UTERINE PROLAPSE SYMPTOMS:
The symptoms associated with uterine prolapse vary with everyone but most patients will experience one or some of the following:
- Vaginal bulge
- Lower back pain
- Pressure in vagina
- Sense of hitting during sex/intercourse
- Pelvic pressure
- Pain with sex
- Lower abdominal discomfort
- Difficulty maintaining a tampon/falling out
UTERINE PROLAPSE DIAGNOSIS:
Uterine Prolapse should be diagnosed by all gynecologists at the time of exam, however most gynecologists miss the diagnosis as they are rightfully concerned with doing a PAP smear and warding off cancer. When the gynecologist places the speculum he/she is pushing the uterus back into the women’s body and obscuring the diagnosis with the speculum
The easiest way to make the diagnosis is using ½ of the speculum to hold the posterior vaginal wall downward and have the patient bear down to see the uterine cervix descend toward the vaginal opening. When this uterus prolapses so does the vaginal vault. It is almost impossible to have uterine prolapse without a vaginal vault prolapse.
UTERINE PROLAPSE TREATMENT
Overview
Uterine prolapse can be treated with and without surgery. Treatments include: doing nothing, pessary therapy (placing a supportive device inside the vagina), Kegel exercises (to strengthen pelvic floor support muscles), surgery with native tissue and surgery with prosthetic devices (cadaveric tissue, pigskin, cowskin, or synthetic mesh).
Most Common Treatment
The most common treatment of uterine prolapse is a hysterectomy. A hysterectomy alone will not treat the patients underlying problem nor the symptoms associated with prolapse. The uterus is not the main problem in uterine prolapse, instead it is the lack of support of the uterus. If your gynecologist is offering you a hysterectomy and that is all he/she is offering you then you are not being offered the correct surgery. If your gynecologist offers you a hysterectomy and some type of vaginal vault (i.e. apex) support then this is the appropriate surgical plan.
Patients should understand that removing the uterus only, does nothing more than removed the fallen uterus. It does nothing to support the vaginal vault (i.e. apex) or the deepest point of the vagina. If the uterus needs to be removed then the surgeon should also offer a vaginal vault support. If the patient wants to keep her uterus then the final surgical option is a Hysteropexy.
UTERINE SUSPENSION/UTERINE PRESERVATION/HYSTEROPEXY
Hysteropexy-can be broken down into two words: hystero- meaning uterus and -pexy meaning suspension or support. Dr. Miklos & Moore are advocates of preserving the uterus, however they have found the hysteropexy using soft polypropylene synthetic mesh is by far the most successful surgery with minimal complications. A hysteropexy entails attaching mesh on the back of the cervix and uterus and then attaching the mesh to the sacrum specifically to the anterior ligament of the sacrum with a needle and suture. Drs Miklos & Moore have been performing this type of hysteropexy for almost 20 years with a 98% chance of surgical success. It is important to understand that when the uterus falls approximately 98% of patients will also have a cystocele and rectocele and these should be treated concurrently to improve the cure rate for the patient. Patients who want to correct uterine prolapse may elect for a uterine preservation surgery known as hysteropexy or uterine suspension.
BENEFITS OF A LAPAROSCOPIC HYSTEROPEXY VS HYSTERECTOMY
- Less pain
- Less narcotic use
- Less cost $$
- Faster recovery
- Lss ureteral injury
- Less bladder injury
- Less bowel injury
- Less blood loss