Uterine Prolapse
In singapore

Uterine prolapse can affect your daily life and overall well-being. This condition occurs when the uterus descends from its normal position into the vaginal canal. It is more common among women in Singapore after childbirth or during menopause. With appropriate diagnosis and treatment, symptoms can often be managed effectively, improving comfort and quality of life.

Dr. Harvard Lin

Obstetrician & Gynaecologist

MBBS (SG)|MRCOG (UK)|MMed (OBGYN) (SG)

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Causes & Risks Symptoms When to see a Doctor Diagnosis Treatment Complications & Prevention FAQ Conclusion

What is Uterine Prolapse?

Uterine prolapse occurs when the muscles and ligaments of the pelvic floor become weakened or stretched, causing the uterus to slip down into or protrude out of the vagina. This happens when the supportive tissues can no longer hold the uterus in its normal position.

The condition varies in severity, categorized into four stages:

Stage 1: The uterus descends slightly into the upper vagina.
Stage 2: The uterus drops further but remains inside the vaginal opening.
Stage 3: The uterus protrudes partially outside the vaginal opening.
Stage 4: The uterus is completely outside the vagina (complete prolapse).

Uterine prolapse can range from mild cases with minimal symptoms to severe forms that interfere with daily activities and overall quality of life.

Causes

Uterine prolapse develops when the pelvic floor muscles and connective tissues that support the uterus become weakened or stretched. This weakening can result from:

Vaginal childbirth, especially multiple deliveries or complicated births
Ageing and decreased oestrogen during menopause
Chronic or repeated increases in abdominal pressure
Previous pelvic surgery that may affect supportive structures
Genetic predisposition to weaker connective tissue

Risk Factors

Several factors increase the likelihood of developing uterine prolapse:

Multiple vaginal deliveries, particularly of large babies
Age over 50 and postmenopausal status
Obesity, which adds pressure on the pelvic organs
Chronic constipation with frequent straining
Chronic cough from smoking or lung conditions
Repeated heavy lifting in daily activities or work
Family history of pelvic organ prolapse
Previous hysterectomy or pelvic surgery
Connective tissue disorders

Signs & Symptoms

Mild Symptoms

Feeling of pelvic heaviness or fullness
Sensation of something “falling out” of the vagina
Lower back discomfort that improves when lying down
Mild urinary urgency or increased frequency
Slight difficulty starting urination
Feeling that the bladder is not fully emptied

Moderate Symptoms

Visible bulge at the vaginal opening
Difficulty with bowel movements, sometimes needing manual support
Urinary incontinence or retention
Discomfort or pain during intercourse
Increased pelvic pressure when standing or walking
Vaginal bleeding or irritation from tissue irritation

Severe Symptoms

Complete protrusion of the uterus through the vaginal opening
Inability to urinate without manual reduction of the prolapse
Severe pelvic or lower back pain
Recurrent urinary tract infections
Difficulty walking or sitting comfortably
Ulceration of exposed tissue

Symptoms typically worsen throughout the day due to gravity and physical activity, often improving when lying down. Many women notice progression over months or years.

Notice a sensation of heaviness, something “falling out,” or urinary changes?

These are common symptoms of uterine prolapse. Speak with our Gynaecology Specialist for guidance and treatment options.

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When to See a Doctor

You should consult a gynaecologist if you experience any sensation of vaginal bulging, pelvic pressure, or difficulty with urination or bowel movements. Seek immediate medical attention if you are unable to urinate, have severe pelvic pain, or notice bleeding from protruding tissue. Early assessment often allows for less invasive treatment options.

During your first consultation, our Gynaecologist can conduct a thorough medical history review and perform a pelvic examination. This includes assessing the degree of prolapse both at rest and when bearing down. You will also discuss your symptoms, how they affect your daily life, and your treatment preferences. This comprehensive evaluation helps determine the most appropriate management approach for your specific situation.

Diagnosis & Testing Methods

Diagnosis of uterine prolapse involves a combination of assessment to determine the severity and guide treatment. The primary diagnostic tool is a pelvic examination performed with you in different positions to assess the degree of prolapse. Our Gynaecologist can use the Pelvic Organ Prolapse Quantification (POP-Q) system to measure and stage the prolapse.

Additional tests may include urodynamic studies to evaluate bladder function if you experience urinary symptoms. These tests measure how well your bladder stores and releases urine. Pelvic ultrasound or MRI may be recommended to assess the position of pelvic organs and rule out other conditions. A bladder function diary may be requested to document urinary patterns.

Results from the physical examination are typically available immediately, while additional test results may take a few days to a week. No special preparation is needed for the initial examination, although you may be asked to arrive with a comfortably full bladder for certain assessments.

Treatment Options Overview

Non-Surgical Treatments

Pelvic Floor Exercises

Pelvic floor muscle training, commonly known as Kegel exercises, helps strengthen the muscles supporting pelvic organs. A gynaecologist or physiotherapist may teach you the correct technique to ensure effectiveness. These exercises involve contracting and relaxing pelvic floor muscles in specific patterns. Regular practice can improve mild to moderate prolapse symptoms and prevent progression. Most women need to perform exercises several times daily for at least three months to notice improvement.

Pessary Devices

A pessary is a removable device inserted into the vagina to support the uterus and hold it in place. Available in various shapes and sizes, pessaries offer a non-surgical option for managing prolapse symptoms. Our Gynaecologist can fit the appropriate type and size during an in-clinic visit. Pessaries offer a non-surgical option for women who wish to delay or avoid surgery, cannot undergo surgery, or need temporary support during pregnancy. Regular follow-up, usually every 3–6 months, is required for cleaning, refitting, and monitoring for any irritation or complications.

Lifestyle Modifications

Weight management through healthy diet and exercise reduces pressure on pelvic organs and can improve symptoms. Managing chronic constipation through dietary fibre, adequate hydration, and proper toileting habits prevents straining that exacerbates prolapse. Avoiding heavy lifting and learning proper lifting techniques protects the pelvic floor from additional stress.

Hormonal Treatment

For postmenopausal women, vaginal oestrogen therapy can improve tissue health and elasticity. Available as creams, tablets, or rings, local oestrogen strengthens vaginal tissues and may reduce prolapse symptoms. This treatment is often combined with pessary use, as it maintains tissue integrity and reduces irritation. Treatment duration varies based on individual response and symptom improvement.

Surgical Treatments

Vaginal Hysterectomy with Vault Suspension

This procedure removes the uterus through the vagina and secures the top of the vagina (vault) to strong ligaments within the pelvis. It’s often combined with anterior and posterior repairs to address accompanying bladder or bowel prolapse. The surgery typically takes 1-2 hours under general or regional anaesthesia. Recovery involves 4-6 weeks of activity restrictions, with most women returning to normal activities within 2-3 months.

Sacrocolpopexy

This minimally invasive procedure uses laparoscopic or robotic techniques to attach the top of the vagina (vaginal vault) to the sacrum using surgical mesh. It provides durable while preserving vaginal approaches. The procedure preserves vaginal length, making it suitable for sexually active women. Hospital stay is typically 1-2 days, with return to normal activities within 4-6 weeks.

Uterine Suspension Procedures

For women who wish to preserve their uterus, suspension procedures reattach and strengthen the supporting ligaments. Options include sacrohysteropexy (attaching the uterus to the sacrum) or uterosacral ligament suspension. These procedures can be performed vaginally or laparoscopically, depending on individual anatomy and surgeon recommendation. Recovery time varies but generally involves 4-6 weeks of healing.

Colpocleisis

For women who are no longer sexually active, this procedure partially or completely closes the vagina to support prolapsed organs. This procedure is generally suitable for older women or those with other medical conditions. It is usually performed under regional anaesthesia, with a short hospital stay and recovery period of 2–4 weeks.

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Complications if Left Untreated

If uterine prolapse is not addressed, the condition may worsen over time, potentially leading to complete prolapse where the entire uterus protrudes outside the vagina. This can cause chronic irritation, bleeding, and ulceration of exposed tissues. Severe prolapse may obstruct normal bladder function, leading to urinary retention, recurrent infections, and potential kidney damage.

Symptoms can interfere with daily activities, exercise, and intimate relationships, impacting overall quality of life.. Some women with untreated prolapse may withdraw from physical and social activities due to discomfort and embarrassment. Seeking timely evaluation allows for appropriate management to address these risks.

Prevention

While not all cases of uterine prolapse are preventable, there are several measures that can reduce your risk or slow progression. Maintaining a healthy weight through balanced nutrition and regular exercise minimises chronic pressure on pelvic organs. Using proper lifting techniques, bending at the knees rather than the waist, can protect the pelvic floor from sudden stress.

Regular pelvic floor exercises throughout life, especially during and after pregnancy, help maintain muscle strength and uterine support. Managing chronic constipation through adequate fibre intake, hydration, and prompt response to bowel urges prevents repetitive straining. Treating chronic cough from smoking or respiratory conditions also helps limit abdominal pressure. For women approaching menopause, discussing hormone therapy options with our Gynaecologist may help maintain tissue strength and elasticity.

Frequently Asked Questions (FAQ)

Can uterine prolapse resolve on its own without treatment?

Uterine prolapse rarely improves without intervention and typically worsens over time. While symptoms may fluctuate daily, the underlying tissue weakness persists. Early-stage prolapse may be managed conservatively with pelvic floor exercises and lifestyle modifications, potentially preventing progression. Once prolapse becomes symptomatic, some form of treatment is usually necessary to improve quality of life and prevent complications.

Will I need a hysterectomy to treat my uterine prolapse?

Hysterectomy is not always necessary for treating uterine prolapse. Many women successfully manage their condition with conservative treatments like pessaries or pelvic floor therapy. For those requiring surgery, uterus-preserving procedures are available for women who wish to maintain their uterus for personal, cultural, or fertility reasons. Our Gynaecologist can discuss all suitable options based on your prolapse severity, symptoms, age, and personal preferences.

How long is the recovery period after prolapse surgery?

Recovery time varies depending on the specific procedure performed. Minimally invasive surgeries typically require 4-6 weeks for full recovery, with return to light activities within 2-3 weeks. Traditional vaginal repairs may need 6-8 weeks of healing. During recovery, you’ll need to avoid heavy lifting, strenuous exercise, and sexual intercourse. Our Gynaecologist can provide detailed post-operative instructions and monitors your healing progress through follow-up appointments.

Can I still have children if I have uterine prolapse?

Pregnancy is possible with mild to moderate uterine prolapse, though it requires careful monitoring. Pregnancy hormones and the growing uterus often temporarily improve prolapse symptoms. Vaginal delivery may worsen existing prolapse. If you’re planning future pregnancies, discuss this with our Gynaecologist before treatment. Non-surgical options may be recommended, with definitive treatment postponed until after childbearing is complete.

What activities should I avoid if I have uterine prolapse?

Activities that increase abdominal pressure should be modified or avoided, including heavy lifting, high-impact exercises, and straining during bowel movements. Staying active is important for overall health. Low-impact exercises like walking, swimming, and modified yoga are generally safe and beneficial. Our Gynaecologist can provide specific activity guidelines based on your prolapse severity and treatment plan.

How effective are non-surgical treatments for uterine prolapse?

Non-surgical treatments can be effective for managing uterine prolapse symptoms in mild to moderate cases. Combined with lifestyle modifications, many women avoid or significantly delay the need for surgery while maintaining good quality of life.

Will prolapse surgery affect my sexual function?

Most prolapse surgeries aim to restore normal anatomy and can improve sexual function by eliminating discomfort caused by prolapse. Specific surgical techniques can be chosen to preserve or enhance vaginal length and function. Our Gynaecologist can discuss how different procedures may affect sexual function and tailor the surgical approach to your needs and concerns.

Conclusion

Uterine prolapse is a common condition that does not need to be endured or accepted as an unavoidable part of ageing. With proper evaluation and treatment, most women experience significant improvement in symptoms and quality of life. From non-surgical treatments like pelvic floor therapy and pessaries to modern surgical techniques, current gynaecological care offers solutions tailored to your specific needs and lifestyle. Our Gynaecology Specialist combines medical expertise with compassionate care to help you make informed decisions about your treatment options.

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Dr. Harvard Lin

Obstetrician & Gynaecologist

MBBS (SG)|MRCOG (UK)|MMed (OBGYN) (SG)

Dr. Harvard Lin is renowned for his expertise in female pelvic medicine and reconstructive surgery.

Dr. Lin’s journey in medicine began at the prestigious National University of Singapore, where he earned his Bachelor of Medicine and Bachelor of Surgery (MBBS). His commitment to excellence led him to further his education by becoming a Member of the Royal College of Obstetricians and Gynaecologists (MRCOG) through the Royal College of Obstetricians and Gynaecologists in the United Kingdom. He also holds a Master of Medicine (Obstetrics and Gynaecology) from the National University of Singapore.

As the Chief Coordinator of Gynaecologic Services at the National University Health System (NUHS), Dr. Lin plays a pivotal role in ensuring the highest quality care for women’s health. His leadership is also evident in his position as the Deputy Clinical Director of Obstetrics and Gynaecology at NUHS, where he contributes to shaping gynaecologic practices and growth across the cluster including Ng Teng Fong Hospital, Alexandra Hospital and Jurong Medical Centre.

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