Uterine Prolapse

Prolapse of the uterus itself can occur along with or even without the presence of vaginal prolapse although the two are often seen together in some combination. The standard for surgical management of uterine prolapse has previously been hysterectomy. Today, uterine preservation is generally utilized unless there is some compounding reason present to remove the uterus. The minimally invasive procedures which I will describe for vaginal prolapse apply equally well for most uterine prolapse cases. However, occasionally, uterine prolapse when most severe can necessitate major abdominal surgery. This is called an abdomino-sacro-colpopexy. Although it sounds complicated, the procedure is performed through and abdominal incision similar to the cesarean section incision and suspends either the vaginal apex if the uterus is already gone or the lower aspect of the uterus to the bony sacrum with a graft using the same polypropylene fabric used for the incontinence and vaginal prolapse procedures. This is the same fabric general surgeons have been using for years to repair hernias in other areas of the body. This procedure requires a short stay in the hospital and a longer post-operative recovery similar to any other major abdominal surgical procedure. Patients are generally back to their normal activities within six weeks.

Vaginal prolapse after hysterectomy occurs when the tissue in the vagina prolpases without a uterus present. Often, a cystocele, and or rectocele may be present with vaginal prolapse but if the top of the vagina descends alone, it is called an enterocele. The bowel lies just above the uterus (and vagina when the uterus is gone) and can push the top of the vagina downward over time. Having bowel prolapsing into the vagina can be a cause of constipation, pressure, low back pain, and the bulging previously described. The most advanced cases or recurrences after all other minimally invasive procedures have failed will respond to the abdominosacrocolpopexy described above.