Uterine prolapse

Uterine prolapse

We are talking about prolapse (relaxation) of the uterus in women when the uterus protrudes into the vagina (hysterocele).
It is a benign common pathology, which although it can be impressive and possibly scare the woman, does not have any serious impact on her health.

Stages

Depending on the degree of prolapse of the uterus, the projection may be limited to the interior of the vagina (1st degree), reach the vulva (2nd degree), or project externally outside the vulva (3rd degree).

Rationale

It occurs mainly in older multiparous women with a history of total hysterectomy and is due to “relaxation” of the pelvic tissues.
It is estimated that 1 in 9 women, during her lifetime, will undergo a total hysterectomy and of these 10% will present symptomatic pelvic floor prolapse.

Symptoms

The fact that a woman has prolapse does not necessarily mean that she also has symptoms. She may not even know it and be diagnosed by chance during a routine exam at her gynecologist. If it is more prolapsed, then the woman may feel a feeling of fullness low in the vagina, or see something like an “egg” projecting out of the vagina, often at the end of the day. In some cases, minor bleeding may occur due to the friction of the mucous membrane with the underwear.

Treatment

The treatment depends on the woman’s discomfort, how much it affects her quality of life, the degree of prolapse and her age.
There is no pharmaceutical treatment since the problem is purely mechanical, so we are oriented towards a conservative solution, such as the placement of vaginal rings.

Vaginal pessaries are rings usually made of silicone, which are placed in the office intravaginally by the gynecologist (no kind of anesthesia is required). In this way, the externalized organs are held in place temporarily.

A more radical and permanent solution is, of course, the surgical restoration of the prolapse and/or the removal of the uterus (hysterectomy).
Another much more specialized and newer technique is the suspension (straightening and support) of the matrix with polypropylene synthetic mesh.
In this way we restore the anatomy by reinforcing the loose pelvic walls with the mesh, thereby improving post-operative recurrence rates. This technique allows us to straighten the uterus or remove it while preserving the cervix.
At the beginning this technique was applied with an open surgery, but now with the development of technology it is almost exclusively performed laparoscopically, by specialized gynecologists, with faster recovery times and better aesthetic results.
It is estimated from studies that the anatomical recovery rate for more than two years after surgery is 90-100%, the satisfaction rate of women is 70-100% while the recurrence rate ranges from 0-12%.
The two most common procedures of this kind are sacrocolpopexy και η pectopexy. These are variations of the same technique where the point of support of the mesh is just different.
It is currently considered the technique of choice for young women presenting with symptomatic uterine prolapse.

In any case, the woman whose daily life is affected by organ prolapse should consult her gynecologist, as there are solutions that can significantly improve her quality of life.