Pelvic organ prolapse affects a global estimated 30.9% of women, according to a systematic review and meta-analysis, yet advanced cases in primiparous postmenopausal patients remain clinically distinct. According to a case report, a 58-year-old postmenopausal woman with a history of a single vaginal delivery developed stage IV uterine prolapse alongside multi-compartment defects, requiring definitive surgical intervention after conservative pessary management failed.
Global Prevalence and Diagnostic Discrepancies in Pelvic Organ Prolapse
Epidemiological data show clear differences in how pelvic organ prolapse is detected across populations. According to findings cited in the review, physical examinations reveal a 41.8% prevalence of prolapse, compared to just 25.0% when using questionnaire-based assessments alone. The condition scales progressively with age, peaking among women aged 60 to 69 years old. Furthermore, research indicates that East Asian women experience apical prolapse more frequently than Caucasian women, pointing to potential ethnic and anatomical variations in pelvic floor support structures.
Regionally, hospital-based studies in Indonesia record a wide prevalence range from 3.4% to 56.4%, particularly among postpartum patients. At Dr. Mohammad Hoesin General Hospital in Palembang, retrospective data show that uterine prolapse made up 7.28% of all gynecological cases between 2020 and 2022, with 53.5% of those patients over the age of 60 and 87.1% postmenopausal.
Pathophysiology and Risk Factors Beyond Multiparity
Uterine prolapse happens when the uterus descends through the vaginal canal due to a compromised pelvic floor support system, yielding symptoms like a vaginal bulge, pelvic pressure, and urinary dysfunction. While vaginal delivery and multiple births represent the primary risk factors—causing direct mechanical injury to the levator ani muscles and the uterosacral-cardinal ligament complex—this recent Indonesian case study highlights a rare presentation in a woman with a parity of one (gravida 1, para 1).
Intrinsic connective tissue abnormalities, altered collagen ratios, and postmenopausal estrogen deficiency also drive the condition. Estrogen is vital for maintaining collagen metabolism and tissue elasticity. Without it, connective tissue degrades rapidly, compounding any prior obstetric trauma regardless of whether a patient is multiparous.
Did you know? According to the Pelvic Organ Prolapse Quantification (POP-Q) system, objective measurements are crucial because symptoms often remain clinically insignificant until the prolapse reaches advanced stages.
Surgical Management and Postoperative Recovery
When conservative treatments like vaginal pessaries fail due to persistent discomfort, expulsion, or unresolved urinary symptoms—as occurred in the 58-year-old patient—definitive surgery becomes necessary. On April 2, 2026, the patient underwent a total vaginal hysterectomy combined with an anterior colporrhaphy under regional anesthesia.
The vaginal approach remains a preferred, highly effective treatment for advanced apical prolapse. It avoids abdominal incisions, shortens operative times, and reduces recovery periods while simultaneously correcting anterior and posterior compartment defects. Twenty-four hours after surgery, the patient’s vaginal pack was removed. She experienced an uneventful recovery and was discharged on postoperative day two. By her follow-up visit on April 13, 2026, she reported complete resolution of her vaginal bulge and urinary symptoms, with normal bowel and bladder function restored.
Frequently Asked Questions
What are the primary symptoms of advanced uterine prolapse?
Patients typically notice a visible or palpable vaginal bulge, pelvic pressure, discomfort during prolonged standing or walking, and urinary symptoms such as incomplete bladder emptying or a weak urinary stream.
Can uterine prolapse occur in women with only one child?
Yes. While multiparity is the strongest risk factor, conditions like postmenopausal estrogen deficiency, aging, and intrinsic connective tissue weakness can drive advanced prolapse even in primiparous women, as demonstrated in recent clinical case reports.
Why did pessary treatment fail in this reported case?
Conservative pessary treatment failed due to persistent urinary symptoms, recurrent expulsion of the device, and ongoing vaginal discomfort over an eight-month trial period, prompting the patient to seek surgical intervention.
What surgical procedure is used for advanced uterine prolapse?
Total vaginal hysterectomy combined with anterior colporrhaphy is a widely accepted approach that corrects apical and anterior compartment defects without requiring an abdominal incision.
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