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.


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.