Unfortunately, some women will experience urinary incontinence due to a vaginal vault prolapse after hysterectomy.
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 and it 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 the bladder can also begin to prolapse, leading to symptoms similar to a uterine prolapse.
If the muscles and ligaments are weak enough, you may even see some of these organs outside of the body. A prolapse of any kind can affect having a normal bowel movement, urination, and sexual dysfunction.
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 are 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 into the vaginal space. It is not uncommon after a hysterectomy when the walls of the vagina are weaker after surgery.
There are different stages of prolapse
- In a first degree prolapse, the pelvic structure is simply drooping into the vaginal vault.
- In second degree prolapse, the pelvic structure drops to the lower part of the vaginal vault.
- In a third degree prolapse, the pelvic structure is visible at the opening of the vagina.
- In a fourth degree prolapse, the pelvic structures are completely outside of the body.
Causes of Prolapse after Hysterectomy
Normally, there are muscles in the pelvic floor that 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. There are supporting ligaments as well that can stretch and can 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 type of prolapse into the vagina include the following:
- Giving birth. The more times a woman gives birth, the more the vagina gets stretched and the greater is the degree of laxity in the pelvic floor muscles and ligaments.
- 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 its 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 weakening 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
- Being overweight
- Having pelvic floor laxity
- Being a smoker
- Having had pelvic surgery before
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 though the vagina.
What You can do for Vaginal Prolapse
They make devices called pessaries, one can insert into the vagina and serve to keep the pelvic structures in their proper position. Modifying your activity to avoid strenuous lifting can help prevent and treat prolapse.
You can also do pelvic floor exercises, called Kegel exercises. These are simple exercises your doctor can teach you that 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 the prolapse.
The Bathroom Key is a book that presents an 8 to 12 week program with specific exercises to strengthen the pelvic floor muscles and that will help you to regain bladder control. It provides step by step instructions 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 to bring back the pelvic organs in their original position.