Reducing the risk of vaginal vault prolapse after hysterectomy

When a hysterectomy takes place it is important that the vagina is reattached to what is called the uterosacral-cardinal ligament complex. Despite this, some women may experience what is called a vaginal vault prolapse following their hysterectomy. Vaginal vault prolapse following hysterectomy is more common in women who have had children naturally because their pelvic floor muscles are weaker from the birth process, this is also the reason why women who have given birth naturally are more likely to suffer other types of prolapse as well. It is thought that up to 40% of such women could be affected.

Before a hysterectomy the bladder, urethra, vagina and uterus are all attached to the pelvic walls by a system of connective tissue that has been called the endopelvic fascia which includes the broad ligaments. When the uterus is removed an element of this supportive structure is also removed. All the abdominal organs are supported by the pelvic floor, a large sling (or hammock) of muscles and other tissues stretching across the floor of the pelvis.

In a vaginal vault prolapse, the top of the vagina gradually falls toward the vaginal opening. Eventually, the top of the vagina may protrude out of the vaginal opening, effectively turning the vagina inside out. A vaginal vault prolapse is often accompanied by the weakness and prolapse of walls of the vagina.

Surgical techniques for vaginal vault prolapse

Surgery for vaginal vault prolapse makes use of the pelvic supporting structures (uterosacral and cardinal ligaments) to support the vaginal cuff. A common surgical technique is known as a sacrocolpopexy. This is where the vagina is attached to the strong ligament and backbone using a mesh.

Preventing vaginal vault prolapse post hysterectomy

The key to avoiding a vaginal vault prolapse, and any other abdominal prolapse for that matter is to strengthen the pelvic floor and that can be achieved through the pelvic floor exercises, also known as the Kegel exercises.

How to do pelvic floor muscles

  • Tighten the muscles around your anus, vagina and ureter lifting up and squeezing as if you’re trying to avoid passing wind and urine at the same time. Make sure you don’t squeeze your legs or buttocks together.
  • Hold the contraction for as long as you can, then rest and repeat the process. Try working up to 10 repetitions at a time and increasing the length of time you hold the contraction as well.
  • When you are confident about the controlled contraction exercises you can follow with quicker contractions where you hold your muscles in for just 1 second at a time and release. Work up to 10 repetitions.
  • Perform one set of each type of contraction three or four times daily.

These are exercises for life and should be performed daily.

Other ways of strengthening the pelvic floor muscles include using vaginal cones. These are inserted into the vagina using the pelvic floor muscles to keep them in place. However, if you are already suffering from anything more than a minor prolapse you won’t be able to use them.

You can also use electrical stimulation of the muscles with pelvic floor toners such as the Kegel 8. These devices use electrical impulses via a probe inserted into the vagina or pads on the back or ankle to create contractions with the pelvic floor.

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