Uterovaginal Prolapse Explained: Differences from Urethrocele & Rectocele + Management

Uterovaginal prolapse is a type of pelvic organ prolapse where the uterus descends into the vaginal canal due to weakened support. It is often confused with urethrocele (prolapse of the urethra) and rectocele (prolapse of the rectum into the vagina). Understanding the differences is crucial for correct diagnosis and treatment. This article explores causes, differences, symptoms, diagnosis, and evidence-based management options.

Definitions & Key Differences

Condition	Definition	Key Difference
Uterovaginal Prolapse	Descent of the uterus into the vagina due to weak pelvic floor and ligaments.	Affects the apical compartment (uterus and cervix).
Urethrocele	Downward sagging of the urethra into the anterior vaginal wall.	Primarily affects urinary tract function.
Rectocele	Prolapse of rectum into the posterior vaginal wall due to weak rectovaginal fascia.	Causes bowel-related symptoms.

Risk Factors

• Multiple vaginal deliveries
• Menopause (low estrogen)
• Obesity
• Chronic constipation or coughing
• Heavy lifting occupations
• Prior pelvic surgery

Symptoms

• Vaginal bulge or “something coming down”
• Pelvic pressure or backache
• Urinary incontinence (common in urethrocele)
• Constipation and incomplete evacuation (common in rectocele)
• Discomfort during intercourse

Diagnosis

1. History: pelvic pressure, urinary or bowel symptoms.
2. Examination: vaginal exam with straining.
3. Staging: POP-Q system (stages 0–IV).
4. Tests: urodynamic studies, ultrasound, MRI for complex cases.

Management

Conservative Management

• Pelvic Floor Muscle Training: Regular Kegel exercises.
• Pessary Use: Device inserted in the vagina to support organs.
• Lifestyle Changes: Weight loss, manage constipation, avoid heavy lifting.
• Hormonal Therapy: Vaginal estrogen in postmenopausal women.

Surgical Management

• Uterine Suspension: Lifting and re-supporting uterus.
• Hysterectomy with Prolapse Repair: Removal of uterus plus repair.
• Anterior Colporrhaphy: For cystocele/urethrocele.
• Posterior Colporrhaphy: For rectocele repair.
• Sacrocolpopexy / Uterosacral Fixation: For apical support.
• Colpocleisis: Vaginal closure for elderly non-sexually active patients.

Prevention

• Strengthening pelvic floor muscles early postpartum.
• Maintaining a healthy weight.
• Preventing constipation and straining.
• Avoiding heavy lifting when possible.
• Treating chronic cough promptly.

Frequently Asked Questions (FAQs)

1. Can uterovaginal prolapse be managed without surgery?
Yes, mild cases respond to Kegel exercises, pessaries, and lifestyle changes.

2. How is urethrocele different from cystocele?
Urethrocele is urethral prolapse, while cystocele is bladder prolapse. They often occur together as cystourethrocele.

3. When is rectocele surgery required?
When symptoms like constipation or incomplete evacuation persist despite conservative treatment.

4. Do all uterine prolapses require hysterectomy?
No. Uterine-preserving surgeries like sacrohysteropexy are available.

5. What are pessary complications?
Possible vaginal irritation, discharge, ulceration, or infection if not managed properly.

6. Does estrogen therapy reverse prolapse?
No, but it improves tissue health and may reduce symptoms.

References

• StatPearls: Pelvic Organ Prolapse
• Cleveland Clinic: Uterine Prolapse
• Cleveland Clinic: Pelvic Organ Prolapse
• AAFP: Pelvic Organ Prolapse Review

Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment decisions.