Symptomatic uterine prolapse

Specialty: Gynecology and breast.

• Hysterocele
• descent of the uterus
• matrix drop
• sensation of vaginal genital lump

Why it occurs

• Weakness of the pelvic support ligaments (uterosacral and cardinal ligaments) due to obstetric trauma (multiparity)
• Hypoestrogenism of menopause with loss of tissue collagen
• Chronically elevated intra-abdominal pressure (obesity, chronic cough due to COPD, severe constipation, heavy physical work)
• Base connective tissue alterations (Ehlers-Danlos or Marfan syndrome)

Initial workup

Comprehensive gynecological physical examination in standing and supine position using the POP-Q classification (Pelvic Organ Prolapse Quantification system). Pelvic ultrasound to assess uterine volume and rule out endometrial pathology. Urinalysis with urine culture and measurement of post-void residue by bladder ultrasound.

Standard management

• There are no drugs to correct the anatomical defect of prolapse. The use of local topical estrogens (estriol cream) is recommended to improve vaginal epithelial trophism, prevent ulcers, and facilitate the use of vaginal pessaries. Silicone pessaries (ring, Gellhorn or cubic type) are the conservative treatment of choice in patients with surgical contraindications or who wish to avoid surgery (note: pelvic floor physiotherapy is useful as an adjuvant in initial grades I and II).