Uterine Prolapse: When is Surgery Necessary? - Obstetrics and Gynecology

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Uterine prolapse is a condition where the uterus descends into the vaginal canal due to weakened pelvic support structures. This can occur as a result of childbirth, aging, hormonal changes, or other factors that affect the pelvic floor. In your mother's case, at 74 years old, it is understandable that she may be experiencing discomfort due to the prolapse, especially if a portion of the uterus is protruding through the vaginal opening.

When considering surgery for uterine prolapse, several factors are taken into account. The severity of the prolapse is typically classified into stages, ranging from mild (first-degree) to severe (fourth-degree). In general, surgery is more likely to be recommended when the prolapse is significant enough to cause bothersome symptoms that affect the patient's quality of life. Symptoms may include pelvic pressure, urinary incontinence, difficulty with bowel movements, and discomfort during physical activities.

In your mother's case, if she is experiencing discomfort while walking, it may indicate that her prolapse is affecting her daily activities. However, the decision to proceed with surgery is not solely based on the physical examination findings. Physicians also consider the patient's overall health, age, and any comorbidities that may increase surgical risks. For older patients, the potential benefits of surgery must be weighed against the risks, which can include complications such as infection, bleeding, and anesthesia-related issues.

There are various surgical options available for uterine prolapse, including vaginal hysterectomy, uterine suspension, and the use of mesh for support. Each option has its own set of risks and benefits. For instance, while vaginal hysterectomy may provide a definitive solution by removing the uterus, it may not be suitable for all patients, especially those who wish to retain their uterus or have other health concerns.

In terms of risks, surgery for uterine prolapse is generally considered safe, but like any surgical procedure, it carries inherent risks. These can include postoperative pain, urinary retention, and potential recurrence of prolapse. Additionally, older patients may have a higher risk of complications due to factors such as decreased healing capacity and the presence of other medical conditions.

It is essential for your mother to have an open discussion with her healthcare provider about her symptoms, concerns, and the potential risks and benefits of surgery. If her discomfort is significant and affecting her quality of life, she may want to seek a second opinion or discuss alternative treatment options, such as pelvic floor physical therapy or the use of a pessary, which can provide support without the need for surgery.

In conclusion, while surgery for uterine prolapse can be beneficial for those with significant symptoms, the decision should be individualized based on the severity of the prolapse, the patient's overall health, and her personal preferences. A thorough evaluation by a qualified healthcare provider will help determine the best course of action for your mother.