What is uterine prolapse and vaginal wall bulge]
Uterine prolapse and vaginal wall bulge are two conditions that, because they often exist together, are collectively referred to as pelvic organ prolapse (POP) and sometimes need to be managed together. This group of conditions is grouped with other conditions such as stress urinary incontinence, vaginal laxity, and fecal incontinence in a relatively new specialty, gynecologic urology.
When uterine prolapse occurs, part of the uterus prolapses from its original position and may be accompanied by a partial bulging of the vaginal wall, mainly in the anterior wall, mainly manifested by palpable sagging tissue in the vagina, similar to a ping-pong ball, with a sensation of falling. Some people need to push the prolapsed uterus or vaginal wall back into the vagina to urinate or defecate. Many people have difficulty walking for long periods of time due to the prolapsed uterus or vaginal wall, which affects their quality of life by interfering with activities outside the home. The condition is usually light in the morning and worsens in the afternoon after activity.
According to statistics in the United States, POP is a condition that affects the quality of life of older adults, and roughly 7% of women require surgery to correct prolapse. When incontinence is added, 11% of women have the opportunity for surgery.
Why does uterine prolapse and vaginal wall bulge occur]
Most people have uterine prolapse and vaginal wall bulge due to pregnancy and delivery. During vaginal delivery, the fetus squeezes the pelvic wall, causing damage to the pelvic floor muscles and nerves, resulting in uterine prolapse and vaginal wall bulge. Many people are concerned about whether a cesarean section should be performed routinely instead of a vaginal delivery, but this is only a consideration from the perspective of preventing pelvic floor prolapse, which is after all a surgical procedure that can result in abdominal incision endometriosis, scar pregnancy, and rupture of the scarred uterus, so it is not recommended.
Another factor that contributes to uterine prolapse and vaginal wall bulge is menopause, which occurs after menopause as estrogen levels drop and collagen and muscle fibers atrophy.
A rare factor is congenital defects, which account for about 2% of cases. Patients with some rare connective tissue disorders such as Marfan’s syndrome may be at greater risk of prolapse.
[What conditions are likely to aggravate the disease].
Chronic cough, constipation, and other conditions that increase abdominal pressure can aggravate the disease, and being overweight is also a risk factor. These factors can also increase the risk of recurrence after surgery, and it is recommended that treatment be adhered to before and after surgery.
How to treat]
Patients with mild cases do not need surgical treatment. They can first try pelvic floor exercises to relieve prolapse by contracting the pelvic floor muscles and strengthening them.
A uterine tray is a good choice for patients of advanced age who are at risk of surgery or whose current condition is not suitable for surgery, but the uterine tray cannot treat the prolapse at its root, and long term placement can result in complications such as localization, ulceration, entrapment, or even tissue necrosis to form fistulas, requiring someone to take care of it, regular removal and placement, and regular follow-up visits are needed.
For patients with more than 3 degrees of severe prolapse, surgery can be considered, depending on the patient’s age, fertility requirements, and the presence of recurrence factors.
Younger patients may opt for Mann surgery, while older patients may undergo hysterectomy and vaginal wall repair with ligamentous reinforcement;
In severe or recurrent cases, mesh placement may be considered;
Suspension of the uterine or vaginal stump to the sacral periosteum or suture fixation to the sacrospinous ligament is also a classic procedure;
Vaginal closure can also be considered in the case of advanced age without sexual requirements. In conclusion, there is no unified way of surgery and individualized treatment is needed.
What are the risks of surgery?
The repair of prolapse mainly affects the bladder and rectum. Urinary incontinence and prolapse are similar to sisters and have the potential to co-exist, and some patients may have new onset of incontinence after surgery.
The risks of mesh implantation surgery include: exposure and erosion of the mesh, bleeding, adjacent tissue and organ damage, pain and secondary infection.
[What to pay attention to before and after surgery].
Prior to surgery, if there are factors that aggravate postoperative prolapse, they should be corrected beforehand, such as weight loss, relief of constipation and treatment of chronic cough.
If the patient is menopausal and the vaginal mucosa is thin or ulcers are formed, local estrogen creams can be applied before surgery and should continue to be used for a long time after surgery.
After surgery, forceful movements that increase abdominal pressure should be avoided, sexual intercourse should be forbidden for 3-6 months, and lifting heavy objects weighing more than 1 hot water bottle should be avoided.
Is there a possibility of recurrence?
Yes, the probability of recurrence depends on age and the type of surgery. The probability of recurrence depends on the age and the type of surgery. 25% of patients who undergo repair surgery using their own tissue may have recurrence, while mesh use is relatively rare, with a 5-10% failure rate.
[How to deal with combined incontinence].
If you have urinary incontinence before surgery, corrective surgery for urinary incontinence will be performed at the same time during surgery, and some patients will have new incontinence after surgery.
What if I still want to have a baby?
In mild cases, pelvic floor exercises are an option. Surgery should be postponed until after the completion of childbirth, because another pregnancy and delivery can aggravate the prolapse and make the surgical effect lost. Mann surgery may also be considered if symptoms are severe.