Therapy | Uterine prolapse


The therapy of a uterine prolapse depends on many factors. One important factor is the age of the patient and whether she still wants to have children. In addition, a distinction is made between different degrees of prolapse or prolapse.

A total prolapse naturally requires a different therapy than a slight, symptom-free prolapse of the uterus. At this point another important aspect becomes clear: Does the patient have any complaints/symptoms due to the prolapse? All these points together form the basis for the individual therapy selection.

The first step in the treatment of a uterus prolapse includes pelvic floor training. These are specific exercises that are intended to train and thus strengthen the pelvic floor muscles and ligaments in particular. In mild forms of uterus prolapse, this can already be promising; in severe forms or a uterine prolapse, these exercises should be carried out in parallel with the therapy.

In addition, drugstores offer special cones for pelvic floor training, which the woman can insert into the vagina and try to hold on with the muscles of the pelvic floor alone. This also leads to a strengthening of the respective muscles. Many women are not even aware which muscles they have to tense for pelvic floor exercises.

In this case, a professionally supervised training, e.g. with a physiotherapist, can bring clarity. For affected women who are already in their menopause, hormonal treatment offers another way to reduce symptoms. Special oestrogen-containing creams or suppositories (oestrogen is the female sex hormone), which are inserted vaginally, can also help to treat uterine prolapse.

Vaginal rings that continuously secrete a certain amount of estrogen can also be used. Pessaries are another non-invasive therapy option, which is particularly suitable for older patients. These provide mechanical support for the uterus and thus the pelvic floor.In particularly severe cases of uterine prolapse or uterine prolapse, surgery is usually the method of choice.

It takes about one hour and is performed under general anesthesia. Often the doctor can operate through the vagina so that there is no scar visible from the outside. Sometimes, however, an abdominal incision is necessary, which is usually about 5 cm long and is made across the lower abdomen.

The aim of the operation is to move the lowered or even inverted abdominal organs back to their original place and to fix them there. There are several possibilities for this. The most common is the so-called vaginal plastic surgery (colporrhapy): In case of a bladder and vaginal prolapse the front plastic surgery and in case of a rectal and vaginal prolapse the back plastic surgery.

Here the pelvic floor muscles are gathered and the bladder or rectum is pulled up and sutured. For women who no longer wish to have children, hysterectomy is also a frequently used treatment option. In this operation the entire uterus is removed through the vagina.

What remains is the sutured stump of the vagina, sometimes with the cervix. In order to prevent a recurrence, this is fixed to the pelvic bone with special tissue strips (vaginosacropexy). Another surgical method is TVM (transvaginal mesh method), in which the surgeon implants a mesh between the pelvic floor and the bladder.

This procedure can also be performed vaginally and is therefore also a good variant for the treatment of uterine prolapse from a cosmetic point of view. In some patients, however, the prolapse is also accompanied by urinary incontinence (uncontrolled urine leakage). In this case, a surgical method should be chosen that focuses on the function of the urinary diversion pathways.

No serious complications are known with any of the above-mentioned therapeutic methods. As a rule, patients remain in hospital for about 3-4 days after the operation for in-patient control. When the anterior vaginal wall is gathered, it is removed from the bladder and individual ligaments that are connected to the bladder wall are gathered upwards.

This causes the bladder to stand a little higher after the operation than before. This change can lead to so-called stress incontinence. This is urinary incontinence that is caused by the bladder and urethra being too steep in relation to each other, which means that continence is no longer completely guaranteed.

As with any surgical procedure, there is still the risk that structures in the surgical field can be injured and that the bladder will descend again. The use of a pessary is often recommended for older patients who cannot be operated on due to their general condition. This is a medical device that is inserted by the gynecologist into the vagina in front of the cervix.

Nowadays most pessaries are made of silicone, porcelain or plastic and can be ring-shaped, bow-shaped, cube-shaped or bowl-shaped. With this method of treatment, however, it is important to note that the pessary does not treat the cause of the uterine prolapse at all, but only counteracts a further sagging of the pelvic floor. To prevent intravaginal inflammation or pressure ulcers, the pessary has to be changed and thoroughly cleaned every eight weeks at the latest.

In many cases it has proven to be useful to apply estrogen-containing vaginal creams or suppositories during pessary use. A prerequisite for the use of a pessary, however, is an intact perineal musculature. For somewhat younger patients there are also pessaries available for self-replacement.

These are only worn during the day so that the vaginal environment has the opportunity to regenerate during the night. It is impossible to restore an already sunken pelvic floor or a prolapsed uterus to its original state using only homeopathic remedies. However, the field of homeopathy offers remedies that can positively influence a cause of the prolapse.

For example, if the uterine prolapse is preceded by a weakness of the connective tissue, taking Silicea D3 (four globules each) several times a day should strengthen the connective tissue again. Some affected women also report that homeopathy can relieve their symptoms. Some homeopaths are of the opinion that there are also remedies that work directly against the uterine prolapse. These include Aesculus, Aletris farinosa, Lilium tigrinum and Podophyllum.In any case, however, a doctor should be consulted, who can then decide together with the patient to what extent a homeopathic therapy can be useful for her.