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Uterine prolapse

Updated: 2017-08-29T09:11Z

Female genital prolapse
Uterine prolapse.jpg
Uterine prolapse in a 71-year-old woman, with the cervix visible in the vaginal orifice.
Classification and external resources
Patient UKUterine prolapse
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Uterine prolapse is a form of female genital prolapse. It is also called pelvic organ prolapse or prolapse of the uterus (womb).

Risk factors for uterine prolapse include pregnancy, childbirth, chronic increases in intra-abdominal pressure such as lifting, coughing or straining, connective tissue conditions,[1][2] and damage to or weakness of the muscles.[3]

Treatment may be conservative or surgical and should be based upon patient symptoms and preference.

Pathophysiology and causes

The uterus (womb) is normally held in place by a hammock of muscles and ligaments. Prolapse happens when the ligaments supporting the uterus become so weak that the uterus cannot stay in place and slips down from its normal position. These ligaments are the round ligament, uterosacral ligaments, broad ligament and the ovarian ligament. The uterosacral ligaments are by far the most important ligaments in preventing uterine prolapse.

The most common cause of uterine prolapse is trauma during childbirth, in particular multiple or difficult births. About 50% of women who have had children develop some form of pelvic organ prolapse in their lifetime.[4] It is more common as women get older, particularly in those who have gone through menopause. This condition is surgically correctable.


Treatment is conservative, mechanical or surgical. Conservative options include behavioral modification and muscle strengthening exercises such as Kegel exercise.[5] Pessaries are a mechanical treatment as they elevate and support the uterus.[6][7] Surgical options are many[8] and may include a hysterectomy or a uterus-sparing technique such as laparoscopic hysteropexy,[9] sacrohysteropexy[10][11] or the Manchester operation.[12]

In the case of hysterectomy, the procedure can be accompanied by sacrocolpopexy.[13] This is a mesh-augmented procedure in which the apex of the vagina is attached to the sacrum by a piece of medical mesh material.[14]

A Cochrane Collaboration (2016) review found[8] that sacral colpopexy was associated with lower risk of complications than vaginal interventions, but it was unclear what route of sacral colpopexy should be preferred. No clear conclusion could be reached regarding uterine preserving surgery versus vaginal hysterectomy for uterine prolapse. The evidence does not support use of transvaginal mesh compared to native tissue repair for apical vaginal prolapse. The use of a transvaginal mesh is associated with side effects including pain, infection, and organ perforation. According to the FDA, serious complications are "not rare." A number of class action lawsuits have been filed and settled against several manufacturers of TVM devices.

Further reading


  1. ^ Carley, Michael (May 2000). "Urinary incontinence and pelvic organ prolapse in women with Marfan or Ehlers-Danlos syndrome". American Journal of Obstetrics & Gynecology. 182: 1021–1023. doi:10.1067/mob.2000.105410. 
  2. ^ Mastoroudes, H (December 2012). "Prolapse and sexual function in women with benign joint hypermobility syndrome". British Journal of Obstetrics & Gynecology. 120: 187–192. doi:10.1111/1471-0528.12082. 
  3. ^ DeLancey, John (February 2007). "Comparison of Levator Ani Muscle Defects and Function in Women With and Without Pelvic Organ Prolapse". Obstetrics & Gynecology. 109: 295–302. doi:10.1097/ 
  4. ^ "Oxford Gynaecological and Pelvic Floor Centre, Gynaecology in Oxford". Retrieved 2017-04-25. 
  5. ^ Hagen, Suzanne (7 December 2011). "Conservative prevention and management of pelvic organ prolapse in women". The Cochrane Library (12): CD003882. PMID 22161382. doi:10.1002/14651858.CD003882.pub4. 
  6. ^ Bugge, Carol (28 February 2013). "Pessaries (mechanical devices) for pelvic organ prolapse in women". Cochrane Library. doi:10.1002/14651858.CD004010.pub3. 
  7. ^ Cundiff, Geoffrey (April 2007). "The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries". American Journal of Obstetrics & Gynecology. 196: 405.e1–405.e8. doi:10.1016/j.ajog.2007.02.018. 
  8. ^ a b Maher, Christopher; Feiner, Benjamin; Baessler, Kaven; Christmann-Schmid, Corina; Haya, Nir; Brown, Julie (2016-10-01). "Surgery for women with apical vaginal prolapse". The Cochrane Database of Systematic Reviews. 10: CD012376. ISSN 1469-493X. PMID 27696355. doi:10.1002/14651858.CD012376. 
  9. ^ Rahmanou, Philip (January 2013). "Laparoscopic hysteropexy: 1- to 4-year follow-up of women postoperatively". International Urogynecology Journal. 25: 131–138. doi:10.1007/s00192-013-2209-5. 
  10. ^ Price N, Slack A, Jackson S (2010). "Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse". BJOG. 117: 62–68. doi:10.1111/j.1471-0528.2009.02396. 
  11. ^ Rosati, Maurizio (August 2014). "A review on the role of laparoscopic sacrocervicopexy". Current Opinions in Obstetrics & Gynecology. 26: 281–289. doi:10.1097/GCO.0000000000000079. 
  12. ^ Surgical correction of uterine prolapse: cervical amputation with uterosacral ligament plication versus vaginal hysterectomy with high uterosacral ligament plication By de Boer T, Milani F, Kluivers K, Withagen M, Vierhout M. Part of ICS 2009 Scientific Programme, Thursday 1 October 2009
  13. ^ Nygaard, Ingrid (May 2013). "Long-term Outcomes Following Abdominal Sacrocolpopexy for Pelvic Organ Prolapse". JAMA. 309: 2016. doi:10.1001/jama.2013.4919. 
  14. ^ NICE interventional procedure guidance IPG284: Sacrocolpopexy with hysterectomy using mesh for uterine prolapse repair by the National Institute for Health and Care Excellence, Issued: January 2009

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