Uterine and Vaginal Prolapse

Uterine and vaginal prolapse means that the womb, the vaginal walls, or both have dropped from their normal position because the pelvic floor muscles and ligaments no longer hold them up. The bladder or bowel may bulge into the vagina at the same time (cystocele and rectocele).

Prolapse is common after childbirth and menopause and is not dangerous in itself. Treatment is guided by how much it bothers you, not by how it looks on examination, and many women manage well without surgery.

Symptome

• A feeling of heaviness or dragging in the pelvis, worse by evening
• A bulge or lump felt or seen at the vaginal opening
• Difficulty emptying the bladder, a slow stream or needing to push the bulge back to pass urine
• Urine leakage on coughing or exercise
• Difficulty emptying the bowel
• Discomfort or reduced sensation during sex
• Rubbing, discharge or spotting when the prolapse protrudes

Ursachen und Risikofaktoren

The supporting tissues are stretched or torn mainly by vaginal childbirth, especially large babies, long second stages and forceps deliveries. Falling oestrogen after menopause thins the tissues further. Anything that raises abdominal pressure for years adds to the load: chronic cough, constipation and straining, heavy lifting and obesity. Previous hysterectomy and inherited connective tissue weakness also increase risk.

Wie es diagnostiziert wird

• Pelvic examination: Performed lying and sometimes standing, while you strain, to see which compartment descends and how far. Severity is graded, commonly with the POP-Q system.
• Bladder assessment: A urine test, a scan of residual urine after voiding, and sometimes urodynamic testing if leakage or poor emptying is part of the picture.
• Pelvic ultrasound: Checks the womb and ovaries before any surgery is planned.
• Pelvic floor MRI or defecography: Reserved for complex or recurrent cases and when bowel symptoms dominate.

Behandlungsmöglichkeiten

• Pelvic floor physiotherapy: Supervised muscle training for at least 3 to 4 months helps mild and moderate prolapse and improves bladder control.
• Vaginal pessary: A silicone ring or other device that holds the prolapse up. It suits women who wish to avoid or delay surgery and needs changing or checking every few months.
• Vaginal oestrogen: Cream or pessaries improve tissue quality and comfort after menopause, often alongside a pessary.
• Vaginal repair surgery: Anterior or posterior repair using your own tissue, sometimes with vaginal hysterectomy or a sacrospinous fixation.
• Sacrocolpopexy or sacrohysteropexy: Laparoscopic or robotic suspension of the vaginal vault or womb to the sacrum with mesh placed through the abdomen. Durable, with specific mesh risks to discuss.
• Colpocleisis: Closure of the vagina for older women who are no longer sexually active. A short operation with a low recurrence rate.

Wenn es dringend ist

Prolapse rarely needs emergency care. Seek urgent local help if you cannot pass urine at all, if a protruding prolapse cannot be pushed back and becomes painful or ulcerated, or if you develop fever with loin pain, which may mean a kidney infection from blocked drainage.

Reisen nach Türkiye zur Behandlung

Prolapse surgery is planned, not urgent, which makes it suitable for travel. Expect 1 to 3 nights in hospital and around 7 to 10 days before flying home, with no heavy lifting for 6 weeks. Recurrence is possible after any repair, so ask who will follow you up at home. Pessary care and physiotherapy need regular local visits and are not a reason to travel.

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