Uterine Prolapse Surgery in Turkey

Uterine prolapse surgery is a corrective surgical intervention that suspends the uterus, which has descended toward the vagina because the supporting ligaments in the pelvic region have lost their strength, back into its original anatomical position using suitable support materials or special suturing techniques. The primary goal of this operation is to restore the body’s disrupted structural balance by returning the pelvic organs that have succumbed to gravity to their previous level. Reconstructive approaches used in the treatment of uterine prolapse focus on directly repairing anatomical herniations caused by connective tissue laxity. These individually planned procedures aim to increase the pelvic floor’s supporting capacity, stop tissue displacement, and restore the woman’s physical comfort and sense of bodily integrity.

What is uterine prolapse?

In the female body, the pelvic floor is a structure made up of muscles, fascia, and connective tissues that spans the bottom of the pelvis like a broad, strong hammock. The main function of this hammock-like system is to hold the bladder, uterus, and final portion of the large intestine together against gravity and changes in intra-abdominal pressure. Uterine prolapse develops when this supporting hammock tears, stretches, or loses its previous strength for various reasons. When the supporting pillars weaken, the pelvic organs begin to descend toward the vaginal canal and, in more advanced cases, may protrude through the vaginal opening.

This process of deterioration is generally not caused by a single factor; it is the combined result of many factors accumulating over the years. Changes in tissue elasticity and physical strain are particularly important contributors.

The main factors that weaken the pelvic floor are:

• Advanced age
• Giving birth to a large baby
• Difficult vaginal deliveries
• Chronic coughing
• Persistent constipation
• Obesity
• Genetic connective tissue weakness

What physical symptoms occur with uterine prolapse?

Weakening of the supporting tissues and downward displacement of the organs cause various physical symptoms that make women’s daily lives more difficult in many ways. The downward pressure exerted by the prolapsed tissues under the influence of gravity generally creates a persistent feeling of heaviness or a foreign body in the lower abdomen and vagina. This sensation is milder in the morning when the body is rested but increases noticeably toward the evening after standing, walking, or physical activity throughout the day. Constant stretching of the ligaments attempting to hold the organs in place can cause lower back pain that does not easily subside even with rest.

Displacement of the organs from their natural positions also adversely affects the coordinated functioning of neighboring systems. Changes in the anatomical angle of the bladder lead to noticeable changes in urination patterns, while displacement of the bowel makes the final stage of digestion more difficult.

The main symptoms that interfere with daily life are:

• A feeling of vaginal fullness
• Pressure in the lower abdomen
• Frequent urination
• Incomplete bladder emptying
• Lower back and groin pain
• Difficulty passing stool

Why do women delay seeking medical attention when they experience symptoms of uterine prolapse?

Although these symptoms substantially reduce quality of life, patients often take years to seek medical help. The proportion of women consulting a doctor when symptoms first begin is quite low. Psychological and sociocultural factors, rather than physical barriers, underlie this delay. Many women tend to view symptoms such as urinary leakage or genital prolapse as an inevitable part of aging and motherhood. The fact that this is a treatable medical problem is often overlooked.

In addition, embarrassment about discussing genital symptoms, fear of surgery, and unfounded stories about risks heard from others can make patients feel compelled to live with the problem. However, prolapse that initially involves only one area and is relatively mild can develop over the years into a complex condition involving much more pronounced prolapse of the bladder, uterus, and bowel if not addressed promptly. Measures taken early can reduce the need for more extensive treatments.

How do the stages of uterine prolapse influence the decision for surgical treatment?

An internationally accepted, standardized anatomical measurement system is used to determine the severity and anatomical extent of prolapse. In this system, the distance between the prolapsed tissues and the vaginal opening is assessed to classify the condition into specific stages. In the early stages, prolapse is very mild, and the descended tissues remain well above the vaginal opening. In the intermediate stages, the tissues reach the vaginal opening, and the individual clearly feels this when standing. In advanced stages, the organs protrude beyond the vaginal opening, exposing the tissues to the external environment.

The treatment decision is not made mechanically based on this staging alone. The difficulties the patient experiences in daily life, the severity of symptoms, and overall health are much more influential. In cases that cause no symptoms or only very mild symptoms, surgery is not immediately chosen; instead, priority is given to conservative methods that support the body.

Conservative approaches used before surgery include:

• Kegel exercises
• Weight management
• High-fiber diet programs
• Vaginal support devices
• Constipation treatment

However, in more advanced cases that significantly impair quality of life, involve protrusion outside the body, and do not benefit from conservative methods, surgical techniques become the main option for providing a lasting solution.

What special urinary tract tests are performed before uterine prolapse surgery?

In advanced prolapse, as the organs are pulled downward by gravity, they can fold and narrow the outlet channel of the bladder like a kinked hose. This physical folding makes urination difficult and may conceal an existing urinary incontinence problem. The patient may believe she has no urinary leakage before surgery, but this may simply be due to a temporary obstruction caused by the prolapse. If this hidden condition goes unrecognized and the organs are surgically suspended upward, a new urinary leakage problem may appear after surgery because the kinked urethra straightens and opens.

A special examination step is performed to identify this situation before surgery. During the examination, the prolapsed tissues are gently pushed toward their natural position, and the patient is asked to cough or strain so that the urinary tract’s response to this pressure can be observed. Ultrasound is also used to measure the amount of residual urine to determine how effectively the patient can empty her bladder independently. Based on these assessments, additional procedures to support the urinary tract are included in the surgical plan when needed.

How are tissue wounds caused by uterine prolapse prepared before surgery?

In cases where prolapse is very advanced and the tissues remain continuously outside the body, the vaginal wall and cervix are constantly exposed to the external environment and friction against underwear. The vaginal mucosa is not structurally designed to withstand outside air and this type of mechanical friction. Over time, this irritation can cause the tissue to dry out, disrupt its cellular structure, and produce extensive surface wounds.

Operating on an area with an open wound or loss of tissue integrity is generally avoided because the tissue’s ability to hold sutures is reduced. Restoring the tissue to a healthy condition before surgery is therefore particularly important.

Steps taken to support wound healing include:

• Repositioning the prolapsed tissues internally
• Topical estrogen creams
• Improved local hygiene
• A period of tissue rest
• Local wound dressings when necessary

This preparation improves the tissue’s blood supply, allows wounds to close, and restores the area’s healthy pink color. It thereby increases the durability of the surgical procedures and the tissue’s healing potential.

When is preserving the uterus considered in uterine prolapse surgery?

In the past, complete removal of the uterus was frequently used to treat uterine prolapse. Today, however, medical practice has shifted toward preserving the patient’s own organs whenever possible. This change has been accelerated not only by reproductive-age women’s desire to preserve fertility but also by older women’s wish to avoid organ loss and maintain bodily integrity. Leaving the uterus in place allows preservation of the natural nerve networks in the area, fewer tissue incisions, and a shorter operation.

In procedures that preserve and suspend the uterus, minimally invasive methods are generally used to attach the posterior surface of the uterus to strong ligaments. In certain specific cases where only the cervix has become excessively elongated but the upper supporting ligaments remain strong, intervention can be limited to the lower portion of the uterus while leaving its main body in place. This largely preserves the individual’s natural anatomy.

How is the pelvic floor supported during uterine prolapse surgery when the uterus must be removed?

If the patient has uterine fibroids, persistent bleeding problems, or other gynecological conditions, removal of the uterus (hysterectomy) may be included in the treatment plan. This procedure is generally performed directly through the vagina without an abdominal incision. However, a very important detail must be considered: removing the uterus alone does not correct pelvic floor weakness. Moreover, because the ligaments holding the uterus in place are detached during surgery, the supporting mechanism at the top of the vagina may become even weaker. Unless appropriate precautions are taken, the vagina itself may be at risk of herniating downward in subsequent years.

To minimize this possibility, supporting procedures that suspend the vaginal apex must be added when the uterus is removed. The remaining healthy connective tissues are joined to the top of the vagina with special sutures to create a strong bridge, or the vaginal apex is secured to strong ligaments deep within the pelvis. This prevents downward pressure from the bowel and keeps the organs in their natural positions.

What role does minimally invasive (laparoscopic) uterine prolapse surgery play in treatment?

Laparoscopic surgery is one of the most important options offered by modern medicine for providing lasting support to the pelvic organs. Particularly in patients with vaginal prolapse after a previous hysterectomy or in advanced stages of the condition, this method provides an anatomically very strong repair. High-resolution cameras introduced through several tiny abdominal incisions allow the surgeon to see even the deepest areas of the pelvis very clearly. During this operation, the prolapsed tissues are suspended from durable connective tissues over the tailbone using special support materials.

The main advantages of the minimally invasive approach for patients are:

• A short hospital stay
• Rapid recovery
• Less postoperative pain
• Minimal scarring
• An early return to daily life

Laparoscopic surgery positions the tissues at their natural depth and angle. This makes it easier to maintain anatomical integrity after surgery and allows the tissues to readjust.

Who is suitable for laparoscopic pectopexy in uterine prolapse surgery?

Although suspending the tissues toward the tailbone is a common method of treating prolapse, operating in this area can be difficult in certain circumstances. Conventional suspension procedures require extra care in patients with severe obesity, extensive bowel adhesions from previous abdominal operations, or vascular anatomy around the tailbone that differs from normal.

In such cases, pectopexy may be preferred as an alternative and safe approach. In this method, the prolapsed organs are suspended from different, very strong connective tissues along the sides of the pelvis rather than from the spinal region. Because this area is farther from major blood vessels, it offers a safe operating field. In terms of anatomical outcomes, it produces similarly satisfactory results to other minimally invasive operations and supports the natural course of bowel function.

Which uterine prolapse operations are preferred in older patients with additional medical conditions?

In very elderly patients, serious chronic conditions such as heart or lung disease may make lengthy operations requiring general anesthesia difficult. However, these patients also need relief from the pain, irritation, and urinary tract problems caused by prolapsed tissues. Obliterative surgery (colpocleisis), performed in geriatric patients with a high anesthesia risk who are not sexually active, offers a highly effective solution.

The aim of this type of operation is not to suspend the organs upward but to permanently prevent them from protruding by closing the vaginal canal. The vaginal walls are gently sutured together without disturbing the uterus.

The main benefits of this method for the patient are:

• A very short procedure time
• The possibility of regional or local anesthesia
• Low surgical stress
• Rapid recovery
• Minimal blood loss

Apart from anatomically ending the possibility of penetrative sexual intercourse, this highly reliable method rapidly improves quality of life in older patients by protecting them from prolonged bed rest and the risks of general anesthesia.

How safe is the use of mesh in uterine prolapse surgery?

Support materials used in prolapse surgery, known as mesh, occasionally become the subject of debate. Older-generation techniques in which mesh was inserted blindly through the vagina and caused problems in some patients have created a prejudice against its use. However, the synthetic support materials used today in laparoscopic or abdominal surgery are structurally entirely different from those used in older methods.

These new-generation meshes, placed through the abdomen, are made from special fibers with a high degree of biocompatibility. Their large pores allow the body’s own connective tissue to grow through the mesh, initiating a natural repair process. Furthermore, because these meshes are placed in deep abdominal tissue planes that are closed to the external environment and have a much lower infection risk, they have a very high safety profile. Only in individuals with uncontrolled diabetes, heavy smoking that impairs tissue healing, or a history of pelvic radiotherapy may repair using the patient’s own tissues be preferred, because the tissue’s capacity to accept the mesh may be reduced.

Can urinary incontinence be treated at the same time as uterine prolapse surgery?

A considerable proportion of women presenting with uterine prolapse also experience urinary leakage when coughing, sneezing, laughing, or lifting heavy objects. In fact, both problems are different manifestations of connective tissue weakness in the pelvic floor. Surgical planning should address all the patient’s pelvic floor symptoms as a whole, rather than only repositioning the prolapsed organs. If preoperative tests identify a tendency toward urinary leakage with exertion, a small additional procedure is included.

While the prolapsed tissues are suspended upward, a thin supporting strip that acts as a hammock is placed beneath the middle portion of the urethra during the same session. This additional procedure lengthens the operation only briefly but allows substantial relief from urinary incontinence after surgery as well. This eliminates the need for separate operations for two different problems and allows the patient to resume a more comfortable life after a single recovery period.

What are the hospital stay and early recovery period like after uterine prolapse surgery?

Although it varies according to the type of operation, modern surgical techniques generally allow a very short hospital stay. Most patients are ready for discharge one or two days after surgery. On the first day immediately following surgery, the vaginal packing placed to control bleeding and the urinary catheter inserted to rest the bladder are generally removed without pain. After catheter removal, the patient is expected to urinate comfortably on her own, and this is monitored.

One of the most critical aspects of the early period is ensuring mobility. Patients are encouraged to get out of bed and take short walks a few hours after surgery. This promotes circulation and prevents possible blood vessel blockages. Regular bowel movements are also very important during this period to avoid pressure on the sutures from inside. Constipation is prevented by emphasizing fluids and high-fiber foods in the diet.

What should patients pay attention to during recovery at home after uterine prolapse surgery?

When the patient leaves the hospital and returns home, the physical repair process is still ongoing. Healing of the sutured tissues, adjustment to their new positions, and integration of the implanted support materials with the body generally take six to eight weeks. Avoiding activities that strain the body and place a load on the pelvic floor during this period is very important for the operation’s long-term success.

Activities to avoid during recovery include:

• Lifting heavy objects
• Vigorous sports
• Intensive housecleaning
• Straining on the toilet
• Sexual intercourse
• Strenuous physical movements

Patients are advised to follow these restrictions until medical checkups confirm that the tissues have completely healed at the cellular level and the sutures have dissolved. Drinking plenty of water, taking gentle walks, and making time for rest help make recovery more comfortable.

What lifestyle changes should be made to prevent recurrence after uterine prolapse surgery?

Surgical procedures repair the disrupted anatomy and support the tissues; however, if habits that weaken the pelvic floor continue, the same problems may reappear over the years. To preserve the improvement throughout life, patients therefore need to invest in their own health and make certain permanent lifestyle changes. Eliminating factors that continuously strain the pelvic floor is the strongest preventive measure.

Long-term preventive steps include:

• Maintaining an ideal weight
• Quitting smoking
• Seeking treatment for chronic coughing
• Following a diet that prevents constipation
• Regular pelvic floor exercises