A hysterectomy is a surgical procedure to remove the uterus. A partial hysterectomy involves the removal of only the uterus. A total hysterectomy is the removal of the uterus with the cervix. Many conditions like uterine fibroids, uterus, cervix or ovary cancer, uterine prolapse, abnormal vaginal bleeding, etc., may lead to hysterectomy.
Prolapse is one of the complications of hysterectomy. The risk of Post-hysterectomy Prolapse increases in women with pelvic prolapse before hysterectomy.
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What is Post-hysterectomy Prolapse?
Post-hysterectomy Prolapse can occur immediately after hysterectomy or even after a few years.
What are the Symptoms of Post-hysterectomy Prolapse?
- ● A feeling of heaviness and lump in the vagina.
- ● Trouble during sexual intercourse
- ● Pain and pressure in the pelvic area while lying down
- ● Feeling stuck in the pelvic floor
- ● Back pain
- ● Constipation
- ● Difficulty in urination or leakage of urine
- ● Bleeding
What are the types of Post-hysterectomy Prolapse?
- ● Enterocele: Enterocele happens when a small part of the intestine descends between the vagina and rectal wall due to gravity. After the hysterectomy, the vaginal wall becomes weak, due to which this prolapse is common in almost every woman.
- ● Rectocele: The front rectal wall herniates into the back vaginal wall, which causes a lot of trouble in bowel movement.
- ● Cystocele: When the bladder descends into the vagina, it is called a cystocele. The bladder may also bulge out of the vagina along with the urethra.
- ● Vaginal vault prolapse: After the hysterectomy, about 10 percent of women have this prolapse. When the upper part of the vagina loses its natural shape and moves inside the vaginal canal or outside the vagina, it is called vaginal vault prolapse. This prolapse can accompany a cystocele, rectocele, and enterocele prolapse.
How is Post-hysterectomy Prolapse Diagnosed?
- ● MRI of the pelvic floor
- ● Ultrasound
- ● CT scan
- ● Urinary tract X-ray
How is Post-hysterectomy Prolapse Treated?
- ● Observation: If the symptoms of prolapse are less, you do not need any special treatment. Try to do pelvic exercises as this strengthens the pelvic muscles and may reduce the symptoms of prolapse. Methods of treatment include other similar self-care such as not lifting weight and avoiding constipation.
- ● Pessary: It is a device that can be of silicon, rubber, or plastic. It provides support to the organ bulging out of the vagina. A pessary can help treat rectocele, cystocele, enterocele, and vaginal vault prolapses. The pessaries come in many styles and shapes. Your doctor will do the calculation of what size will fit best. Apart from this, doctors will also tell you how to apply it and how to clean it.
- ● Surgery: There are several ways to treat pelvic prolapse surgically. The doctor may perform the surgical procedure via the vagina or the abdominal route. Robotic surgery is also an option.
The main objective of this surgery is to keep the protruding tissue in its correct position. Then, the surrounding pelvic muscles are tightened. A synthetic mesh helps to prevent re-prolapse. This mesh provides strength to the weak tissues and reduces the possibility of re-prolapse.
What are the Risks Associated with Post-hysterectomy Prolapse treatments?
- ● Obesity
- ● Cancer of any pelvic organ
- ● Chronic constipation
- ● Chronic cough or respiratory disease
- ● Hard stretch exercise
What are the preventive measures for Post-hysterectomy Prolapse?
- ● Maintain a healthy weight.
- ● Do pelvic exercises to strengthen the pelvic floor.
- ● Avoid constipation.
- ● Do not drink or smoke. It may cause chronic cough and also weaken the pelvic floor.
- ● Avoid heavy lifting.
Post-hysterectomy Prolapse is a severe condition in which pelvic organ prolapse occurs. A hysterectomy involves detaching the pelvic muscles from the uterus. The surgery weakens the pelvic organs and allows the organs to prolapse.
Some precautionary measures can prevent Post-hysterectomy Prolapse. There are many types of surgical and nonsurgical treatments available to treat post-hysterectomy prolapse.