From the Guidelines
Uterine prolapse treatment should prioritize a multidisciplinary approach focusing on improving the patient's quality of life, as the condition primarily causes morbidity but is not life-threatening. The treatment options for uterine prolapse range from conservative approaches to surgical interventions, depending on the severity of symptoms and the patient's health status. For mild cases, pelvic floor muscle exercises (Kegel exercises) performed regularly can strengthen the supporting structures and prevent progression 1.
Key Considerations
- Vaginal pessaries are silicone or plastic devices inserted into the vagina to support the uterus and can be used as a temporary or permanent solution, particularly for women who cannot or do not wish to undergo surgery.
- Weight loss is recommended for overweight patients as excess weight increases abdominal pressure.
- Hormone replacement therapy may help postmenopausal women by improving tissue elasticity.
- For more severe cases, surgical options include vaginal hysterectomy (removal of the uterus through the vagina), which is often combined with repair of weakened pelvic tissues.
Surgical Options
- Sacrocolpopexy involves attaching the vagina to the sacrum using surgical mesh, while sacrospinous fixation attaches the vaginal vault to pelvic ligaments.
- Uterine-preserving procedures like hysteropexy can be performed for women who wish to maintain fertility. The choice of treatment depends on factors including the patient's age, desire for future pregnancies, sexual activity, overall health, and the degree of prolapse, as highlighted in the study on pelvic floor dysfunction in females 1. Addressing contributing factors such as chronic cough, constipation, and heavy lifting is also essential for successful management.
From the Research
Treatment Options for Uterine Prolapse
Uterine prolapse, also known as uterine procidencia, is a condition where the uterus slips out of its normal position into the vagina. The treatment options for uterine prolapse can be categorized into non-surgical and surgical methods.
Non-Surgical Treatment Options
- Pelvic floor muscle training (PFMT): Studies have shown that PFMT can improve symptoms and severity of prolapse 2, 3.
- Lifestyle modifications: Giving lifestyle advice and delivering pelvic floor muscle training are often used in cases of mild to moderate prolapse 2, 3.
- Vaginal pessaries: Pessaries are mechanical devices that can be inserted into the vagina to support the prolapsed uterus 4, 5, 6.
Surgical Treatment Options
- Abdominal surgery with mesh placement: This is a recommended option for cases of apical and anterior prolapse 4.
- Vaginal surgery with autologous tissue: This is a recommended option for elderly and fragile patients 4.
- Laparoscopic sacrocolpopexy: This is a recommended option for cases of apical and anterior prolapse 4.
- Posterior vaginal route with autologous tissue: This is a recommended option for cases of isolated rectocele 4.
Management of Uterine Prolapse During Pregnancy
- Vaginal pessary: A case report showed that a vaginal pessary can be used to successfully manage uterine prolapse during pregnancy 6.
Key Considerations
- The decision to place a mesh must be made in consultation with a multidisciplinary team 4.
- Comprehensive evaluation of bladder and urethral function should be done before any surgical repair is undertaken 5.
- The management and treatment of uterine prolapse should be individualized depending on the patient's preference 6.