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Vault prolapse after hysterectomy treatment. Post Hysterectomy Vaginal Vault Prolapse: Causes, Symptoms, and Treatment Options

What are the causes of post-hysterectomy vaginal vault prolapse. How is vaginal vault prolapse diagnosed. What are the treatment options for vaginal vault prolapse. Is surgery necessary for vaginal vault prolapse. How can vaginal vault prolapse be prevented.

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Understanding Post Hysterectomy Vaginal Vault Prolapse

Post hysterectomy vaginal vault prolapse is a condition that can occur following the surgical removal of the uterus. It involves the descent of the upper portion of the vagina, often accompanied by other pelvic organs, into the vaginal canal. This complication can significantly impact a woman’s quality of life, causing urinary, anorectal, and sexual dysfunction.

To fully comprehend this condition, it’s crucial to understand the supporting mechanisms of the uterus and vagina. The pelvic floor muscles, ligaments, and connective tissue all play vital roles in maintaining the position of these organs. When a hysterectomy is performed, it can potentially disrupt these support structures, leading to vaginal vault prolapse.

Prevalence and Risk Factors

Vaginal vault prolapse is a relatively common complication following hysterectomy. While exact prevalence rates vary, studies suggest that it can affect a significant percentage of women who have undergone this procedure. Several risk factors have been identified that may increase the likelihood of developing vault prolapse:

  • Pre-existing pelvic floor defects
  • Age
  • Obesity
  • Chronic cough
  • Constipation
  • Heavy lifting
  • Genetic factors

Among these, pre-existing pelvic floor defects are considered the single most important risk factor for developing vault prolapse after hysterectomy.

Diagnosing Vaginal Vault Prolapse

Proper diagnosis of vaginal vault prolapse is essential for determining the most appropriate treatment approach. Healthcare providers typically use a combination of methods to assess the condition:

  1. Physical examination: This involves a pelvic exam to evaluate the extent of prolapse and identify any other pelvic floor defects.
  2. Imaging studies: Ultrasound or MRI may be used to visualize the pelvic organs and assess the severity of prolapse.
  3. Urodynamic testing: This helps evaluate bladder function, which can be affected by vault prolapse.
  4. Quality of life questionnaires: These assess the impact of prolapse on a woman’s daily activities and overall well-being.

How is the severity of vaginal vault prolapse graded? The severity of prolapse is typically graded using the Pelvic Organ Prolapse Quantification (POP-Q) system, which ranges from Stage 0 (no prolapse) to Stage 4 (complete eversion of the vagina).

Conservative Management Options for Vaginal Vault Prolapse

Before considering surgical intervention, healthcare providers often recommend conservative management strategies for vaginal vault prolapse. These approaches can be particularly beneficial for women with mild to moderate prolapse or those who are not suitable candidates for surgery.

Pelvic Floor Exercises

Kegel exercises, also known as pelvic floor muscle training (PFMT), can help strengthen the muscles that support the pelvic organs. Regular practice of these exercises may help alleviate symptoms and prevent the progression of prolapse.

Pessaries

A pessary is a removable device inserted into the vagina to provide support to the prolapsed organs. It comes in various shapes and sizes and can be an effective non-surgical option for managing vault prolapse.

Lifestyle Modifications

Certain lifestyle changes can help manage symptoms and reduce the risk of prolapse progression:

  • Maintaining a healthy weight
  • Avoiding heavy lifting
  • Managing chronic cough
  • Treating constipation
  • Quitting smoking

Are conservative management options effective for all cases of vaginal vault prolapse? While conservative approaches can be beneficial for many women, they may not be sufficient for severe cases or those with significant symptoms. In such instances, surgical intervention may be necessary.

Surgical Approaches for Vaginal Vault Prolapse Repair

When conservative management fails to provide adequate relief, surgical intervention may be recommended. Several surgical techniques have been developed to address vaginal vault prolapse, each with its own advantages and potential risks.

Vaginal Approach

The vaginal approach for vault prolapse repair offers several advantages:

  • Lower complication rates
  • Reduced blood loss
  • Less postoperative discomfort
  • Shorter hospital stay
  • Cost-effectiveness
  • Ability to repair coexistent pelvic floor defects simultaneously

Two common vaginal procedures for vault prolapse repair are:

  1. Sacrospinous fixation: This technique involves attaching the vaginal vault to the sacrospinous ligament.
  2. Uterosacral ligament suspension: In this procedure, the vaginal vault is suspended using the uterosacral ligaments.

Abdominal Approach

The abdominal approach, specifically abdominal sacrocolpopexy, is associated with a lower rate of recurrent vault prolapse and dyspareunia compared to vaginal sacrospinous colpopexy. This procedure involves attaching a mesh or graft material from the vaginal vault to the sacrum.

Which surgical approach is most appropriate for vaginal vault prolapse? The choice of surgical approach depends on various factors, including the severity of prolapse, the patient’s overall health, and the surgeon’s expertise. Each case should be evaluated individually to determine the most suitable option.

Emerging Techniques and Technologies in Vault Prolapse Repair

As medical technology advances, new techniques and materials are being developed to improve the outcomes of vaginal vault prolapse repair. These innovations aim to enhance the efficacy of procedures while minimizing complications and recovery time.

Laparoscopic and Robotic-Assisted Procedures

Minimally invasive approaches, such as laparoscopic and robotic-assisted sacrocolpopexy, are gaining popularity. These techniques offer the benefits of smaller incisions, reduced postoperative pain, and faster recovery compared to traditional open abdominal surgery.

Mesh Augmentation

The use of surgical mesh in vaginal prolapse repair has been a topic of ongoing research and debate. While mesh can provide additional support and potentially reduce the risk of recurrence, it also carries risks such as erosion and infection. Recent advancements in mesh materials and placement techniques aim to address these concerns.

Regenerative Medicine Approaches

Emerging research is exploring the potential of regenerative medicine in pelvic floor disorders. This includes the use of stem cells and growth factors to enhance tissue repair and strengthen the supporting structures of the pelvic organs.

How do these emerging techniques compare to traditional surgical approaches? While promising, many of these newer techniques are still in the investigational stage. Long-term data on their safety and efficacy compared to established procedures is still being gathered.

Preventing Vaginal Vault Prolapse After Hysterectomy

Prevention of vaginal vault prolapse is a key consideration for surgeons performing hysterectomies. Several strategies have been developed to minimize the risk of this complication:

Surgical Techniques

Modifications to hysterectomy techniques can help preserve pelvic support structures:

  • McCall culdoplasty: This procedure involves suturing the uterosacral ligaments to the vaginal cuff, providing apical support.
  • Moschcowitz procedure: This technique closes the cul-de-sac to prevent enterocele formation.
  • Prophylactic sacrospinous fixation: Some surgeons perform this procedure at the time of hysterectomy for patients at high risk of prolapse.

Pelvic Floor Rehabilitation

Implementing a pelvic floor muscle training program before and after hysterectomy can help strengthen the supporting structures and potentially reduce the risk of prolapse.

Addressing Risk Factors

Managing modifiable risk factors can play a crucial role in preventing vault prolapse:

  • Weight management
  • Smoking cessation
  • Treatment of chronic cough
  • Proper lifting techniques

Can vaginal vault prolapse be completely prevented? While these preventive measures can significantly reduce the risk, it’s important to note that some level of risk may still exist, especially in patients with pre-existing pelvic floor defects or genetic predisposition.

Long-Term Management and Follow-Up for Vaginal Vault Prolapse

The management of vaginal vault prolapse doesn’t end with initial treatment. Long-term follow-up and ongoing care are essential to ensure optimal outcomes and address any potential complications or recurrences.

Regular Pelvic Examinations

Periodic pelvic exams are crucial for monitoring the status of the repair and detecting any signs of recurrence or new pelvic floor defects. The frequency of these examinations may vary based on the individual’s risk factors and the type of treatment received.

Symptom Monitoring

Patients should be educated about potential symptoms of recurrence or complications, such as:

  • Feeling of vaginal pressure or fullness
  • Urinary or bowel dysfunction
  • Sexual difficulties
  • Pelvic pain or discomfort

Early reporting of these symptoms can lead to prompt intervention if necessary.

Ongoing Pelvic Floor Exercises

Continuing pelvic floor muscle exercises can help maintain the strength of the supporting structures and potentially prevent recurrence. Patients may benefit from periodic sessions with a pelvic floor physical therapist to ensure proper technique and progression of exercises.

Lifestyle Maintenance

Adherence to lifestyle modifications that reduce stress on the pelvic floor remains important in the long term. This includes:

  • Maintaining a healthy weight
  • Avoiding heavy lifting
  • Managing chronic conditions that may impact pelvic floor health

What is the long-term success rate of vaginal vault prolapse treatment? The success rates vary depending on the treatment approach, with surgical procedures generally showing good long-term outcomes. However, recurrence is possible, emphasizing the importance of ongoing management and follow-up.

Quality of Life Considerations in Vaginal Vault Prolapse Management

The impact of vaginal vault prolapse on a woman’s quality of life is a crucial aspect that should be considered throughout the management process. This condition can affect various aspects of daily living and well-being.

Physical Impact

Vaginal vault prolapse can cause physical discomfort and functional issues:

  • Pelvic pressure or pain
  • Urinary incontinence or difficulty emptying the bladder
  • Bowel dysfunction
  • Discomfort during physical activities

Psychological and Emotional Effects

The condition can also have significant psychological and emotional impacts:

  • Anxiety about symptoms or potential worsening of the condition
  • Embarrassment or self-consciousness
  • Depression related to physical limitations or body image concerns

Sexual Function

Vaginal vault prolapse can affect sexual function and satisfaction, potentially leading to:

  • Discomfort or pain during intercourse
  • Decreased sexual desire
  • Changes in body image and self-esteem

Social and Occupational Considerations

The condition may impact social interactions and occupational performance:

  • Limitations in physical activities or exercise
  • Concerns about symptoms affecting work performance
  • Avoidance of social situations due to symptoms or treatment needs

How can healthcare providers address quality of life concerns in vaginal vault prolapse management? A comprehensive approach that considers both physical symptoms and psychosocial impacts is essential. This may include:

  • Regular assessment of quality of life using validated questionnaires
  • Incorporating patient preferences and goals into treatment planning
  • Providing resources for psychological support and counseling when needed
  • Offering education and support for partners and family members

By addressing these quality of life considerations, healthcare providers can ensure a more holistic and patient-centered approach to the management of vaginal vault prolapse.

[Posthysterectomy vault prolapse of vaginal walls: choice of operating procedure]

. 2012 Sep-Oct;140(9-10):666-72.

doi: 10.2298/sarh2210666a.

[Article in

Serbian]

Rajka Argirović

  • PMID:

    23289289

  • DOI:

    10.2298/sarh2210666a

Free article

[Article in

Serbian]

Rajka Argirović.

Srp Arh Celok Lek.

2012 Sep-Oct.

Free article

. 2012 Sep-Oct;140(9-10):666-72.

doi: 10.2298/sarh2210666a.

Author

Rajka Argirović

  • PMID:

    23289289

  • DOI:

    10. 2298/sarh2210666a

Abstract

Post-hysterectomy vaginal vault prolapse is a common complication following different types of hysterectomy with a negative impact on the woman’s quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanisms for the uterus and vagina is important in order to make the right choice of the corrective procedure and also to minimize the risk of posthysterectomy occurrence of vault prolapse. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced in hysterectomy to prevent vault prolapse. Vaginal vault repair can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures. The vaginal approach for vault prolapse is superior to the abdominal approach in terms of complication rates, blood loss, postoperative discomfort, length of hospital stay and cost-effectiveness. Moreover, it allows the simultaneous repair of all coexistent pelvic floor defects, such as cystocele, enterocele and rectocele. Abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. Other less commonly performed procedures include uterosacral ligament suspension and illeococcygeal fixation with a high risk of ureteric injury. Surgical mesh of non-absorbent material is gaining in popularity and preliminary data from vaginal mesh procedures is encouraging.

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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.



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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.






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


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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.

Most of the patients receive assistance free of charge (without hidden surcharges for nets, etc.) within the framework of compulsory medical insurance ( under the CHI policy ).

Application for CHI treatment

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.

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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).

Cost of treatment

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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.