Uterine prolapse

Alternative names:

pelvic floor hernia; pudendal hernia

Treatment:

A vaginal pessary (a doughnut-shaped object inserted into the vagina to hold the uterus in place) may be used as a temporary measure or if surgery is contraindicated (that is, if there are factors that prohibit surgery). Vaginal pessaries are effective for many women with uterine prolapse, however, depending on the extent of the prolapse and vaginal wall relaxation, pessaries may be of little or no use. In addition to the limits of their use in treatment there are other drawbacks. Pessaries tend to cause an irritating and abnormal smelling discharge, and they require periodic cleaning, usually done by the physician. In some women they rub on and irritate the vaginal mucosa, and in some cases may erode and cause ulcerations. In addition, they may interfere with normal sexual intercourse by limiting the depth of penetration.

If the woman is obese, attaining and maintaining optimal weight is recommended. Heavy lifting or straining should be avoided.

Surgery should be deferred until symptoms are significant enough to outweigh the risks. The surgical approach depends on:

• the woman's age and general health
• desire for future pregnancies
• preservation of vaginal function
• degree of prolapse
• associated conditions

When indicated, a vaginal hysterectomy is performed. Any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time.

Expectations (prognosis):

With proper precautions (periodic check-ups, regular douching, and periodic cleaning) vaginal pessaries can be effective for many women with uterine prolapse. Surgery, if done, usually provides excellent and permanent support.

Complications:

Urinary tract infections may occur repeatedly due to the frequently associated cystocele. Constipation and hemorrhoids may also occur as a result of the associated rectocele. Ulceration and infection may occur.

Calling your health care provider:

Call for an appointment with your health care provider if symptoms of uterine prolapse occur.

Also, if you are a woman who has not had regular pelvic examinations, call to schedule an examination.

Picture:
P0523.pctReproductive anatomy - female