Prolapse after hysterectomy is often a concern, particularly for women with prolapse prior to surgery.
There are a number of things you can do to to reduce your risk of post hysterectomy prolapse.
Knowing the prolapse risks can help you prevent prolapse after hysterectomy.
Read on now to learn:
- Hysterectomy factors that increase the risk of prolapse
- How to reduce your risk of prolapse after a hysterectomy
Hysterectomy Recovery Exercises e-Book
Reduce the risk of common hysterectomy side effects and promote the speed of your recovery.
- Early hysterectomy recovery (abdominal or vaginal hysterectomy)
- Preparing for a hysterectomy
- Reducing the risk of common side effects e.g. back pain, constipation and gas
- Preparing your body for return to work and regular activity.
Hysterectomy and Prolapse
Hysterectomy surgery involves removing the uterus by cutting through strong supportive ligaments and tissues that are involved in suspending or holding the uterus in place.
Cutting through the pelvic floor tissues can cause damage to nerves and blood vessels that supply the pelvic floor which is the support system for the pelvic organs (including the bladder, vagina, uterus and bowel). The risk of prolapse increases when the pelvic floor supports are damaged.
A prolapse can occur during the early stages of hysterectomy recovery or many years following their hysterectomy surgery.
Hysterectomy Factors That Increase the Risk of Prolapse
There are a number of factors directly related to the hysterectomy procedure that can increase the risk of prolapse after surgery.
1. Hysterectomy and Prolapse Repair
When a hysterectomy is performed to treat a prolapse, the risk of repeat prolapse is increased when compared with hysterectomy for other gynaecological reasons.1
Women who have a combined hysterectomy and prolapse repair have an increased risk of repeat prolapse.1
2. Type of Hysterectomy
The type of hysterectomy performed can increase the occurrence of some forms of prolapse.
Some particular types of prolapse occur more frequently after vaginal hysterectomy.
Vaginal vault prolapse (the top of the vagina falls down into the vagina) and enterocele (small bowel prolapse) are more common after vaginal than abdominal hysterectomy.2 This may be caused by the difficulty restoring the strong supportive ligaments and tissues during vaginal hysterectomy (compared with an abdominal hysterectomy where there is better access during surgery).
3. Time Elapsed Since Hysterectomy
The amount of time since the hysterectomy can influence prolapse occurrence.
The risk of prolapse increases with increasing length of time elapsed since the hysterectomy.
One study reported the the proportion of women with requiring a prolapse repair 20 years after hysterectomy was 3.3% and this figure increased to 5.1% at 30 years after hysterectomy.1
4. Removal of the Cervix
During a total hysterectomy the cervix is removed and the top part of the vagina is stitched together. In a partial hysterectomy the cervix is not removed.
Removing the cervix may reduce support for the pelvic organs and increase the risk of prolapse after hysterectomy. For some women removal of the cervix is necessary during hysterectomy. Speak with your surgeon prior to your surgery to understand whether this risk applies to you.
5. Surgical Technique to Support the Vagina
The top of the vagina is known as the vaginal apex. The tissues that help hold up the vaginal apex are removed during a hysterectomy.
If the top of the vagina is not suspended or stitched to surrounding structures once the uterus is removed, the risk of future prolapse (particularly vaginal vault prolapse) may be increased.
The process of stitching the top of the vagina to supporting tissues to prevent a prolapse is known as prophylactic apical suspension of the vagina. During your preoperative appointment you may wish to discuss the measures your surgeon intends to perform in order to suspend your vagina and reduce your risk of future prolapse.
How to Prevent Prolapse After Hysterectomy
There are a number of things you can do to reduce your risk of prolapse after hysterectomy.
There are factors in your everyday life that you can modify or avoid to reduce the load on your pelvic floor. These factors include:
1. Moving Safely Immediately After Surgery
The way you move during your early postoperative recovery affects the load on your pelvic floor after your hysterectomy.
It’s important to move using the correct technique that reduces load on your pelvic floor when:
- Getting in and out of bed
- Moving around the bed
- Protecting when you cough or sneeze
- Using your bowels without straining
For more information refer to Exercise After Hysterectomy
2. Managing Your Body Weight
Body weight has the potential to increases the load on the pelvic floor, especially abdominal (visceral) fat that sits around the organs directly above the pelvic floor.
Managing your body weight to protect your pelvic floor involves losing weight if you are overweight and avoiding unnecessary weight gain.
Carrying too much abdominal weight increases the load on your pelvic floor and your pelvic floor supports increasing the risk of strain and prolapse.
3. Avoiding Heavy Lifting
Heavy lifting increases the strain and load on the pelvic floor. Lifting is a broad term used here to include pushing or pulling a heavy load. Repetitive lifting can also overload the pelvic floor supports.
Enlist the help of others, use safe lifting techniques and avoid moving any load that causes you to strain to reduce your risk of post hysterectomy prolapse.
4. Choosing Pelvic Floor Friendly Exercises
Regular exercise keeps your body strong and helps you reduce the overall load on your pelvic floor during your everyday activities e.g. carrying shopping.
Minimise the load on your pelvic floor by choosing low impact exercises, avoiding intense core abdominal exercises and choosing pelvic floor safe strength training (resistance) exercises and techniques.
5. Managing Your Bowels
Bowel problems such as constipation, diarrhoea and straining can increase the risk of overloading the pelvic floor.
Managing constipation or diarrhoea and avoiding straining involves eating appropriately for your bowel, reducing your intake of foods that aggravate bowel problems after hysterectomy and drinking sufficient fluid to keep your stool soft and well formed.
Use the correct bowel emptying position and technique to empty your bowels and reduce strain on your pelvic floor.
6. Manage Coughing
Coughing creates downward pressure on the pelvic floor. Coughing can result from chronic chest conditions, acute chest infection (e.g. bronchitis) or allergies and hay fever. Forceful or repeated coughing often causes the pelvic floor muscles and tissues to stretch and weaken, increasing the risk of prolapse.
Managing coughing can involve taking appropriate medication, using The Knack exercise technique to protect the pelvic floor along with using physiotherapy chest clearance techniques.
7. Maintaining Your Pelvic Floor Fitness
Regular Pelvic Floor Exercises (Kegels) help you maintain a strong supportive pelvic floor after a hysterectomy. If your pelvic floor is working well then you will reduce your risk of postoperative prolapse problems.
If you’re unsure how to recover your pelvic floor condition after your surgery, seek a consultation with a Pelvic Floor Physiotherapist to guide your recovery.
Key Points for Preventing Prolapse After Hysterectomy
There are a number of ways you can reduce your risk of prolapse after hysterectomy.
To reduce your risk of prolapse:
- Speak with your surgeon to better understand the hysterectomy procedure you’re undergoing and know your risks
- Manage your general health and lifestyle factors that can influence your risk of prolapse.
ABOUT THE AUTHOR, Michelle Kenway
Michelle Kenway is an Australian Pelvic Floor Physiotherapist. Michelle lectures to health professionals and promotes community health through her writing, radio segments, online exercise videos and community presentations. She holds dual post graduate physiotherapy qualifications in women’s health and exercise.
1 Blandon R., Bharucha A et.al. (2007) Incidence of pelvic floor repair after hysterectomy. A population-based cohort study. American Journal of Obstetrics & Gynecology 197(6): 664.e1–664.e7.
2 Swift S. (2000) The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. American Journal of Obstetrics & Gynecology 183(2):277-85.