Advanced Care for Complete Uterine Prolapse.
When the pelvic floor muscles and supporting tissues weaken significantly, the uterus may descend through the vaginal canal and protrude beyond the vaginal opening. This advanced form of uterine prolapse, known as procidentia, can cause physical discomfort, pelvic pressure, difficulty with daily activities, and other symptoms that affect quality of life.
At Nova Femina, Nagpur, we believe that women experiencing advanced pelvic organ prolapse deserve a careful assessment and an individualised treatment plan. Our approach focuses on understanding the severity of the prolapse, evaluating associated bladder or bowel symptoms, and discussing appropriate reconstructive and surgical options.
Led by Dr. Rucha Sanap Changle, Nova Femina is dedicated to cosmetic and reconstructive gynaecological care, with an emphasis on patient dignity, privacy, and informed decision-making.
What Is Procidentia?
Procidentia refers to complete or near-complete uterine prolapse, in which the uterus descends through the vaginal opening and may protrude outside the body.
The condition develops when the muscles, ligaments, and connective tissues supporting the uterus and pelvic organs become significantly weakened.
Factors associated with uterine prolapse may include pregnancy and childbirth, ageing, menopause-related tissue changes, chronic straining, and previous pelvic floor damage.
In advanced cases, exposed vaginal or cervical tissues may become irritated, dry, ulcerated, or prone to bleeding. Bladder and bowel symptoms may also occur.
The severity of procidentia and its effects vary between individuals. A detailed gynaecological assessment is essential to determine the extent of the prolapse and identify the most suitable treatment.
Common Symptoms of Procidentia
Women experiencing advanced uterine prolapse may notice:
- A visible vaginal bulge: The uterus or associated tissues protrude through the vaginal opening.
- Pelvic heaviness or pressure: A persistent dragging or uncomfortable sensation in the pelvic region.
- Vaginal irritation: Exposed tissues may become dry, irritated, or sore.
- Urinary difficulties: Problems emptying the bladder, urinary leakage, or other urinary symptoms.
- Bowel-related symptoms: Difficulty passing stool or incomplete bowel emptying in some cases.
- Discomfort during daily activities: Walking, standing, or other routine activities may become uncomfortable.
- Vaginal spotting or bleeding: Fragile or irritated exposed tissues may bleed and require clinical assessment.
These symptoms can have other causes as well. A clinical examination helps confirm the diagnosis and identify any associated conditions requiring treatment.
Reconstructive Surgery Options for Procidentia
The appropriate procedure depends on the severity of the prolapse, the patient's overall health, previous surgeries, associated pelvic floor defects, and preferences regarding uterine preservation.
1. Vaginal Hysterectomy with Pelvic Support Repair
A vaginal hysterectomy involves removing the uterus through the vagina. In selected cases of uterine prolapse, it may be combined with procedures that restore support to the top of the vagina and other affected pelvic structures. Removing the uterus alone does not address every aspect of pelvic support. Appropriate suspension or reconstructive repair may therefore be an important part of the surgical plan. This option may be considered for women who do not wish to preserve the uterus and for whom the procedure is clinically appropriate.
2. Uterus-Preserving Prolapse Surgery
Some women prefer to preserve their uterus. Depending on their anatomy and clinical circumstances, a procedure called hysteropexy may be considered. Hysteropexy involves repositioning and supporting the uterus using surgical techniques that secure it to supportive pelvic structures. Uterus-preserving surgery is not suitable for every patient. The potential benefits, recurrence risks, future pregnancy considerations, and available techniques should be discussed with the treating surgeon.
3. Sacrospinous Hysteropexy or Fixation
Sacrospinous procedures use sutures to attach and support the uterus or vaginal apex to a strong ligament within the pelvis. The exact procedure depends on whether the uterus is being preserved or has already been removed. These techniques may be considered as part of an individualised plan for selected cases of uterine or vaginal prolapse.
4. Manchester Repair
Manchester repair is a surgical option for selected women with uterine prolapse. It involves modifying and supporting specific cervical and pelvic structures to improve uterine support. Its suitability depends on the anatomical findings, the degree of prolapse, reproductive plans, and other clinical factors. It is not appropriate for every case of advanced procidentia.
5. Colpocleisis in Selected Cases
Colpocleisis is an operation that partially or completely closes the vaginal canal to provide support for advanced prolapse. It may be considered for selected women who do not wish to have penetrative vaginal intercourse in the future and for whom the procedure is appropriate. Because it changes or closes the vaginal canal, its implications must be clearly explained before a patient considers this option. The choice of surgery is individualised. Not every procedure is appropriate for every woman, and the available options should be discussed alongside their benefits, risks, and alternatives.
Who May Need Surgery for Procidentia?
A consultation with a gynaecological or urogynecological specialist may be appropriate for women experiencing:
- Advanced uterine prolapse:The uterus descends significantly or protrudes beyond the vaginal opening.
- Persistent pelvic discomfort: Heaviness, pressure, or discomfort that affects daily activities.
- Urinary or bowel difficulties: Symptoms associated with prolapse that require assessment and may need additional treatment.
- Irritation of exposed tissues: Repeated soreness, ulceration, or bleeding involving protruding vaginal or cervical tissues.
- Limited improvement with conservative management: Symptoms that remain troublesome despite appropriate non-surgical measures.
Surgery is not the only treatment option. A vaginal pessary, which supports the pelvic organs, may help manage symptoms in some women. Other non-surgical measures may also be considered depending on the severity of the prolapse and individual circumstances.
Your Treatment Journey at Nova Femina
1. Private Consultation
Your consultation begins with a discussion about your symptoms, medical history, previous pregnancies or surgeries where relevant, and the effect of prolapse on your daily life.
2. Comprehensive Clinical Assessment
A pelvic examination helps determine the severity of the prolapse and identify associated vaginal wall, bladder, or bowel concerns. Additional investigations may be recommended when clinically necessary.
3. Personalised Treatment Planning
Your doctor will discuss appropriate non-surgical and surgical options, including whether uterine preservation is possible and suitable for your circumstances.
4. Surgical Treatment
If surgery is recommended, the proposed procedure, expected outcomes, recovery, potential complications, and alternatives will be explained before you make an informed decision.
5. Recovery and Follow-Up
After surgery, you will receive personalised instructions regarding wound care, hygiene, activity restrictions, and follow-up appointments to monitor healing and recovery.
Potential Benefits of Reconstructive Surgery
When appropriately indicated, surgery for procidentia may help address symptoms associated with advanced uterine prolapse.
- Restoring support to the affected pelvic structures.
- Reducing the protrusion or bulge associated with prolapse.
- Improving pelvic pressure and discomfort.
- Improving selected bladder or bowel symptoms when these are related to the prolapse.
- Supporting greater comfort during everyday activities.
Recovery After Procidentia Surgery
Recovery depends on the procedure performed, the extent of reconstruction, individual health, and whether additional repairs are required.
Temporary discomfort, light vaginal bleeding, swelling, and changes in bladder or bowel function may occur. Your surgeon will provide guidance on wound care, hygiene, physical activity, heavy lifting, and when sexual activity can safely resume.
Follow-up appointments are important to assess healing and identify complications. Seek prompt medical attention if you experience heavy bleeding, fever, severe or worsening pain, difficulty passing urine, or other concerning symptoms.
Understanding the Risks
Like any major pelvic reconstructive procedure, surgery for procidentia carries potential risks, including:
- Bleeding or infection.
- Injury to surrounding organs or structures.
- Difficulty emptying the bladder or new urinary leakage.
- Bowel-related complications.
- Pain during sexual intercourse.
- Scarring or delayed healing.
- Recurrent prolapse or the need for further surgery.
- Procedure-specific complications associated with implants or mesh, where used.
The risks vary according to the surgical technique and individual circumstances. If a mesh-based procedure is considered, the type of mesh, its intended use, potential complications, and alternatives should be discussed separately. A detailed consultation helps you understand the potential benefits and limitations before deciding whether to proceed.
Why Choose Nova Femina?
1. Personalised Clinical Assessment
Treatment recommendations based on the severity of prolapse, associated symptoms, and individual health needs.
2. Individualised Surgical Planning
A balanced discussion of uterus-preserving procedures, reconstructive surgery, and other appropriate treatment options.
3. Privacy and Confidentiality
A respectful clinical environment where women can discuss pelvic floor and intimate health concerns comfortably.
4. Informed Decision-Making
Clear explanations of the proposed surgery, recovery expectations, potential complications, and alternatives.
5. Care Beyond Surgery
Personalised aftercare guidance and follow-up to monitor recovery and address concerns.
Consult for Procidentia Treatment in Nagpur
If you are experiencing a significant vaginal bulge, pelvic pressure, or other symptoms of advanced uterine prolapse, a specialist assessment can help determine the severity of the condition and identify appropriate treatment options.
At Nova Femina, Nagpur, you can enquire about a consultation with Dr. Rucha Sanap Changle to discuss your symptoms and explore suitable reconstructive gynaecological care.
Understand your condition. Explore your options. Make an informed decision.