symptoms, the degree of prolapse, and her expectations regarding quality of life when examining uterine prolapse and pelvic organ prolapse. Based on this comprehensive assessment, a personalized treatment plan is developed.
What Is Uterine Prolapse?
Uterine prolapse occurs when the muscles and connective tissues supporting the uterus within the pelvis weaken, causing the uterus to descend into the vaginal canal. The prolapse may remain mild, while in advanced cases the cervix or part of the uterus may become visible at or extend beyond the vaginal opening.
Uterine prolapse may also be accompanied by other pelvic organ problems, such as bladder prolapse or bulging of the rectum toward the vagina.
What Are the Symptoms of Uterine Prolapse?
Uterine prolapse does not cause the same symptoms in every woman.
The most common symptoms include:
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A feeling of fullness or pressure in the vagina
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Feeling or noticing a bulge protruding from the vagina
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A sensation of heaviness in the pelvic area
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Discomfort in the lower back or lower abdomen
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Urinary incontinence or difficulty emptying the bladder completely
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Constipation or difficulty during bowel movements
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Discomfort during sexual intercourse
Mild prolapse may sometimes cause no symptoms and may only be detected during a gynecological examination.
What Causes Uterine Prolapse?
The main cause of uterine prolapse is reduced strength of the pelvic floor support structures. Vaginal deliveries—particularly difficult or multiple deliveries—aging, menopause, excess weight, chronic constipation, frequent heavy lifting, and chronic coughing can increase pressure on the pelvic floor.
How Is Uterine Prolapse Diagnosed?
The diagnosis is usually made through a gynecological examination. During the examination, the patient may be asked to bear down or cough so that the physician can carefully assess the movement of the pelvic organs. The support of the bladder, the front and back walls of the vagina, and the rectum is also evaluated.
What Are the Stages of Uterine Prolapse?
Pelvic organ prolapse can be classified according to the position of the uterus or other pelvic organs in relation to the vagina.
In mild prolapse, the uterus has shifted downward but has not extended outside the vagina. In advanced stages, the cervix or uterine tissue may reach the vaginal opening or protrude outside it.
However, treatment decisions are not based solely on the stage of prolapse. Two women with the same degree of prolapse may experience completely different symptoms.
Can Uterine Prolapse Be Treated Without Surgery?
Yes. Non-surgical treatment may be possible under the supervision of a specialist, particularly in women with mild or moderate prolapse or in those who do not wish to undergo surgery. Pelvic floor exercises may strengthen the supporting muscles and help relieve certain symptoms.
A vaginal pessary may also be considered in suitable patients. The pessary supports the prolapsed organs mechanically and may help reduce symptoms; however, it requires regular medical follow-up.
How Is Uterine Prolapse Surgery Performed?
Uterine prolapse surgery may be considered when the condition significantly affects daily life and non-surgical methods do not provide adequate relief. The procedure may be performed through a vaginal, laparoscopic, or, in suitable patients, robotic approach.
In some patients, pelvic support is repaired after removing the uterus, while in selected women, uterus-preserving suspension procedures may be performed.
The most appropriate method is determined according to the patient’s age, future pregnancy plans, sexual activity, type of prolapse, and any accompanying pelvic organ problems.
Is the Uterus Removed During Uterine Prolapse Surgery?
Not necessarily. Uterine prolapse surgery does not always require removal of the uterus. In suitable patients, uterus-preserving surgery may be performed by keeping the uterus in place and attaching it to supportive structures. The decision is made individually according to the patient’s medical findings, expectations, and reproductive plans.
Can Uterine Prolapse Recur?
Although the likelihood may be low in appropriately selected and treated patients, uterine prolapse can recur after treatment. The risk of recurrence may be influenced by the type of surgery, tissue characteristics, body weight, chronic coughing, constipation, and heavy lifting.
For this reason, maintaining a healthy weight, preventing constipation, managing chronic cough, and reducing activities that place excessive strain on the pelvic floor are important after treatment.
Obstetrician and Gynecologist Prof. Dr. İsmail Mete İtil evaluates not only the existing prolapse but also bladder and bowel function, pelvic floor support, and the patient’s future expectations when planning a personalized approach to uterine prolapse treatment.
Frequently Asked Questions
Can Uterine Prolapse Resolve on Its Own?
Significant uterine prolapse usually does not resolve completely on its own. In mild cases, symptoms may be controlled through lifestyle changes and pelvic floor therapy.
Does Uterine Prolapse Cause Pain?
Pressure or heaviness in the pelvic area and lower back pain may occur. However, uterine prolapse does not necessarily cause pain in every patient.
Can Uterine Prolapse Cause Urinary Incontinence?
Yes. Pelvic support disorders may be associated with urinary incontinence or difficulty emptying the bladder completely.
Does Uterine Prolapse Affect Sexual Intercourse?
Advanced prolapse may cause pressure, discomfort, or pain during sexual intercourse. However, sexual problems may also have other underlying causes.
Can Uterine Prolapse Prevent Pregnancy?
Mild prolapse does not necessarily prevent pregnancy. However, women with advanced prolapse who are planning a pregnancy should be assessed individually.
Does Uterine Prolapse Worsen After Menopause?
The strength of supportive tissues may decrease with aging and menopause. For this reason, pelvic organ prolapse may become more common or symptomatic at older ages.
Which Doctor Should I Consult for Uterine Prolapse?
Women with uterine or pelvic organ prolapse should consult an obstetrician and gynecologist. When necessary, they may be referred to a physician experienced in pelvic floor surgery.
Does a Pessary Permanently Treat Uterine Prolapse?
A pessary supports the prolapsed organs mechanically and may help reduce symptoms. However, it is not a surgical treatment that permanently restores weakened tissues to their original position.
Can I Exercise After Uterine Prolapse Surgery?
Yes. However, the timing of returning to exercise, particularly intense exercise or heavy lifting, should be determined by the physician according to the type of surgery and the patient’s recovery.
Is Pregnancy Possible After Uterus-Preserving Prolapse Surgery?
Pregnancy may be possible after uterus-preserving surgery. However, pregnancy and childbirth may affect the risk of recurrence. Therefore, future fertility and delivery plans should be discussed before surgery.
This article is intended for informational purposes only and does not replace medical diagnosis or treatment.