[KoK! Health] "Feeling Like It's Leaking" Key to Treating Uterine Prolapse... Whether Accompanied by Urinary Incontinence

“It feels like something is falling out.”

When a middle-aged woman visits a hospital and describes her symptoms this way, uterine prolapse is generally suspected. Uterine prolapse can occur when muscles and ligaments are damaged during pregnancy and childbirth, causing abnormalities in the support tissues of the pelvic floor area. The risk is also higher in cases of obesity or severe constipation. It can be accompanied by urinary incontinence or frequent urination, and in severe cases, inflammation of the cervix or a sensation of the uterus protruding outside the vagina can be felt.

If the symptoms are not severe and the patient is relatively young, the progression can be slowed by strengthening the pelvic floor muscles through exercises such as Kegel exercises. However, complete resolution is difficult, and symptoms tend to worsen with aging. Uterine prolapse can be corrected using a pessary on the cervix or resolved through surgery.

A key consideration in the treatment of uterine prolapse is the coexistence of urinary incontinence. It is best to treat both simultaneously, but often urinary incontinence is discovered late after uterine prolapse treatment. Even if urinary incontinence symptoms have not appeared, a displaced uterus may press on the urethra or cause the proximal urethra to bend, resulting in no or mild urinary incontinence symptoms, a condition called occult urinary incontinence. If only uterine prolapse surgery is performed in such cases, urinary incontinence symptoms may appear after surgery, significantly lowering patient satisfaction and quality of life.

Professor Ki-Hoon Ahn of the Department of Obstetrics and Gynecology at Korea University Anam Hospital emphasized, “To prevent a decline in quality of life due to occult urinary incontinence and to increase patient satisfaction, it is advisable to assess the presence and severity of occult urinary incontinence through urodynamic testing and decide the scope of treatment together with the patient.”

International guidelines state that when uterine prolapse is present, even if urinary incontinence is absent, urodynamic testing and consultation should be conducted with the possibility of occult urinary incontinence in mind. In Korea as well, interest in occult urinary incontinence is growing in line with international guidelines during the diagnosis and treatment of uterine prolapse.

Professor Ahn said, “If the pelvic floor muscles are weakened due to pregnancy, childbirth, obesity, or aging, the risk of not only uterine prolapse but also urinary incontinence is quite high. When urinary incontinence symptoms appear after uterine prolapse treatment, the patient’s quality of life can decline, so it is important to detect and treat it simultaneously to increase patient satisfaction.” Last month, Professor Ahn presented on uterine prolapse and urinary incontinence at the Korean Society of Urogynecology conference, drawing significant interest and consensus from the academic community.

Professor An Gi-hoon

This content was produced with the assistance of AI translation services.