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Uterine prolapse: impact of the condition and practical advice

13 October 2022
Professional
02 October 2022
Volume 31 · Issue 18

Abstract

Pelvic-organ prolapse is where organs such as the uterus move out of place; in some cases, they can protrude out of the body. It occurs when muscles extending from the pubic bone to the coccyx or the levator ani muscles become weak or are injured. Although it is not life-threatening, the condition can be life limiting, adversely affecting physiological processes, function and quality of life, with patients reporting years of pain, discomfort, humiliation and embarrassment. Uterine prolapse is often under-reported as women may feel resigned to a condition that is viewed as part of getting old or the menopause, or a consequence of childbirth; they may also feel embarrassed. Gynaecology has the fastest growing waiting lists of any NHS specialty, and women may wait a long time for treatment. This article focuses on uterine prolapse, management of symptoms from conservative self-help to surgical options, and includes a case study of a successful laparoscopic hysteropexy with bifurcated polypropylene mesh apical support procedure carried out by a skilled surgeon.

Prolapse of the pelvic organs occurs when the hammock-like pelvic floor muscles extending from the pubic bone to the coccyx or the levator ani muscles that hold the pelvic floor closed become weak or injured and fail to support one or more of the pelvic organs, namely the bladder, uterus or rectum, causing them to protrude outside the body in advanced cases (see Figure 1 showing a normal uterus and Figure 2 showing a prolapse, stage 3, as described in the case study).

Although not life-threatening, pelvic-organ prolapse can be life limiting and adversely affect physiological processes, function and quality of life, with those affected reporting years of pain, discomfort, humiliation and embarrassment (Ramage et al, 2022).

Under-reporting of uterine prolapse may be attributed to women feeling resigned to a condition that is often dismissed as part of getting old, the menopause or a consequence of childbirth. Additionally, anecdotal evidence indicates that reluctance to seek help may arise from embarrassment because of stigma or a fear of becoming the object of ill-considered jokes.

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Pelvic floor
Uterine prolapse
Laparoscopic hysteropexy
Gynaecology waiting lists