While it is true that women undergo a hysterectomy for a variety of reasons, including severe cases of pelvic organ prolapse (POP) also known as genitourinary prolapse—it is also true that having a hysterectomy can contribute to the development of prolapse. More than 10 percent of women who have a hysterectomy experience varying degrees of prolapse symptoms.
Removing the uterus can affect the surrounding tissues and organs, which all work together to maintain proper placement in the pelvis. Prolapse occurs when the pelvic organs are not adequately supported by the pelvic floor and shift downward, out of position.
If prolapse symptoms are mild, women may not require treatment. Women with severe symptoms of prolapse may experience pain or pressure in the abdomen or low back, incontinence or constipation, pain during sex, the inability to insert or keep a tampon in place, or the presence of prolapsed pelvic organs protruding into the vagina. These symptoms often require surgery.
Vaginal Vault Prolapse
The pelvic organs and tissues are linked by connective, supportive tissues that attach them to the pelvic bone structure. When a hysterectomy is performed and the uterus is removed, this structure becomes vulnerable, as weakening support tissues pull away and other pelvic organs, like the bladder, cervix or rectum, start to collapse into the vagina.
Women who have had a hysterectomy are prone to a specific type of prolapse known as vaginal vault prolapse, which refers to the top portion of the vagina (vaginal vault) collapsing into itself. When vaginal vault prolapse is severe, the vagina begins to turn itself inside out, something that is both palpable and visible for women.
Surgery can repair the pelvic floor and ease the symptoms of prolapse. A device called transvaginal mesh has been used in many pelvic floor repairs. Unfortunately, it has been linked to painful complications like mesh erosion, organ perforation and sexual dysfunction that can require multiple revision surgeries to correct.
The Food and Drug Administration (FDA) has stated that procedures that do not use mesh can be equally effective in repairing the pelvic floor and reducing prolapse symptoms. All surgery has risks, and women should discuss the safest surgical options with their doctor.
After a hysterectomy, women may wish to consult a physiotherapist who specialises in pelvic health. Physiotherapists use techniques like biofeedback therapy to help women isolate the pelvic floor muscles and learn how to properly strengthen them.
Physiotherapists may also use pelvic massage, manual stimulation and special weights. Most will suggest that women begin a daily routine of Kegel exercises. These contractions of the pelvic floor muscles together and upward are one of the most effective ways to strengthen the pelvic floor.
High-impact activities can further weaken the pelvic floor, but exercise is important. Women should consider exercises like yoga or Pilates, which strengthen the pelvic floor, build core strength and correct posture.
After a hysterectomy, women should do their best to avoid excessive coughing, heavy lifting or frequently straining to produce a bowel movement, as these can weaken the pelvic floor. Being overweight or obese increases pressure on the pelvic floor, so women should take steps to manage body weight.
Doctors may suggest the use of a vaginal pessary. A pessary is a small device fitted and inserted by a doctor to act as support for the vaginal vault and pelvic floor.
Linda Grayling is a content writer for Drugwatch.com. She educates the public about dangerous prescription drugs and defective medical devices.