What is uterine prolapse surgery?

Uterine prolapse surgery includes various procedures to repair a prolapsed uterus that has slipped out of place. This condition results from damage to or weakening of muscles, ligaments and tissues that hold a woman’s uterus in place. Uterine prolapse is more common in women who have had children. It can cause protrusion of the uterus into the vagina, pain, urinary incontinence, and other problems. 

Uterine prolapse surgery is a major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having uterine prolapse surgery. 

Types of uterine prolapse surgery

The types of uterine prolapse surgery include:

  • Ligament suspension lifts the uterus using a mesh material or stitches to attach the uterus or vaginal vault (upper part of the vagina) to a strong ligament in the pelvis to support them. This is called a sacrospinous ligament suspension or uterosacral ligament suspension. Sometimes your surgeon lifts the uterus by attaching it to a muscle. This is called an ileococcygeus suspension.
  • Uterine suspension lifts the uterus using a mesh material to attach the uterus to the pelvis. This is called a sacral colpohysteropexy. Another version of the surgery shortens stretched-out ligaments that support the uterus. 

Other procedures that may be performed 

Uterine prolapse often goes hand-in-hand with prolapse of other pelvic organs, such as the bladder or rectum. Your doctor may perform other procedures in addition to uterine prolapse surgery to treat these conditions. 

Procedures can include:

  • Colporrhaphy lifts a prolapsed bladder (cystocele) or rectum (rectocele) by repairing the weakened wall between the vagina and the bladder or rectum. The surgery is performed through the vagina.
  • Hysterectomy helps treat a prolapsed uterus by removing it. 
  • Vaginal vault suspension lifts the upper part of the vagina (vaginal vault) by stitching it to strong ligaments toward the back of pelvis. Another version lifts the vaginal vault by attaching it to a mesh device, which is attached to the pelvis. This is called a sacrocolpopexy. Vaginal vault suspension can help treat a uterus, bladder, or small bowel that has slipped out of place due to a weakness in the vaginal wall.

Why is uterine prolapse surgery performed? 

Your doctor may recommend uterine prolapse surgery to lift a fallen uterus back to its normal position in the pelvis. Doctors generally recommend uterine prolapse surgery when your symptoms are severe enough to interfere with your daily life. 

Symptoms of uterine prolapse include:  

  • A mass or protrusion from the vagina
  • Abnormal vaginal bleeding or discharge
  • Pain with sex
  • Pelvic or back pressure or pain
  • Urinary problems including repeated bladder infections, incontinence, and sudden urges to empty the bladder

Uterine prolapse is associated with the following:

  • Aging and menopause
  • Hysterectomy
  • Long-term coughing
  • Obesity
  • Prolonged labor or having a large baby
  • Repeated childbirth or having a multiple birth, such as twins or triplets
  • Smoking

Who performs uterine prolapse surgery?

The following specialists perform uterine prolapse surgery:

  • Obstetrician-gynecologists specialize in women’s health and pregnancy.
  • Urologists specialize in diseases and conditions of the urinary tract and the male reproductive organs.
  • Female pelvic medicine and reconstructive surgeons are urologists or gynecologists who have completed specialized training in women’s pelvic floor disorders.

How is uterine prolapse surgery performed?

Your uterine prolapse surgery will be performed in a hospital or surgery clinic. The procedure varies depending on the type and severity of your uterine prolapse and other factors. Your doctor will perform uterine prolapse surgery using one of the following approaches:

  • Minimally invasive surgery uses a laparoscope, which is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon will insert a laparoscope and special instruments through small incisions in the lower abdomen to perform the surgery. Your surgeon may also use a surgical robotic system for laparoscopic uterine prolapse surgery. Your surgeon directs a robotic device from a computer to perform many steps of the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.
  • Open prolapse surgery allows your surgeon to directly view and access the inside of your body. Open surgery requires a larger incision and more cutting and displacement of muscle and other Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients. 
  • Vaginal approach involves repairing uterine prolapse through the vagina. Your surgeon inserts a speculum into the vagina to hold it open and repairs damage or weakness in the vaginal wall. This procedure does not require an incision into the abdomen and has a quicker recovery. It is not appropriate for all types of uterine prolapse surgery.