How Common is a Prolapse After a Hysterectomy?

The uterus is one of the most important support structures in the pelvic floor. It provides support for the vagina and can help prevent conditions like vaginal prolapse or bladder prolapse. A hysterectomy removes the uterus, thus, removing additional vaginal support. In 2008 and 2014, two studies were conducted to determine whether or not the risk of prolapse developing increased once the uterus was removed. Both studies concluded that the possibility of developing vaginal prolapse 1 to 2 years post surgery is greater than not having the procedure done at all.

The most common form of vaginal prolapse associated with a hysterectomy is called enterocele – the small intestine herniating down toward the vagina. However, depending on the type of hysterectomy and your recovery, there is a risk of developing various types of vaginal prolapse.

Prolapse After Hysterectomy Symptoms

Although a hysterectomy is often recommended as a way to treat uterine prolapse. However, even a surgical procedure that seeks to resolve one issue, may run the risk of presenting complications during or post recovery. Removing the uterus may put you at a higher risk pelvic organ prolapse. Below are a few symptoms you may experience if this is the case.

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The Most Common Prolapse Symptoms

Oftentimes, when a person is suffering from a vaginal prolapse, they may experience a feeling or sensation of pressure or heaviness in the vaginal region. This may present as a throbbing pain or a slight discomfort. Some people also report:

• A sensation of fullness (like something is stuck, or like sitting on a ball)
• Feeling as if something is falling out of the vagina.

Other Possible Prolapse Symptoms

• Your pelvic organs are all supported by each other. If one is removed or if you are recovering from a previous prolapse, it may affect the ability for the other supporting organs to function properly. In some cases people report:
• Difficulty performing bowel movements
• Urinary incontinence, or retention (difficulty emptying the bladder)
• Secondary prolapses – especially rectocele and cystocele
• Pain, discomfort during sex
• Difficulty using tampons

Pelvic Organ Prolapse After Hysterectomy

After a vaginal hysterectomy, many women are at risk of prolapse developing. The pelvic organs may become unsupported and slip (such as the bladder or intestines) and descend or herniate into the vaginal region. If you are experiencing increased pelvic pressure after your hysterectomy, it may be best to consult your doctor for a proper diagnosis, as this may be a sign of prolapse.

It may be helpful to understand how this happens and why you may be at a higher risk of prolapse after having a hysterectomy. Each of the organs located in the pelvic region are all supported and attached to the pelvic wall by the same ligaments, muscles, and tissues. If the uterus and cervix are removed, support structures must be added in order to maintain the normal support that was previously there. This may actually leave the pelvic area less secure and more vulnerable to prolapse.

If prolapse does present post-hysterectomy, there are a few that are more prone to occur. These include:

• Vaginal vault prolapse: This occurs when the vaginal vault (the top portion of the vagina) descends into the lower part of the vagina. In very severe cases, the vagina may actually turn inside out and protrude outside of the person’s vaginal opening.
• Cystocele: Also known as bladder prolapse, this occurs when the supportive tissues between the vaginal wall and bladder are stretched or weakened, causing the bladder to descend into the vagina.
• Rectocele: Rectocele occurs when the tissues and muscles that separate the rectum from the vagina are compromised. This can cause a bulge in the back vaginal wall.
• Enterocele: This occurs when the small intestine herniates and drops into the pelvic cavity, pressing against the vagina. This may occur simultaneously with rectocele after a hysterectomy.

We understand that this may sound frightening. However, it is important to understand the risk of undergoing a procedure if you have any pre-existing pelvic floor issues. This is one of the greatest risks of developing a prolapse after a hysterectomy.

How to Prevent Prolapse After Hysterectomy

Resting and Moving About Safely Post-Op

The way you move during your early postoperative recovery affects the load on your pelvic floor after your hysterectomy.

The way you move and engage your muscles during your post-op recovery can affect your pelvic floor after a hysterectomy. It is important that you use techniques that reduce pelvic floor load when you are:

• Rising out of bed or getting into bed
• Moving while in bed
• How you cough or sneeze
• And trying to use the restroom without straining

Avoiding Heavy Lifting

As with any surgical procedure, it is important to not engage in heavy lifting. This can cause additional strain (pushing and pulling) on the pelvic floor. Being cautious when lifting may help reduce the risk of developing prolapse.

Choosing Pelvic Floor Friendly Exercises

Once you have recovered and are at a point when physical therapy and exercise are encouraged, it is important to consider a restorative program that can help you strengthen your core and pelvic region without adding any unnecessary stress and strain.

Your doctor may recommend Kegel exercises as the only form of pelvic floor muscle treatment. Kegel exercises are the favorite prescription within the medical field for weakness in pelvic floor muscles but it is essentially an old school approach that fails to work for many and makes things worse for many others. We strongly believe in a more functional approach to the pelvic floor – one that incorporates the whole body for healing and works on integrating your pelvic floor into the whole system of pressure, load and movement.

How to Treat A Prolapse After a Hysterectomy

Treatment options for vaginal prolapse varies, depending on the severity of the symptoms. Many cases will not require treatment. In mild cases, your physician may recommend pelvic floor exercises to strengthen the muscles.

Treatment for vaginal prolapse after a hysterectomy varies. Some cases may not require intensive treatment and may resolve through proactive exercise routines and lifestyle changes. In most mild cases, your doctor may recommend pelvic floor exercises in order to strengthen your weakened muscles. However, in severe cases, your doctor may recommend additional prolapse surgery. The two most common procedures include:

Pessary

A vaginal pessary is a soft, removable device that is inserted into the vagina. It may help supply additional support to the bladder, rectum, or uterus. A pessary may also help resolve symptoms of urinary incontinence.

Colposuspension

A colposuspension is usually only considered in very severe cases of prolapse. This surgery is typically minimally invasive. Colposuspension attempts to attach the vaginal wall to a stable ligament in the pelvis. This is a major surgical procedure and will require general anesthetic. Colposuspension, however, has a lower success rate. In many cases, only half of the people who undergo the procedure will experience improved symptoms.

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Can Prolapse Be Reversed With Exercise?

Pelvic floor exercises are an effective way to improve and treat the symptoms of pelvic organ prolapse. These can help strengthen and restore pelvic function, help prevent further slipping or descent of organs, and help improve symptoms of urinary incontinence, pelvic pain, and weak ligaments and muscles.

Although there is no sure way to guarantee exercise and movement therapy will resolve all symptoms or treat prolapse, there is a greater increased rate of success among people who have pursued exercise therapy. It is important that you consider a program or workout plan that will get you exercising regularly and effectively. In order to help prevent pelvic organ issues to recurr, it may be helpful to consider long-term physical therapy or exercise treatment. Regardless, exercise will usually show no negative effects and can become an integral part of your daily life.

Prolapse Recovery with Restore Your Core

It is important to understand that our overall health can be significantly impacted by the way in which we move.  My 12 Week Program: Restore Your Core offers a step by step approach to developing a strong, healthy, responsive core & pelvic floor system, for the health of your whole body. Restore Your Core® seeks to train women to intelligently and holistically heal from core and pelvic floor disorders while educating them on how their body’s function and how to properly engage their bodies during their daily activities.

To learn more about the various exercises that assist in core strength and resolving core and pelvic floor pain, check out one of my previous blog posts.