Interesting Facts About Prolapse after Hysterectomy I Bet You Never Knew
Unfortunately, some women will experience urinary incontinence due to a vaginal vault prolapse after hysterectomy or due to the weakening of the urethra-supporting tissues.
Many women undergo a hysterectomy because of prolapse of the uterus through the vaginal canal. This means that the muscles and ligaments have failed to suspend the uterus in the pelvis, which falls by gravity through the vaginal canal.
The uterus isn’t the only pelvic organ that can prolapse through the vaginal canal. The rectum, urethra, small bowel, vaginal tissue, and bladder can also begin to prolapse, leading to symptoms similar to uterine prolapse.
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If the muscles and ligaments are weak enough, you may see some of these organs outside the body. A prolapse of any kind can cause problems with bowel movements, urination, and sexual intercourse.
Types of Prolapse
There are several types of prolapse after hysterectomy that can occur.
These include the following:
- Vaginal Vault Prolapse. This is the major type of prolapse that can occur after having a hysterectomy. It affects about ten percent of women who have their uterus removed. What happens is that the top part of the vagina telescopes through the vagina toward the opening of the vagina. The wall of the vagina is weaker so that the vaginal tissue sticks out of the vagina.
- Cystocele(fallen bladder). This is when the bladder falls back from its place in the front of the pelvis into the vaginal space so that the bladder, along with the urethra, is in the vaginal canal or even outside the body.
- Rectocele. The vagina and rectum share a wall in common with one another. This wall can fall forward and into the vaginal space. It can make bowel movements difficult.
- Enterocele. This happens when the small bowel falls by gravity between the vaginal and rectal walls into the vaginal space. It is not uncommon after a hysterectomy when the walls of the vagina are weaker after surgery.
These are the different stages of prolapse:
- Having a first-degree prolapse means the pelvic structure drops into the vaginal vault.
- A second-degree prolapse means the pelvic structure drops to the lower part of the vaginal vault.
- With a third-degree prolapse, the pelvic structure is visible at the opening of the vagina.
- And with a fourth-degree prolapse, the pelvic structures are completely outside of the body.
Causes of Prolapse after Hysterectomy
Normally, muscles and ligaments in the pelvic floor support the organs of the pelvis. When the pelvic muscles become weak, gravity takes hold, and the organs fall through the weakest spot, which, in this case, is the vagina. Some supporting ligaments can also stretch and fail to suspend the pelvic structures in their proper position, and the structures fall.
Things that can contribute to having a vaginal vault prolapse or other types of prolapse in the vagina include the following:
- Giving birth. The more times a woman gives birth, the more the vagina gets stretched, and the greater the degree of laxity in the pelvic floor muscles and ligaments. Traumatic births and prolonged pushing are two other reasons.
- Lack of estrogen. This can occur after surgical or natural menopause. You need estrogen to keep the ligaments and muscles strong.
- Having a hysterectomy. The uterus normally holds the ligaments that keep the pelvic organs in their place. When they remove the uterus, they can damage the ligaments, making way for other pelvic organs to fall into the vagina. Vaginal vault prolapse after hysterectomy may also happen when the structures that hold up the top of the vagina are not reattached during the hysterectomy surgery or because these structures weaken over time.
Risk Factors for Vaginal Prolapse
Not every woman will suffer a vaginal prolapse after hysterectomy. But you have to keep the following risk factors in mind:
- Connective tissue diseases
- Heavy physical activity
- A higher body weight
- Having pelvic floor laxity
- Being a smoker
- Having had pelvic surgery before
- Chronic cough
- Chronic lifting
Symptoms of Prolapse after Hysterectomy
While you may have no symptoms at all, some women experience symptoms suggestive of vaginal prolapse. You may experience the following feelings:
- Like something is falling out of the uterus or of pressure in the pelvis,
- A lump at the vaginal opening
- Difficulty having intercourse
- An improvement in pain and pressure when lying down.
If you have difficulty having a bowel movement, it may be because of a rectocele. Stress incontinence can be a symptom of a cystocele. Vaginal tissue outside of the vagina itself can be due to a rectocele or cystocele. The opening of the vagina can also be widened because of the tissue that is falling through the vagina.
What You can do for Vaginal Prolapse
They make devices called pessaries, which one can insert into the vagina and serve to keep the pelvic structures in their proper position. Avoiding strenuous lifting can help prevent and treat prolapse.
You can also do pelvic floor exercises, called Kegel exercises. These simple exercises your doctor can teach you will strengthen the pelvic floor muscles so that the supporting muscles will better hold up the pelvic structures. It can take several months of daily Kegel exercises to see an effect on urinary incontinence.
I can recommend The Bathroom Key , a book that presents an 8 to 12-week program with specific exercises to strengthen the pelvic floor muscles and help you regain bladder control. It provides step-by-step instructions on how you can cure urinary incontinence without resorting to medication or surgery
If the prolapse after hysterectomy is severe, often surgery is the only real option, depending on how much the tissues affect you. With surgery, they aim to reconstruct the pelvic floor and bring back the pelvic organs to their original position.
Reviewed by: Kimberly Langdon M.D. (OB/GYN)
Date reviewed: 19/3/2019
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I am 74 years old had complete hysterectomy in 1980. 4 years ago felt a bulge in my vagina. Went to doctor. said I had vaginal prolapse. . Doctor put in pessary. First 2 didn’t hold wall up kept flipping Have a new ring device for 3 months. Working very well. In 2004 had bariatric surgery. And I have IBS B/U. I am scheduled for vaginal prolapse mesh repair and a sling for bladder leakage. I am having reservations about this surgery after hearing the problems associated with this surgery.
Hi Mary, have you discussed your concerns with your doctor? If the new pessary works well maybe you can postpone the surgery for a year or two. This means of course that it has to be regularly cleaned and replaced. Why postpone the surgery? The problem with this surgery is usually the mesh material they use. Because scientist at the University of Sheffield are working hard to find a safer material that can be used as a vaginal mesh instead of the polypropylene mesh surgeons are currently using. They have developed this new material which appears to have a very low complication rate but it still needs to go through some rigorous testing.
I had a hysterectomy in 2012 after being diagnosed with endemetrial cancer. I had my uterus, ovaries, fallopian tubes, and cervix removed. I now have a prolapsed bladder. At the moment I am having eostrogen treatment and hopefully some physio to strengthen my pelvic floor. I was told by my gynacologist that surgery only lasts about five years and then has to be repeated. I am now 75 and am very worried about surgery at all. I am so sore most of the time and have several other health issues and life if very depressing. I wish I knew what the future holds for me.
I had my uterus removed because I had cystocele and rectocele. 10 months later I went back to work as a CNA. Four months later the surgery failed. My surgery was done by robot. My Doctor wants to do another surgery using my own flesh.
What caused it to fail? What if my second surgery fails? This is frustrating and depressing. I’ve always worked but I honestly don’t think I will be able to after the next surgery. I have been having pain that makes me feel bruised in the pelvic area I’m scared and have an appointment next week.. I need answers
I am waiting to have a hysterectomy due to a (5 months pregnant size) fibroid and several others. Since my last appointment with the consultant, I had blood clot in my left leg, so been taking the blood thinning tablets daily, iron tablets three times a day which makes me constipate but I have no choice as I still have my period, now every 3 weeks and very heavy.
My period came on boxing day, it was so painful, I was having severe back pain but at the same time I felt it was coming from my abdomen. I went to see my GP, he examined me (very painful when he pressed) and said that my abdomen is very tense.
I am still getting the pain, worse time is when I sleep at night and getting up in the morning.
I did say to the consultant about my hysterectomy regarding the rest of my organs as common/logical sense tells me that if I have a hysterectomy it will leave a big hole and it makes sense that the rest of my organs will come tumbling down and after reading all of the above comments, I fear that I may get more than I bargain by having this operation.
I am due to see the consultant next Tuesday so I definitely will tell him that I want to keep my ovaries and cervix as I had a laparoscopy last year, he told me that my ovaries are healthy!
I had a vaginal hysterectomy 4 weeks ago. I have been back to see my surgeon as I have a feeling everything is falling out. If I lie down it is so much better. My surgeon tells me all is well and it is all part of the healing process.
Eventually got to see a GP last week and she tells me it is part of my bowel, it is now level with the outside of my body and very very uncomfortable. To make matters worse I am very sore in that area there is a burning feeling. I wish I had not gone ahead with the surgery
Hi Joanna my bowel prolapse was different to yours, my wound hadn’t healed and I had a lot of small intestine come out of my vagina, as I had a hole in my surgical site my vaginal canal didn’t prolapse. I went to emergency surgery to put my inside back in. Doing ok now 5 weeks post surgery fingers crossed
Hi Joanna,
I had a hysterectomy and a prolapsed bladder repair 6 weeks ago. I now once again feel a bulge in my vagina and I fear the repair didn’t work and it’s back the same again.
How are you feeling now? Did the weeks that have passed since you last wrote this comment solve its problem? Or do you still feel the pressure of things fallen down?
I’m extremely worried and would love some first hand feedback.
Laura
I so wish I had not had the surgery also, so much pain now and doctors just don’t care. I feel your pain as It is 10 months since my surgery. No one seems to care about my pain or anything I have been complaining about all this time.
I had a partial hysterectomy about 34 years ago and my doctor told me in about 20 years I would need surgery again because they had to tie the muscles to my bladder and it would start to fail. Well 34 years later and it seems to be starting. What is the fix for this? I presume it’s probably something more simple than 34 years ago.
Hi Patti I had partial hysterectomy done 10 years ago and now I have got prolapse in that area, it has been 4 years that I use the donut shape device to hold the organs in place, I get a lot of bladder infection, I am tired of all these bladder infection and I have decided to fix the problem, but I am confused of which surgery to go with. There are Robotics, the one that go with camera or vaginally they fix. I would like to find out from people who have done these type of surgeries.
About eight weeks after my hysterectomy I had a complete organ prolapse my intestines came out also what kind of complications could I have from that. They had to put intestines back
Hi Melinda, I’m hoping your still on here. I have just had the same happen to me 6 weeks post surgery after Drs clearance. Can you please tell me how you got through the psychological trauma and did your second surgery hold up. Sex? How did you overcome this fear, thanks Mia
I had complications during my hysterectomy in May 2012. I had ovarian cysts and ruptures and fibroids, but I had a lot of scar tissue from c sections and my bladder tore during the hysterectomy so they left my ovaries. They didn’t want me waking up in menopause on top of the complication. I have since had problems with ovarian cysts and in an ultrasound two months ago something was seen that looked like my cervix. Mine was removed. I had a repeat ultrasound and it was still there so I am having an MRI. The order says vaginal cuff mass. I, of course, am very nervous. I had the DaVinci robot surgery. What could this be?
Thank you for these articles! I started having mild urinary leakage directly after surgery. There may be a tear or hole caused from this procedure. Very informative.