Uterıne Prolapse Treatment
Uterine prolapse is a condition in which the uterus descends toward the vaginal canal as a result of weakening of the pelvic floor muscles, connective tissues, and supporting structures that hold the uterus in place. In medicine, it is also called uterine prolapse. In mild cases, there may only be a feeling of fullness and pressure in the vagina, while in advanced cases, the uterus may become clearly visible protruding from the vaginal opening [1].
Uterine prolapse treatment is not a one-size-fits-all approach. The treatment plan is prepared individually according to the degree of prolapse, the patient’s complaints, age, menopausal status, sexual life, whether she wants pregnancy in the future, and whether there is an accompanying bladder or bowel prolapse [2].
“ The aim in uterine prolapse treatment is not only to correct the prolapsed tissue, but also to evaluate pelvic floor support, urinary-bowel functions, and quality of life together. ”
What Is Uterine Prolapse?
Uterine prolapse is the downward displacement of the uterus from its normal anatomical position. Pelvic floor tissues support the uterus, bladder, and intestines. When these supporting tissues weaken, the uterus may descend into the vagina. In some patients, uterine prolapse may be accompanied by cystocele, meaning bladder prolapse, or rectocele, meaning bowel prolapse.
Mayo Clinic states that uterine prolapse develops as a result of weakening of the pelvic floor muscles and connective tissues; symptoms may include a feeling of heaviness in the vagina, tissue protrusion, urinary problems, difficulty with bowel movements, and a feeling of looseness during sexual intercourse [1].
What Causes Uterine Prolapse?
The main cause of uterine prolapse is weakening of pelvic floor support. This weakening is often not due to a single cause; childbirth, aging, menopause, chronic straining, excess weight, and connective tissue characteristics may all contribute together.
The main factors that may lead to uterine prolapse include:
- Having had one or more vaginal births,
- A history of difficult delivery, delivery of a large baby, or assisted delivery,
- Aging and weakening of pelvic support tissues,
- Reduced tissue elasticity due to decreased estrogen after menopause,
- Excess weight and increased intra-abdominal pressure,
- Chronic constipation and constant straining,
- Chronic cough or long-term cough related to smoking,
- Heavy lifting or physically demanding work,
- Previous pelvic surgeries,
- Genetic predisposition to connective tissue weakness.
Johns Hopkins Medicine states that weight control, a fiber-rich diet, quitting smoking, and pelvic floor exercises may help reduce the risk of uterine prolapse [3].
What Are the Symptoms of Uterine Prolapse?
Symptoms of uterine prolapse may vary depending on the degree of prolapse and accompanying pelvic organ prolapses. Mild cases may cause no symptoms. In moderate and advanced prolapse, complaints such as vaginal fullness, pressure, a pulling-down sensation, and a palpable mass may occur.
Symptoms of uterine prolapse include:
- A feeling of fullness, pressure, or heaviness in the vagina,
- A downward pulling or prolapse sensation,
- Palpable tissue or a mass at the vaginal opening,
- Pelvic discomfort that increases after standing for a long time,
- A feeling of pressure that decreases when lying down,
- Frequent urination or a feeling of not emptying the bladder completely,
- Urinary incontinence during coughing, laughing, or straining,
- Constipation, difficulty during bowel movements, or bowel pressure,
- Discomfort, pain, or pressure during sexual intercourse,
- Difficulty using tampons.
NHS states that pelvic organ prolapse may cause symptoms such as a feeling of heaviness in the vagina, a bulge coming out of the vagina, urinary problems, and discomfort during sexual intercourse [4].
How Are the Degrees of Uterine Prolapse Evaluated?
When evaluating uterine prolapse, it is examined how far the uterus has descended into or outside the vagina. In mild prolapse, although the uterus has moved downward, it is not visible from the outside. In advanced cases, tissue may be noticed at the vaginal opening or outside.
- Mild Uterine Prolapse: The uterus has descended but has not reached the vaginal opening. There may be no symptoms or only a mild feeling of pressure.
- Moderate Uterine Prolapse: The uterus descends to lower levels inside the vagina. Fullness, pressure, and urinary complaints may occur.
- Advanced Uterine Prolapse: The uterus becomes clearly visible toward the vaginal opening or outside. Daily life, sexual life, and urinary-bowel functions may be affected.
Grading should not be evaluated only according to appearance; it should also be assessed together with the patient’s complaints, urinary and bowel functions, sexual life, and other accompanying prolapses.
How Is Uterine Prolapse Diagnosed?
The diagnosis of uterine prolapse is usually made through a detailed patient history and gynecological examination. During the examination, the position of the uterus, the support of the vaginal walls, and whether bladder or bowel prolapse is present are evaluated. The patient may be asked to cough or strain so that the degree of prolapse can be observed more clearly.
If there are accompanying complaints such as urinary incontinence, inability to empty the bladder completely, constipation, or pain during sexual intercourse, additional examinations may be required. These tests may include urinalysis, urine culture, ultrasound, post-void residual urine measurement, or urodynamics.
How Is Uterine Prolapse Treatment Planned?
Uterine prolapse treatment is planned according to the degree of prolapse and its impact on the patient’s quality of life. In mild and asymptomatic cases, follow-up may be sufficient. When symptoms increase, pelvic floor exercises, lifestyle changes, vaginal pessary, or surgical treatment options are evaluated.
ACOG states that treatment options for pelvic organ prolapse may include observation, pelvic floor exercises, pessary, and surgery; surgery is generally considered when symptoms are significant [5].
The following questions are considered in the treatment plan:
- Is the prolapse mild, moderate, or advanced?
- How much is the patient affected in daily life?
- Is there urinary incontinence or difficulty urinating?
- Is constipation or a bowel emptying problem present?
- Is the patient sexually active?
- Is there a future pregnancy plan?
- Is the general health condition suitable for surgery?
- Is preservation of the uterus desired?
“ Treatment selection in uterine prolapse should not be based only on the degree of prolapse; it should be made according to the patient’s complaints, lifestyle, sexual life, and pregnancy plan. ”
Non-Surgical Uterine Prolapse Treatment Options
Non-surgical methods have an important place in uterine prolapse treatment, especially in patients with mild and moderate complaints. These methods may not completely eliminate the prolapse; however, they may reduce symptoms, slow progression, and improve quality of life.
Methods used in non-surgical uterine prolapse treatment include:
- Pelvic Floor Exercises: Kegel exercises and pelvic floor physiotherapy may help strengthen supporting tissues.
- Weight Control: Since excess weight increases pressure on the pelvic floor, weight management is important.
- Prevention of Constipation: A fiber-rich diet, adequate fluid intake, and reducing straining may decrease pressure on the prolapse.
- Treatment of Chronic Cough: Persistent coughing may worsen prolapse by increasing intra-abdominal pressure.
- Avoiding Heavy Lifting: This is important to reduce the load on the pelvic floor.
- Vaginal Estrogen: It may be considered in suitable postmenopausal patients to support vaginal tissue.
- Vaginal Pessary: Prolapse may be mechanically supported with a support device placed inside the vagina.
NHS states that pelvic floor physiotherapy, hormone therapy, vaginal pessary, and surgical options in severe cases may be used in pelvic organ prolapse treatment [4].
Uterine Prolapse Treatment with a Vaginal Pessary
A vaginal pessary is a medical device made of silicone or similar material, placed inside the vagina to support prolapsed pelvic organs. It may be considered in patients who do not want surgery, are not suitable for surgery, are elderly, are planning pregnancy, or want to postpone surgery.
NHS Inform states that a vaginal pessary supports the vaginal walls and pushes the prolapse back; it may come in different shapes and sizes and may not be suitable for everyone [6].
Things to consider when using a pessary:
- The appropriate size should be determined by a physician.
- Comfort and fit should be checked after the first placement.
- Regular follow-up and cleaning should be performed.
- A physician should be consulted if discharge, bad odor, bleeding, pain, or irritation occurs.
- Local treatments may be needed if there is tissue sensitivity after menopause.
When Is Uterine Prolapse Surgery Necessary?
Not every uterine prolapse requires surgery. However, if the prolapse is advanced, if tissue protrudes outside the vagina, if urinary or bowel functions are affected, if there is significant discomfort in sexual life, or if sufficient benefit cannot be obtained from non-surgical methods, surgical treatment may be considered.
Uterine prolapse surgery may be evaluated in the following situations:
- Marked tissue prolapse at or outside the vaginal opening,
- Pelvic pressure and heaviness that disrupt daily life,
- Difficulty urinating or inability to empty the bladder completely,
- Pelvic organ prolapse accompanied by urinary incontinence,
- Constipation and difficulty with bowel movements,
- Pain or significant discomfort during sexual intercourse,
- Inability to use a vaginal pessary or lack of benefit from a pessary,
- Prolapse causing recurrent irritation, wounds, or infection.
Surgical Options in Uterine Prolapse Treatment
Uterine prolapse surgery does not consist of a single method. The surgical plan is prepared according to the degree of prolapse, the patient’s age, expectations regarding sexual life, desire for pregnancy, whether the uterus will be preserved, and accompanying conditions such as cystocele or rectocele.
Surgical options may include:
- Uterus-Preserving Prolapse Repairs: In patients for whom preserving the uterus is appropriate, the aim is to strengthen supporting tissues.
- Repair Together with Hysterectomy: In suitable patients, removal of the uterus and repair of vaginal supporting tissues may be planned.
- Vaginal Repair Surgeries: Correction of prolapse through the vaginal route and strengthening of supporting tissues.
- Laparoscopic or Minimally Invasive Repairs: In selected patients, support surgeries may be performed through small abdominal incisions.
- Repair of Accompanying Cystocele or Rectocele: If bladder or bowel prolapse is present, repair in the same session may be considered.
Mayo Clinic states that vaginal or laparoscopic minimally invasive surgery may be an option in uterine prolapse surgery; in some cases, weakened pelvic floor tissues are repaired [7].
Which Uterine Prolapse Treatment Is Suitable for Which Patient?
| Patient Profile | Prominent Approach | Explanation |
|---|---|---|
| Patient with mild prolapse and few complaints | Follow-up + pelvic floor exercises | If symptoms are mild, regular follow-up, lifestyle regulation, and exercise may be the first step. |
| Patient with moderate prolapse who does not want surgery | Vaginal pessary | It is a supportive option for people who do not want surgery or are not suitable for surgery. |
| Patient with postmenopausal tissue sensitivity | Supportive treatments + local approach | After examination, treatments that support vaginal tissue quality may be planned in suitable patients. |
| Patient with advanced prolapse whose daily life is affected | Surgical evaluation | If there is significant pressure, tissue protrusion, and functional loss, surgery may be a stronger option. |
| Patient planning pregnancy in the future | Uterus-preserving planning | Treatment selection should be specially arranged according to the fertility plan. |
Recovery Process After Uterine Prolapse Treatment
The recovery process varies according to the treatment applied. Regular practice is required to see results from pelvic floor exercises. With pessary use, some patients may feel relief in a short time; however, regular follow-up is essential. Recovery after surgical treatment varies according to the scope of the procedure performed.
Things to pay attention to after surgery include:
- Not lifting heavy objects for the period recommended by the physician,
- Avoiding constipation and straining,
- Waiting for the recovery period recommended by the physician before sexual intercourse,
- Avoiding environments that may pose a risk of infection, such as pools, Turkish baths, jacuzzis, and bathing in a bathtub,
- Not missing follow-up appointments,
- Continuing pelvic floor exercises with the physician’s approval,
- Consulting a physician in cases of fever, foul-smelling discharge, heavy bleeding, severe pain, or inability to urinate.
Does Uterine Prolapse Recur?
After uterine prolapse treatment, long-term relief may be achieved in some patients; however, prolapse may recur over time. The risk of recurrence does not depend only on the treatment applied. Connective tissue structure, age, menopausal status, excess weight, chronic constipation, chronic cough, heavy lifting, and accompanying pelvic floor problems also affect the risk of recurrence.
To reduce the risk of recurrence, regular follow-up, pelvic floor exercises, weight management, prevention of constipation, avoiding heavy lifting, and treatment of chronic cough are important.
The Importance of Early Consultation in Uterine Prolapse Treatment
Many women may consider symptoms of uterine prolapse normal for a long time and postpone seeing a doctor. However, evaluation at an early stage may increase the chance of benefiting from non-surgical methods, and a treatment plan can be created before complaints impair quality of life further.
If there is vaginal fullness, a downward pulling sensation, palpable tissue, difficulty urinating, a feeling of constipation, or pelvic pressure affecting daily life, a gynecological examination should not be delayed.
Does Uterine Prolapse Affect Sexual Life?
Uterine prolapse may cause pressure, pain, discomfort, loss of self-confidence, or avoidance behavior during sexual intercourse in some patients. The degree of prolapse, the condition of vaginal tissues, and factors such as accompanying dryness or urinary incontinence may affect sexual life.
When an appropriate treatment plan is prepared, vaginal pressure sensation and discomfort may decrease. However, expectations related to sexual life should be discussed openly before treatment; because when surgical planning is made, vaginal length, tissue support, and comfort should also be taken into account.
Uterine Prolapse Treatment Prices 2026
Uterine prolapse treatment prices may vary depending on the degree of prolapse, whether the treatment is planned as exercise, pessary, or surgery, whether the surgery is performed vaginally, laparoscopically, or in combination, the type of anesthesia, hospital conditions, and whether accompanying cystocele, rectocele, or urinary incontinence treatment is required.
The most accurate information about current uterine prolapse treatment prices for 2026 can be provided after examination and personal evaluation. This is because each patient’s degree of prolapse, complaints, and treatment needs are different.
Frequently Asked Questions About Uterine Prolapse Treatment
Uterine prolapse generally does not completely improve on its own. In mild cases, symptoms may remain stable or become milder with exercise and lifestyle changes. However, clear anatomical prolapse requires follow-up and a treatment plan.
No. Surgery is not required in every patient. In mild and moderate cases, non-surgical options such as pelvic floor exercises, lifestyle changes, and vaginal pessary may be evaluated [4,6].
In suitable patients, pelvic floor exercises may ease symptoms and improve the function of supporting tissues. However, they may not be sufficient alone in advanced prolapse.
When the appropriate size is selected by a doctor and regular follow-up is performed, it may be a safe and effective option. However, if discharge, irritation, bleeding, or pain occurs, a check-up is required [6].
Yes. Some patients may experience pressure, discomfort, pain, or loss of self-confidence during intercourse. These complaints may decrease with an appropriate treatment plan.
In some patients, uterine prolapse and pelvic floor weakness may occur together with urinary incontinence, frequent urination, or a feeling of not emptying the bladder completely. Therefore, urinary complaints should be evaluated separately.
Yes, prolapse may recur over time in some patients. Factors such as connective tissue structure, weight, constipation, heavy lifting, chronic cough, and age affect the risk of recurrence.
A gynecological examination should be performed if there is vaginal fullness, a downward pulling sensation, palpable tissue, difficulty urinating, a feeling of constipation, or pelvic pressure affecting daily life.
References
- Mayo Clinic. Uterine prolapse - Symptoms and causes. (https://www.mayoclinic.org/diseases-conditions/uterine-prolapse/symptoms-causes/syc-20353458)
- ACOG. Surgery for Pelvic Organ Prolapse. (https://www.acog.org/womens-health/faqs/surgery-for-pelvic-organ-prolapse)
- Johns Hopkins Medicine. Uterine Prolapse. (https://www.hopkinsmedicine.org/health/conditions-and-diseases/uterine-prolapse)
- NHS. Pelvic organ prolapse. (https://www.nhs.uk/conditions/pelvic-organ-prolapse/)
- ACOG. Pelvic Support Problems. (https://www.acog.org/womens-health/faqs/pelvic-support-problems)
- NHS Inform. Pelvic organ prolapse. (https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/pelvic-organ-prolapse/)
- Mayo Clinic. Uterine prolapse - Diagnosis and treatment. (https://www.mayoclinic.org/diseases-conditions/uterine-prolapse/diagnosis-treatment/drc-20353464)