Uterine Prolapse

What Is Uterine Prolapse? What Does Pelvic Organ Prolapse Mean?

Organs located within the pelvic cavity, such as the uterus, bladder, and rectum, are supported by the pelvic floor muscles, connective tissues (fasciae), and ligaments. When these supportive structures weaken or tear for various reasons, the organs shift downward from their normal position and press against the vaginal walls or prolapse into the vagina. This is generally referred to as Pelvic Organ Prolapse (POP).

Uterine Prolapse specifically refers to the displacement of the uterus into the vagina. The degree of prolapse can vary:

• Mild Prolapse (Stage 1): The uterus has descended somewhat, but the cervix is still in the upper half of the vagina.
• Moderate Prolapse (Stage 2): The cervix has descended to the vaginal opening (hymenal level).
• Severe Prolapse (Stage 3-4): The cervix or the entire uterus protrudes outside the vaginal opening (total prolapse).

Women with uterine prolapse are often also affected by prolapse of the bladder into the anterior vaginal wall (cystocele) and/or prolapse of the rectum into the posterior vaginal wall (rectocele).

What Causes Uterine Prolapse? Who Is at Risk?

The primary cause of uterine prolapse is the weakening of the pelvic floor support structures. The main risk factors leading to this weakening are as follows:

• Pregnancy and Vaginal Delivery: These are the most important risk factors. In particular, having multiple deliveries, difficult or prolonged labor, delivering a large baby (macrosomia), or the use of forceps or vacuum extraction during delivery can damage the pelvic floor muscles and ligaments.
• Aging and Menopause: As age advances and estrogen levels decline with menopause, the pelvic support tissues may lose elasticity and weaken.
• Conditions That Chronically Increase Intra-Abdominal Pressure:
  
  • Chronic Cough: Persistent coughing due to causes such as asthma, COPD, or smoking.
  • Chronic Constipation: The constant need to strain.
  • Obesity: Excess weight increases intra-abdominal pressure.
  • Heavy Lifting: Jobs or activities that require repeated heavy lifting.
• Genetic Predisposition: In some women, connective tissue structure may be inherently weaker, which increases susceptibility to prolapse. A family history of prolapse can raise the risk.
• Previous Pelvic Surgery: There is a risk of vaginal vault (cuff) prolapse, particularly after hysterectomy (removal of the uterus).
• Smoking: This can increase risk both by causing chronic cough and through its negative effects on connective tissue.

What Are the Symptoms of Uterine Prolapse? When Should You See a Doctor?

The symptoms of uterine prolapse vary depending on the degree of prolapse and any accompanying prolapse of other organs (cystocele, rectocele). Mild prolapse usually causes no symptoms at all. When symptoms do appear, the most common ones are as follows:

• A Sensation of Fullness, Pressure, or Downward Pulling in the Vagina: A feeling that something is about to come out of the vagina, which worsens especially when standing, walking, or straining. Patients sometimes describe it as “feeling like there’s a ball down there.”
• A Mass Protruding from the Vagina: In advanced prolapse, the cervix or the uterus itself protrudes from the vaginal opening and becomes noticeable to the touch or visible to the eye.
• Low Back Pain: A dull low back pain that usually worsens toward the end of the day or after prolonged standing and eases with lying down.
• Pelvic Pain or Discomfort: Pain in the groin area or lower abdomen.
• Urinary Problems (if accompanied by cystocele):
  
  • Urinary incontinence (especially in situations of increased intra-abdominal pressure such as coughing, sneezing, or laughing – stress incontinence).
  • Frequent urge to urinate.
  • Difficulty starting urination or a weak urine stream.
  • A sensation of incomplete bladder emptying.
  • The need to press on the vagina or lower abdomen by hand in order to urinate.
  • Recurrent urinary tract infections.
• Bowel Movement Problems (if accompanied by rectocele):
  
  • Constipation.
  • Straining during bowel movements or a sensation of incomplete emptying.
  • The need to press by hand on the posterior vaginal wall or around the anus to facilitate bowel movements.
• Problems During Sexual Intercourse:
  
  • Painful intercourse (dyspareunia).
  • A sensation of looseness or widening in the vagina.
  • Feeling the prolapsed tissue during intercourse or having it act as an obstacle.
  • Decreased sexual desire.

If you are experiencing any of these symptoms, it is important to consult a gynecology and obstetrics specialist before they are allowed to diminish your quality of life.

How Is Uterine Prolapse Diagnosed? The Evaluation Process in Ankara

Uterine prolapse is usually diagnosed with a simple gynecological examination. The evaluation performed by Prof. Dr. Nuray Bozkurt in Ankara includes the following:

• Detailed Medical History: The patient’s complaints, when they began, their severity, how they affect quality of life, obstetric history (number of deliveries, mode, difficulties), previous surgeries, chronic illnesses, smoking, and risk factors such as constipation or coughing are all questioned in detail. Questions are also asked about urinary and bowel habits and sexual life.
• Gynecological Examination: This is the most critical step for diagnosis. The doctor carefully examines the patient on the gynecological examination table, both in the normal supine position and while straining or coughing. Using a vaginal speculum, she determines how far the cervix has descended, identifies any prolapse of the vaginal walls (cystocele, rectocele), and establishes the degree (staging) of the prolapse. She may also assess the strength of the pelvic floor muscles.
• Additional Tests (When Necessary):
  
  • Urinalysis and Culture: May be ordered to rule out a urinary tract infection.
  • Urodynamic Testing: May be performed, particularly in patients with pronounced urinary complaints such as incontinence or difficulty voiding, to evaluate bladder function in detail and assist in surgical treatment planning.
  • Pelvic Floor Ultrasound or MRI: Rarely required, to visualize the degree of prolapse or other accompanying pathologies in more detail, or for preoperative planning.

Uterine Prolapse Treatment Options: Current Approaches in Ankara

Treatment for uterine prolapse is determined on a personalized basis according to the degree of prolapse, the patient’s age, general health status, sexual activity, desire for future children, and, most importantly, the severity of the patient’s complaints and their impact on quality of life. Treatment options span a wide range, from conservative (non-surgical) methods to surgical techniques. In Ankara, Prof. Dr. Nuray Bozkurt will work together with you to determine the treatment option best suited to you.

1. Conservative (Non-Surgical) Treatment Methods: These methods are generally suitable for patients with mild to moderate prolapse, mild symptoms, or those who are unsuitable for or unwilling to undergo surgery:

• Follow-up and Observation: In patients with no symptoms or very mild symptoms, regular follow-up to monitor for progression may be sufficient.
• Pelvic Floor Exercises (Kegel Exercises): Regularly training the pelvic floor muscles can strengthen them, slowing the progression of mild prolapse and reducing symptoms (especially mild urinary incontinence). However, it does not correct advanced prolapse. It is important that the exercises are learned correctly and performed regularly (help can be sought from a physiotherapist).
• Lifestyle Changes:
  
  • Weight Loss: In overweight patients, losing weight can reduce intra-abdominal pressure and ease prolapse symptoms.
  • Treating Constipation and Chronic Cough: Treating the underlying causes can reduce straining and prevent the progression of prolapse. A high-fiber diet, adequate fluid intake, laxative use if necessary, quitting smoking, and treating the cause of coughing are all important.
  • Avoiding Heavy Lifting: Reduces the load placed on the pelvic floor.
• Pessary Use (Vaginal Ring):
  
  • These are devices made of silicone or plastic, in various shapes and sizes (usually ring-shaped), that are placed inside the vagina. They mechanically support the uterus and other prolapsed organs, holding them in place and relieving prolapse-related symptoms.
  • This is a good option for patients who do not want surgery or are not suitable candidates for it (advanced age, serious comorbidities). It can also be used as a temporary solution while awaiting surgery, or until after pregnancy in patients who are planning to conceive.
  • The correct type and size of pessary must be selected by the doctor, and the patient must be taught how to use it. The pessary needs to be removed and cleaned at regular intervals (generally every 2-3 months, or more often for self-manageable models), and the vaginal tissue should be checked. Possible side effects include vaginal discharge, odor, infection, or pressure-related sores (ulceration).
• Local Estrogen Therapy: Particularly in postmenopausal women, low-dose estrogen creams, tablets, or rings applied to the vagina can improve the quality of vaginal tissue, helping to reduce atrophy-related complaints such as dryness and burning, and sometimes mild prolapse symptoms. It does not treat prolapse on its own.

2. Surgical Treatment: Surgery is recommended when conservative methods prove insufficient, the prolapse is advanced (stage 3-4), it seriously impairs the patient’s quality of life, or the patient requests a surgical solution. The primary goal of surgery is to return the prolapsed organs to their normal anatomical position and repair the weakened support tissues. The surgical technique used is determined according to the type and degree of prolapse, whether the patient wishes to preserve her uterus, her age, and her sexual activity.

• Uterus-Preserving Surgical Techniques (Uterine Suspension): These are preferred especially in younger women who wish to preserve their uterus or may want children in the future. The uterus is left in place and suspended to sturdier anatomical structures (the sacrum, sacrospinous ligament, uterosacral ligaments) using special sutures or synthetic mesh patches. These operations can be performed vaginally, laparoscopically (closed), or abdominally (open). Laparoscopic or robotic sacrohysteropexy is one of the current and effective uterus-preserving methods.
• Hysterectomy (Removal of the Uterus) with Pelvic Reconstruction (Repair): This method is frequently used in patients who do not wish to have children, or in whom uterine preservation is not necessary, especially those with advanced prolapse. The uterus is usually removed vaginally (vaginal hysterectomy). Because there is no abdominal incision, this method allows for rapid recovery. After the uterus is removed, supportive sutures (sacrospinous fixation or uterosacral ligament suspension) are placed to prevent recurrent prolapse of the vaginal cuff. In the same session, if present, anterior vaginal wall repair (anterior colporrhaphy) is performed for bladder prolapse (cystocele) and posterior vaginal wall repair (posterior colporrhaphy) for rectal prolapse (rectocele). Depending on the case, hysterectomy and repair procedures can also be performed laparoscopically or through an open approach.
• Vaginal Closure Surgery (Colpocleisis): This is a procedure, rarely chosen for patients who are not sexually active, are very elderly, and whose general health status is unsuitable for major surgery, in which the anterior and posterior vaginal walls are sutured together and closed. It effectively corrects prolapse but makes sexual intercourse impossible.

In Ankara, Prof. Dr. Nuray Bozkurt determines the surgical technique (vaginal, laparoscopic, or open) most suitable for the patient’s condition and performs the operation accordingly.

Recovery After Uterine Prolapse Surgery and Points to Consider

The postoperative recovery process varies depending on the type and extent of the surgery performed:

• Hospital Stay: A hospital stay of usually 1-2 days is required after vaginal or laparoscopic surgery, and 2-4 days after open surgery.
• Pain: Postoperative pain is usually controlled with painkillers. Pain is less with vaginal and laparoscopic methods.
• Activity: It is important to get up and walk early on. However, heavy lifting, straining, strenuous exercise, and sexual intercourse should be avoided for a certain period (usually 4-8 weeks).
• Diet and Bowel Care: Preventing constipation is very important during the postoperative period. It is necessary to eat high-fiber foods, drink plenty of fluids, and, if needed, use stool softeners recommended by the doctor.
• Hygiene: Paying attention to wound care (if any) and personal hygiene reduces the risk of infection.
• Long-Term Success: To maintain the success of the surgery, measures such as weight control, prevention of chronic cough and constipation, and continuing pelvic floor exercises are important. It should be remembered that, despite even the best surgery, prolapse can recur over time.

Uterine Prolapse Treatment in Ankara: Prof. Dr. Nuray Bozkurt’s Comprehensive Approach

Prof. Dr. Nuray Bozkurt offers her patients in Ankara an experienced and holistic approach to pelvic floor health and uterine prolapse:

• Accurate Diagnosis and Staging: Through a detailed history and careful gynecological examination, she accurately determines the type and degree of prolapse and evaluates other accompanying issues (urinary incontinence, bowel problems).
• Personalized Treatment Plan: Taking into account the patient’s age, general health status, complaints, expectations, and lifestyle, she evaluates all conservative and surgical treatment options together with the patient and develops the most suitable plan.
• Conservative Treatment Options: She provides education on Kegel exercises and performs pessary fitting and follow-up for suitable patients.
• Modern Surgical Techniques: When surgery is needed, she determines the method best suited to the patient’s condition (uterus-preserving surgery or hysterectomy; vaginal, laparoscopic, or open surgery) and safely performs the operation at modern, well-equipped hospitals in Ankara. She particularly favors minimally invasive methods (vaginal surgery, laparoscopy) to promote the patient’s comfort and rapid recovery.
• Postoperative Follow-up and Support: She closely monitors the postoperative recovery process, provides necessary recommendations, and supports her patients.
• Empathetic Approach: Aware of the impact uterine prolapse has on women’s quality of life and self-confidence, she treats her patients with understanding and support. She answers all questions and addresses any concerns. Being accessible is important (0538 983 18 78)(0312 284 00 12).

If you are experiencing uterine prolapse or similar pelvic floor problems, you should know that this is not something you have to live with, and that effective treatment methods are available. To regain your quality of life, you can learn about diagnosis and treatment options tailored to you by consulting Prof. Dr. Nuray Bozkurt at our clinic in Ankara. To make an appointment, you can reach us at 0538 983 18 78.