Pelvic organ prolapse can occur after a hysterectomy. A hysterectomy involves removing the uterus, which alters the pelvis’s supportive structures. Pelvic organ prolapse is a condition where one or more pelvic organs descend from their normal positions, often bulging into the vagina.
Understanding Pelvic Organ Prolapse
The pelvic floor is a network of muscles, ligaments, and tissues forming a supportive hammock at the pelvis’s base. This structure holds pelvic organs, including the bladder, rectum, and vagina, in place. These muscles also maintain continence and contribute to sexual function.
When pelvic floor support weakens or becomes damaged, organs can no longer be held adequately. This allows one or more pelvic organs to descend or bulge into the vaginal canal. The specific type of prolapse depends on the affected organ or part of the vagina, such as the bladder, rectum, or vaginal apex.
Factors Contributing to Prolapse After Hysterectomy
Removing the uterus during a hysterectomy directly impacts the pelvic support system, as the uterus contributes to pelvic floor integrity. Without the uterus, the vaginal vault loses a key attachment point and can descend. This is known as vaginal vault prolapse.
Several factors increase prolapse risk after hysterectomy. Prior pelvic floor weakness, often from vaginal childbirth, is a factor, especially with multiple deliveries or large babies. Age-related weakening of tissues also contributes. Conditions increasing abdominal pressure, such as chronic constipation, coughing, or heavy lifting, further strain the pelvic floor. Obesity also adds pressure, increasing prolapse likelihood.
Identifying Prolapse Symptoms
Symptoms of pelvic organ prolapse after a hysterectomy include a feeling of pressure, heaviness, or fullness in the pelvis or vagina. This sensation may worsen towards the end of the day or after prolonged standing, lifting, or coughing. Some individuals may feel or see a bulge or lump inside or coming out of the vagina.
Other symptoms include discomfort or pain during sexual activity. Urinary changes, such as leaking urine when coughing or laughing, a constant urge to urinate, or incomplete bladder emptying, can occur. Bowel issues, like difficulty with bowel movements or constipation, may also be present.
Approaches to Managing Prolapse
Managing pelvic organ prolapse after a hysterectomy involves non-surgical and surgical strategies. Non-surgical options are often the first approach for mild to moderate cases. Lifestyle modifications include weight management to reduce pelvic floor pressure and avoiding heavy lifting or straining. Managing chronic constipation and coughing also helps reduce strain.
Pelvic floor physical therapy, including Kegel exercises, strengthens pelvic floor muscles to improve organ support. A physical therapist can guide proper technique and develop a personalized program. Another non-surgical option is a vaginal pessary, a removable silicone device inserted into the vagina for mechanical support. Pessaries come in various shapes and sizes and can be a long-term solution, especially for those who prefer to avoid surgery.
For severe cases or when non-surgical methods are insufficient, surgical interventions may be considered. Surgery aims to reposition and support prolapsed organs. Common procedures for post-hysterectomy prolapse, especially vaginal vault prolapse, include vaginal vault suspension, which reattaches the vaginal apex to supportive structures. Anterior or posterior vaginal repairs address bladder or rectal prolapse.