Treatments for a Prolapsed Uterus
If the symptoms are not severe, no treatment may be necessary at all. If the cervix and uterus reach the opening of the vagina, however, treatment may be desired and recommended to alleviate discomfort and avoid further complications.
The most common non-surgical treatment for uterine prolapse is a pessary. This is a support device that is made of rubber or plastic. While pessaries are made in different shapes and sizes, the most common shape is similar to a donut. Other potential shapes include a cube and a round inflatable pessary. The physician chooses the shape that best matches the individual patient’s anatomy and condition. Inserted into the vagina similar to a diaphragm, the pessary holds the uterus in place, preventing it from dropping further into the vaginal canal. Each pessary is customized to fit the individual, and the patient can be taught how to remove it, clean it, and reinsert it. In some instances, the pessary can be removed during sleep. The devices must be changed two to three times per year, however, and they can interfere with sexual intercourse, preventing satisfactory depth of penetration.
Occasionally, a patient must be fitted with a new pessary if the first one does not stay in place during normal daily activities. Sometimes, trial and error is necessary until the right pessary is found. After the initial insertion, the physician asks the woman to walk, sit, stand, stretch, and try different movements to see if the pessary shifts or causes discomfort.
There are some additional issues that can plague pessary users. In some women, they cause irritation and sores and/or a vaginal discharge that can have an unpleasant odor. In severe cases, they have been known to damage vaginal tissues. Acute pelvic inflammatory disease is a rare side effect. This disease is simply a condition in which any of the organs in the pelvic area become inflamed. If left untreated, scar tissue and infection can result. If inflammation occurs as a result of the insertion of a pessary, it would necessitate the removal of the device.
Pessaries often do not work for women who have advanced cases of uterine prolapse, and a pessary may not work forever. In other words, the condition can still continue to worsen such that the pessary is no longer sufficient to hold the uterus in place. If that happens, surgery may eventually become necessary.
An estrogen cream or suppository may be helpful in strengthening the muscles and tissues in the pelvis. The cream replenishes the hormone, which is lost during the process of menopause. The cream is often prescribed for women who have received a pessary in order to provide an additional therapy to prevent further weakening of the tissues.
Synthetic estrogens in any form – even creams and suppositories – have their risks. They increase a woman’s chance of developing endometrial cancer, especially if she is postmenopausal. The risk of ovarian and breast cancer is also increased to some degree, particularly if the estrogen is used long-term.
Bioidentical estrogen creams, which are made from plant sources and are biologically identical to the estrogen in the human body, may be safer, but the verdict is still out. These creams have not been in existence long enough or studied enough to know for certain about their safety. If an estrogen cream is desirable for severe uterine prolapse, a bioidentical version may be a preferred option since the belief is that they will have fewer potential side effects.
Since there are inherent risks with all types of operations, surgical treatment is not generally recommended unless the risks caused by the prolapsed uterus are greater than the risks of the surgical intervention. If a younger woman has experienced uterine prolapse, however, she may opt for surgery in order that she may become pregnant in the future. Other women wish to remain sexually active, and if their prolapse inhibits intercourse, they may opt to have the surgery.
In some cases, a hysterectomy – removal of the uterus – is recommended, but this is avoided if at all possible and prevents a woman from ever becoming pregnant. Other procedures may provide additional support for the uterus, putting it back in its normal position. During these procedures, any sagging of other organs in the pelvic area due to weakening muscles and ligaments may be treated as well. To restore support to what is called the pelvic floor (the foundation for all of the organs in the pelvic area of the body), a graft of the patient’s own tissue, donor tissue, or synthetic material (usually a type of mesh) may be used.
One such procedure is called sacrospinous fixation. The sacrospinous ligament is part of the pelvic floor. In this operation, the ligament is attached to the cervix or the upper portion of the vagina through an incision in the back wall of the vagina in order to secure the higher position of the uterus.
In cases where other organs are sagging within the pelvis, sacrospinous fixation may need to be performed along with a vaginal hysterectomy. So, sacrospinous fixation does not always allow the patient to avoid removal of the uterus. After sacrospinous fixation surgery, most patients require two to three months off from work. While the results of this procedure are generally long-lasting, prolapse can occur again after a period of time. It is estimated that 20% of women must have a second operation in their lifetime for a recurrence of prolapse.
For women who have a vaginal vault prolapse as well, a procedure called abdominal sacrocolpopexy may be an option to avoid hysterectomy. This surgery is more complex and has greater risks than sacrospinous fixation, but it allows the patient to continue to have sexual intercourse without discomfort, pain, or obstruction. It should be noted, however, that not all women with uterine prolapse also develop a prolapse of the vagina.
Generally speaking, surgery that requires an incision in the abdomen presents more risks than surgery that is performed vaginally. Vaginal surgery also does not require as long a recovery time as abdominal surgery because it is less invasive. There is a minimally invasive abdominal surgical procedure called a laparoscopy that is sometimes used to reattach the tissues so that the uterus is repositioned and held in place once again. This involves a very small incision in the abdomen and a laparoscope, which is a tiny camera, to allow the surgeon to do the work without the need for a larger incision.
Operations for advanced cases of uterine prolapse can be quite complex and require a very experienced surgeon who is capable of restoring function while also restoring normal anatomy as much as possible so that a woman can continue to have sexual intercourse. Once the surgeon is able to see the structures during surgery, decisions may have to be made in the moment to create the optimal result. Of course, in extreme cases, the degree of anatomical normalcy that can be restored may be minimal in order to ensure proper function after surgery.
If a woman has surgery for prolapse prior to childbirth, the strain of the birth could cause prolapse to recur. For other women, surgery is not possible because they are at risk of having a reaction to general anesthesia.