What is vaginal vault prolapse after hysterectomy. How common is this condition among women. What are the main symptoms of post-hysterectomy vaginal prolapse. Which treatment options are available for managing vaginal vault prolapse.

Understanding Vaginal Vault Prolapse: A Post-Hysterectomy Complication

Vaginal vault prolapse is a condition that can occur following a hysterectomy, where the top of the vagina (vaginal vault) weakens and descends into the vaginal canal. In severe cases, it may even protrude outside the body. This condition is part of a broader category of pelvic organ prolapses, which affect a significant number of women throughout their lives.

Vaginal vault prolapse after hysterectomy, also known as post-hysterectomy vaginal vault prolapse, is a specific type of prolapse that occurs in women who have undergone uterus removal surgery. While hysterectomy is sometimes performed to treat uterine prolapse, it can paradoxically lead to vaginal prolapse in some cases.

Prevalence of Vaginal Prolapse

How prevalent is vaginal prolapse among women? Studies suggest that approximately one-third of women will experience some degree of prolapse during their lifetime. The risk increases with age and is influenced by various factors, including childbirth history and hormonal changes associated with menopause.

Risk Factors Contributing to Post-Hysterectomy Vaginal Vault Prolapse

Several factors can increase a woman’s risk of developing vaginal vault prolapse after hysterectomy:

• Multiple vaginal deliveries
• Advancing age, particularly during and after menopause
• Obesity or being overweight
• Chronic conditions that increase abdominal pressure (e.g., chronic cough, constipation)
• Genetic predisposition to weak connective tissue
• Previous pelvic surgeries

Understanding these risk factors can help healthcare providers identify women who may be more susceptible to developing vaginal vault prolapse following a hysterectomy.

Recognizing the Symptoms of Vaginal Vault Prolapse

Identifying the symptoms of vaginal vault prolapse is crucial for timely diagnosis and treatment. Women experiencing this condition may report various symptoms:

Vaginal Pressure and Fullness

Can women with vaginal vault prolapse experience a sensation of pressure? Indeed, one of the most common symptoms is a feeling of pressure or fullness in the vaginal area. This sensation is often described as if sitting on a small ball or having something stuck in the vagina.

Pelvic Organ Dysfunction

How does vaginal vault prolapse affect surrounding pelvic organs? The prolapse can impact the function of nearby organs, leading to:

• Urinary issues (e.g., difficulty emptying the bladder, urinary incontinence)
• Bowel problems (e.g., constipation, difficulty with bowel movements)
• Sexual dysfunction (e.g., pain or discomfort during intercourse)

Visual and Physical Changes

In more severe cases, women may notice physical changes, such as:

• A bulge or protrusion at the vaginal opening
• The sensation that something is falling out of the vagina
• Difficulty using tampons

These symptoms can significantly impact a woman’s quality of life and should prompt a medical evaluation.

Diagnostic Approaches for Vaginal Vault Prolapse

Accurate diagnosis of vaginal vault prolapse is essential for determining the appropriate treatment plan. Healthcare providers employ various methods to assess the condition:

Medical History and Physical Examination

The diagnostic process typically begins with a thorough review of the patient’s medical and surgical history, followed by a comprehensive physical examination. During the exam, the healthcare provider assesses the extent of the prolapse and identifies any associated conditions, such as cystocele or rectocele.

Imaging Studies

Are additional tests necessary for diagnosing vaginal vault prolapse? In most cases, a physical examination is sufficient for diagnosis. However, in some instances, imaging studies may be recommended:

• Ultrasound: To visualize the pelvic organs and assess the severity of the prolapse
• MRI: For a more detailed view of the pelvic floor anatomy, particularly in complex cases

Urodynamic Testing

In cases where urinary symptoms are prominent, urodynamic testing may be performed to evaluate bladder function and determine if the prolapse is affecting urinary tract function.

Treatment Options for Post-Hysterectomy Vaginal Vault Prolapse

The management of vaginal vault prolapse after hysterectomy depends on the severity of symptoms and the impact on the patient’s quality of life. Treatment options range from conservative measures to surgical interventions:

Conservative Management

For mild cases or women who are not candidates for surgery, conservative approaches may be recommended:

• Pelvic floor exercises (Kegel exercises) to strengthen pelvic muscles
• Lifestyle modifications (e.g., weight loss, avoiding heavy lifting)
• Vaginal pessaries: Devices inserted into the vagina to provide support

Surgical Interventions

When conservative measures are insufficient, surgical options may be considered:

1. Colposuspension: A minimally invasive procedure where the vaginal wall is attached to a stable ligament in the pelvis
2. Sacrocolpopexy: An abdominal surgery that uses mesh to support the vaginal vault
3. Vaginal vault suspension: A procedure that involves attaching the vaginal vault to the sacrospinous ligament or uterosacral ligaments

The choice of surgical approach depends on various factors, including the patient’s age, overall health, and the severity of the prolapse.

Preventing Vaginal Vault Prolapse After Hysterectomy

While it’s not always possible to prevent vaginal vault prolapse, certain measures may help reduce the risk:

• Maintaining a healthy weight
• Performing regular pelvic floor exercises
• Avoiding activities that increase intra-abdominal pressure
• Addressing chronic cough or constipation
• Hormone replacement therapy in postmenopausal women (under medical supervision)

Healthcare providers may also consider prophylactic measures during hysterectomy to reduce the risk of subsequent vault prolapse.

Long-Term Management and Follow-Up Care

Managing vaginal vault prolapse is often an ongoing process that requires regular follow-up care:

Monitoring Progression

How often should women with vaginal vault prolapse be evaluated? Regular check-ups are essential to monitor the progression of the prolapse and assess the effectiveness of treatment. The frequency of these visits depends on the severity of the condition and the chosen management approach.

Adjusting Treatment Plans

Treatment plans may need to be adjusted over time based on:

• Changes in symptom severity
• The development of new symptoms
• The patient’s overall health status

Quality of Life Considerations

Healthcare providers should regularly assess the impact of vaginal vault prolapse on a woman’s quality of life, addressing concerns related to:

• Sexual function
• Urinary and bowel function
• Physical activity and daily routines

By taking a comprehensive approach to long-term management, healthcare providers can help women with post-hysterectomy vaginal vault prolapse maintain their quality of life and prevent complications.

Advances in Vaginal Vault Prolapse Research and Treatment

The field of urogynecology continues to evolve, with ongoing research aimed at improving the understanding and management of vaginal vault prolapse:

Tissue Engineering and Regenerative Medicine

Can regenerative medicine offer new solutions for vaginal vault prolapse? Researchers are exploring the use of stem cells and tissue engineering techniques to develop new approaches for strengthening and repairing pelvic floor tissues. These innovative strategies may provide alternatives to traditional surgical methods in the future.

Minimally Invasive Surgical Techniques

Advancements in surgical technology have led to the development of less invasive procedures for treating vaginal vault prolapse. These techniques aim to reduce recovery time and minimize complications while providing effective support for the vaginal vault.

Improved Materials for Pelvic Floor Support

Ongoing research is focused on developing new materials for use in pelvic floor reconstruction. These materials aim to provide better long-term support while reducing the risk of complications associated with current mesh products.

As research progresses, women with post-hysterectomy vaginal vault prolapse may have access to more effective and personalized treatment options, improving their overall outcomes and quality of life.

Vaginal Prolapse | Johns Hopkins Medicine

What You Need to Know

• Vaginal prolapse, also known as vaginal vault prolapse, occurs when the top of the vagina weakens and collapses into the vaginal canal. In more serious cases of vaginal prolapse, the top of the vagina may bulge outside the vaginal opening. 
• Symptoms of vaginal prolapse include the feeling of vaginal pressure or fullness — like you’re sitting on a small ball — and the sensation that something has fallen out of your vagina.
• A cystocele or rectocele usually occurs with vaginal prolapse.
• Mild cases of vaginal prolapse do not require treatment. Moderate to severe symptoms require nonsurgical therapies or minimally invasive surgeries, such as vaginal prolapse repair.

What is vaginal prolapse?

Prolapse occurs when a woman’s pelvic floor muscles, tissues and ligaments weaken and stretch. This can result in organs dropping out of their normal position. Vaginal prolapse refers to when the top of the vagina — also called the vaginal vault — sags and falls into the vaginal canal. In severe cases, the vagina can protrude outside of the body.

What causes vaginal prolapse?

There are no direct causes of vaginal prolapse. However, women are at an increased risk of developing vaginal prolapse if they:

• Delivered children vaginally, especially repeat deliveries
• Are approaching or experiencing menopause
• Have certain lifestyle factors, including being overweight
• Were born with a rare condition, such as bladder exstrophy

Vaginal Prolapse After Hysterectomy

Hysterectomy, a surgery to remove a woman’s uterus, is sometimes performed to treat uterine prolapse. However, vaginal prolapse can occur after hysterectomy (regardless of the reason for hysterectomy). This is called “vaginal prolapse after hysterectomy. ”

How common is vaginal prolapse?

Vaginal prolapse is relatively common. About one-third of women will experience some degree of prolapse during their lifetime. If you have more than one risk factor, your chances of developing vaginal prolapse increase.

What are the signs and symptoms of vaginal prolapse?

Vaginal Pressure

Women with vaginal prolapse often report feeling pressure in the vaginal area, described as a throbbing pain in the vagina. Women also report:

• Vaginal fullness (such as the feeling that something is stuck in the vagina)
• The sensation that something is falling out of her vagina

Additional Vaginal Prolapse Symptoms

The pelvic organs are all supported by each other. When one organ prolapses, it can affect the functioning of other nearby organs. Thus, some women also experience:

• Changes in bowel function, such as difficulty having a bowel movement
• Changes in bladder function, such as inability to empty the bladder
• Secondary prolapses, specifically rectocele prolapse (sagging of the connective tissue between the vagina and rectum) or cystocele prolapse (sagging of the connective tissue between the vagina and the bladder).
• Pain or discomfort during sexual intercourse
• Difficulty using tampons

How is a vaginal prolapse diagnosed?

Your doctor will review your medical and surgical history and complete a physical exam. Additional tests, such as ultrasound or MRI, are rarely needed. In some cases, your doctor may also recommended urodynamics testing, a group of tests that evaluate bladder function.

The Johns Hopkins Women’s Center for Pelvic Health & Reconstructive Surgery

Our team of compassionate urogynecologists uses the latest research and advanced technologies to treat a range of pelvic floor disorders.

Learn how our urogynecology team can help.

How is vaginal prolapse treated?

Treatment 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. In moderate cases, your doctor may insert a vaginal pessary to support your vaginal wall. In the most severe cases, you may benefit from surgery, such as colposuspension, a minimally invasive surgical procedure, where the vaginal wall is attached to a stable ligament in the pelvis.

Understanding Pelvic Organ Prolapse | ACOG

Pelvic organ prolapse is a disorder in which one or more of the pelvic organs drop from their normal position. It is caused by injury to the muscles or tissues that support the pelvic organs. The pelvic organs include the vagina, uterus, bladder, urethra, and rectum. These organs are held in place by muscles of the pelvic floor.

The main cause of pelvic organ prolapse is pregnancy and childbirth, especially vaginal childbirth. Other causes can include aging and obesity. This problem also runs in families.

The following videos show the different types of prolapse that can occur. Prolapse happens in stages. Mild cases are those in which the organs have dropped only a short distance. Severe cases are those in which the organs have dropped a greater distance. Sometimes several organs can be affected at once. There also are videos showing treatment with pessaries.

Jump To:

Types of Prolapse

• Uterine Prolapse

• Anterior Vaginal Wall Prolapse

• Posterior Vaginal Wall Prolapse

• Uterovaginal Prolapse

Prolapse After Hysterectomy

• Anterior Vaginal Wall Prolapse (After Hysterectomy)

• Vaginal Vault Prolapse (After Hysterectomy)

• Posterior Vaginal Wall Prolapse (After Hysterectomy)

Treatment with Pessaries

• Gellhorn Pessary

• Ring with Support Pessary

• Ring with Knob Pessary

Types of Prolapse

Uterine Prolapse

The uterus drops down into the vagina. In severe uterine prolapse, the uterus may protrude from the vagina.

Anterior Vaginal Wall Prolapse

The bladder drops down and creates a bulge into the front wall of the vagina. In severe cases, the bulge can protrude outside the vagina. Another name for bladder prolapse is cystocele.

Posterior Vaginal Wall Prolapse

The rectum drops down and creates a bulge into the back wall of the vagina. In severe cases, the bulge can protrude outside the vagina. Another name for this condition is rectocele.

Uterovaginal Prolapse

In some cases, several organs can drop. Here the bladder, uterus, and rectum are shown shifting down.

Prolapse After Hysterectomy

Pelvic organ prolapse also can occur after hysterectomy (an operation to remove the uterus). The following videos show the different types of prolapse that can occur without a uterus.

Anterior Vaginal Wall Prolapse (After Hysterectomy)

Bladder prolapse can occur in a person without a uterus. Another name for bladder prolapse is cystocele.

Vaginal Vault Prolapse (After Hysterectomy)

The top of the vagina drops down, creating a bulge. In severe cases, the top of the vagina may protrude outside of the vagina. It also may occur with small intestine prolapse (shown here), anterior vaginal wall prolapse, or posterior vaginal vault prolapse.

Posterior Vaginal Wall Prolapse (After Hysterectomy)

The rectum can drop downward, creating a bulge into the back wall of the vagina. It may occur with prolapse of the vaginal vault. Another name for this condition is rectocele.

Treatment with Pessaries

Pessaries are a nonsurgical treatment option that can relieve prolapse symptoms. A pessary is a device that is inserted into the vagina to provide support for prolapsed organs. Three types of pessaries are shown in the following videos.

Gellhorn Pessary

This pessary is used to treat uterine prolapse.

Ring with Support Pessary

This pessary is used to treat bladder prolapse.

Ring with Knob Pessary

This pessary is used to treat urinary incontinence caused by bladder prolapse.

PEV001

Published: April 2021

Last reviewed: April 2021

Topics:

Pelvic Floor Disorders
Diseases and Conditions
Healthy Aging
After Pregnancy
Postpartum Healing and Support

Copyright 2021 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women’s health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

Consequences of removal of the uterus. Vaginal prolapse and prolapse: causes, symptoms, treatment, surgery.

Vaginal prolapse

• Description
• Video
• Organization of treatment
• Cost of treatment
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Description

Vaginal prolapse is a condition characterized by displacement of one or more walls of the vagina from its natural position. Formally, the prolapse of the walls of the vagina is characteristic of any prolapse, however, this term is more often used to describe prolapse that develops after removal of the uterus. At the same time, the term incomplete prolapse of the vaginal walls is often used, which characterizes the initial degrees of prolapse of the uterus and vagina.

Symptoms

Symptoms of vaginal prolapse, depending on the organ involved, can be divided into the following groups:

• Associated with prolapse of the bladder (prolapse of the anterior wall of the vagina): difficulty urinating, urination in small portions, the need to set the prolapse to completely empty the bladder, a feeling of incomplete emptying of the bladder, frequent urination, loss of urine during exertion and against the background of a sharp urge to toilet
• Associated with prolapse of the rectum (prolapse of the posterior wall of the vagina): difficult bowel movements, feeling of incomplete emptying of the rectum, defecation in portions, the need to reduce the prolapse or empty the bowel with a finger to completely empty it

In addition, prolapse of any of the walls of the vagina is characterized by a feeling of a foreign body in the vagina, vaginal discharge, dryness of the vaginal mucosa that has descended to the outside, traumatization of the protruding walls of the vagina with the possible formation of ulcers, discomfort during sexual intercourse, as well as pulling pains in the lower abdomen

Causes

Of course, this is only a trigger, since most often there is a predisposing factor – a hereditary weakness of the connective tissue. Another mechanism for the development of the disease is chronically high intra-abdominal pressure, which significantly increases the load on the ligamentous apparatus of the pelvic floor. The main culprits of this condition are heavy physical labor, chronic lung disease, accompanied by severe coughing, and chronic constipation.

Another reason that leads to prolapse of the walls of the vagina is surgery to remove the uterus. The fact is that most often these interventions are performed as a method of treating prolapse of the uterus and vaginal walls. Unfortunately, in this situation, this often leads to even greater damage to the supporting apparatus of the pelvic floor and recurrence of the disease, reaching up to 50%. The so-called prolapse of the vaginal stump or post-hysterectomy prolapse is formed, in which the walls of the vagina partially and completely turn outwards.

Diagnosis

Diagnosis of prolapse of the walls of the vagina consists in performing a standard gynecological examination, which determines the part of the vagina involved in the pathological process and the degree of prolapse. In total, there are 4 degrees of prolapse of the walls of the vagina:

• Grade 1 – Characterizes the condition when the walls of the vagina have shifted from their natural position, but do not yet reach the entrance to the vagina by 2 cm or more
• Grade 2 – In this stage of prolapse, the walls of the vagina are at the level of the entrance to the vagina.
• Grade 3 – In this case, there is a prolapse of the walls of the vagina beyond the genital gap, but not more than 2/3 of its length
• Grade 4 – Complete prolapse of the vaginal walls

In the first two degrees, the patient may not feel the prolapse, and it is often asymptomatic and requires only observation. 3-4 degree of omission is an advanced stage of the disease, which requires treatment.

Treatment

Treatment of prolapse of the walls of the vagina is performed only in case of a significant decrease in the quality of life of patients and dysfunction of the internal organs. In principle, all types of assistance can be divided into conservative and operational.

The first type includes pelvic floor muscle training and pessaries. Exercises for the prolapse of the walls of the vagina are ineffective, since most often there is damage to the ligamentous apparatus of the pelvic floor, which cannot be restored by training. This is especially true for posthysterectomy prolapse. Pessaries are devices that, like a spacer, prevent the sagging walls of the vagina from falling out. This method can be considered as a temporary measure when, for some reason, surgical treatment is not possible. Moreover, the use of pessaries is accompanied by discomfort in the vagina, leading to chronic inflammation and discharge, which requires regular visits to the gynecologist.

The only effective method of treatment is surgery. At the same time, it is also the most difficult, since performing operations after removal of the uterus is associated with a high risk of complications and relapses. Interventions for prolapse of the walls of the vagina can be carried out both through the abdominal cavity and through the vagina. The first option, in addition to expensive equipment and the cost of treatment, is associated with a long duration of the operation, which requires the patient to be in good health. It is also characterized by specific complications: the risk of damage to the abdominal organs and ureters and postoperative problems with defecation. More popular is the transvaginal type of reconstruction, which has a shorter duration of operations, which means it is easier for patients to tolerate.

Almost completely eliminated damage to the abdominal organs. Moreover, it allows simultaneous reconstruction of both walls of the vagina and perineum. At the same time, the risk of developing complications associated with the use of synthetic prostheses, both in abdominal and transvaginal operations, is the same and directly depends on the experience of the surgeon. The most popular now are hybrid operations, which combine the advantages of using synthetic materials and the patient’s own tissues.

Video

Treatment organization

Hospitalization for the purpose of surgical treatment is carried out according to the principle “one window” . It is enough for a patient (or a person representing him) to write a letter with the wording of his question. At any time (both before hospitalization and after), you can ask questions of interest to the staff of the department.

CHI and VMP treatment

Citizens of the Russian Federation can receive free treatment under the CHI program for most diseases

No matter where you live

80% of patients come to us from the regions of the Russian Federation and countries of near and far abroad

Many years of experience

Every year more than 3000 operations of any complexity are performed in the Department of Urology

At any time (both before hospitalization and after), you can ask questions of interest to the staff of the department.

1. Online consultation with a specialist

The organization of hospitalization for the purpose of surgical treatment is carried out according to the principle of “one window”. To do this, it is enough for the patient (or the person representing him) to write a letter with the wording of his question.

Write a letter

2. Appointment of the date of hospitalization

After the consultation, our administrator will contact you within a few days to make an appointment for hospitalization.

3. Examination before hospitalization

Preoperative examination should be carried out only after the approval of the date of hospitalization. You can get most of the examinations at the antenatal clinic or polyclinic at the place of residence free of charge, under the CHI policy.

If in your locality there is no opportunity to be adequately examined – do it in the regional center, if everything cannot be done within the framework of compulsory medical insurance (under the policy) – do it in paid laboratories (clinics).

NO LATE THAN 14 DAYS before hospitalization, you must send SCANS (not photographs) of the test results to the email address: [email protected]

4. Hospitalization in the department

10 days prior to surgery it is NECESSARY to stop drugs that affect blood coagulation (aspirin, Plavix, warfarin, etc.) unless otherwise agreed with the attending physicians.

It is highly desirable to arrive for surgical treatment with pre-selected and purchased surgical compression stockings (white stockings, antithrombotic 2nd class of compression or as recommended by the vascular surgeon).

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Prolapse of the vaginal walls – causes, symptoms, treatment, surgery.

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Since the uterus provides support for the upper part of the vaginal canal, descent of the vaginal walls after its removal is a very likely consequence of the operation. This pathology, according to the observations of doctors, occurs in 40% of women after hysterectomy.

Prolapse of the walls of the vaginal canal after hysterectomy

Complete removal of the uterus is a serious and radical measure that can be resorted to after carefully weighing all the possible consequences and realistically assessing the risk of refusing the operation. Hysterectomy is performed mainly in women in late reproductive age or after menopause. The main indications for such an operation are malignant and benign tumors, advanced cases of adenomyosis, uterine fibroids, as well as prolapse or prolapse of the uterus. In the latter case, the extirpation of the organ is the best option, especially after 60-70 years, when the weakened body is no longer able to restore all its functions and provide normal support to the pelvic organs.

Under normal conditions, the uterus is a kind of holder for the vaginal vault, which is maintained in an anatomical position with the help of the fasciae of the muscular-ligamentous apparatus. In fact, the vagina is a thick muscular tube that is integral with the internal reproductive system of a woman. Vaginal prolapse after removal of the uterus becomes inevitable due to trauma to the pelvic tissue, as well as in cases where the pathology began to develop long before the operation. It should be noted that during the hysterectomy, the doctor must pay special attention to the anatomical position of the walls of the vaginal canal and fix the dome of the vagina firmly enough to avoid undesirable consequences.

After removal of the uterus, with sufficient fixation of the vagina during the operation, prolapse can still occur due to a special lifestyle in one way or another associated with strong physical exertion and malnutrition, which causes severe constipation.

Vaginal prolapse is often caused by prolapse of organs after removal of the uterus into the free cavity left after surgery. In such cases, a cystocele or rectocele often develops – the omission of the anterior or posterior walls of the vaginal canal along with the bladder or part of the intestine, respectively.

Prolapse is usually accompanied by various unpleasant symptoms that make a woman feel very uncomfortable. Firstly, the presence of something superfluous in the vaginal canal is felt, as if you are sitting astride a ball. Often this process is accompanied by severe pain, retention or, conversely, urinary incontinence, frequent urination, problems with defecation. With complete prolapse of the vagina after removal of the uterus, the mucous membrane of its walls is subject to severe injuries, which leads to the development of infectious diseases, abscesses, and even tissue death.

Treatment of vaginal prolapse after hysterectomy

Conservative methods of treatment in this case are ineffective and can only aggravate the pathology. In order to get rid of such a problem once and for all, it is best to resort to surgical plastic surgery of the walls of the vaginal canal.