What are the symptoms (s/s) of uterine prolapse?

From the Guidelines

The signs and symptoms of uterine prolapse include a sensation of heaviness or pulling in the pelvis, tissue protruding from the vagina, and pelvic pressure or bulge, as noted in patients with pelvic organ prolapse 20. The presentation of uterine prolapse can vary, but common symptoms include:

• A bulge or protrusion at the vaginal opening
• Urinary problems such as leakage or retention
• Difficulty with bowel movements
• Discomfort during sexual intercourse
• Lower back pain that eases when lying down These symptoms often worsen with prolonged standing, coughing, or physical exertion and may improve when lying down, as the effect of gravity is reduced 1. The severity of symptoms typically correlates with the degree of prolapse, ranging from mild to severe, where the uterus protrudes outside the vaginal opening. Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, no longer providing adequate support for the uterus, commonly resulting from childbirth, aging, chronic coughing, constipation, obesity, or genetic factors affecting connective tissue strength. Initial evaluation of patients with symptoms of uterine prolapse is clinical and begins with the physical examination, with imaging obtained when clinical evaluation is difficult or considered inadequate by the physician, or if patients present with persistent or recurrent prolapse symptoms after attempted surgical or nonsurgical treatments 1.

From the Research

Symptoms and Signs of Uterine Prolapse

• The symptoms and signs of uterine prolapse are not explicitly mentioned in the provided studies, however, the management and treatment options are discussed in detail 2, 3.

Management and Treatment Options

• Conservative management options include:
  • Pelvic floor muscle training, which is more beneficial than self-taught Kegel exercises 2.
  • Use of vaginal pessaries, which should be managed with regular follow-up care to minimize complications 2.
• Surgical treatment options include:
  • Abdominal and vaginal approaches, with sacrocolpopexy having better long-term success for treatment of apical prolapse than vaginal techniques 2.
  • Minimally invasive sacrocolpopexy, which appears to be as effective as the gold standard abdominal sacrocolpopexy (ASC) 2.
  • Robotic assisted sacrocolpopexy (RASC) and laparoscopic assisted sacrocolpopexy (LASC), which are equally effective and should be utilized by pelvic floor surgeons based on their skill level and expertise in laparoscopy 2.

Important Considerations

• Comprehensive evaluation of bladder and urethral function should be done before any surgical repair is undertaken 3.
• Reconstructive surgery provides definitive therapy if all anatomic defects are addressed and the necessary lifestyle changes are instituted 3.