Hysterectomy for Uterine Prolapse

Hysterectomy for uterine prolapse at a glance

  • A hysterectomy for uterine prolapse removes the uterus that has dropped into the vagina.
  • When the symptoms of uterine prolapse become debilitating for a woman and nonsurgical treatments and surgical options to repair the uterus are not appropriate, we recommend hysterectomy.
  • Hysterectomy can be performed through an abdominal incision via minimally invasive approaches (laparoscopy, robotic), open surgery and vaginally. With vaginal surgery, there will be no abdominal incisions or scars.
  • Risks of a hysterectomy include clots forming in the legs or lungs, blood loss, urinary retention, injury to adjacent organs, anesthesia complication and infections including urinary tract infections.
  • A hysterectomy for uterine prolapse will leave a woman unable to carry a child and is only recommended for women who are beyond their childbearing years.

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What is uterine prolapse?

Uterine prolapse is the loss of normal support of the uterus causing it to drop into the vagina. Uterine prolapse is most common in postmenopausal women who have had at least one vaginal delivery.

Mild uterine prolapse often does not cause any signs or symptoms and does not need to be treated. Once a woman’s symptoms start to become bothersome or disrupt normal activities, it is time to see a doctor. Symptoms could include:

  • Tissue protruding from the vagina.
  • Feeling as if something is falling out of the vagina.
  • Sensation of pulling from the pelvis.
  • Having trouble with bowel movements.
  • Urinary leakage or urinary retention.
  • Pain during sex.
  • Lower back pain.

Learn more about uterine prolapse

Hysterectomy for uterine prolapse

Performing a hysterectomy for uterine prolapse removes the uterus that is protruding into, or out of, the vagina. This prolapse does not result in a serious medical condition, but the symptoms for a woman can be both uncomfortable physically and cause emotional feelings of misery.

When a woman’s uterine prolapse is mild, observation may be the best treatment. Kegel exercises, weight loss, pelvic floor therapy and a pessary can work for some uterine prolapse. When these fail, we have surgical options, which can include hysterectomy when the uterus is prolapsing. When the uterus drops, other organs, such as the bladder and the bowels, can sometimes fall with it. To address this, other procedures such as a bladder suspension are often done in combination with a hysterectomy.

A hysterectomy can be completed through an open abdominal, vaginal or laparoscopic surgery. Our surgeons will discuss the positives and negatives of each treatment option before coming to the best option for each patient.

At CU Urogynecology a common type of hysterectomy for uterine prolapse is a vaginal approach, where the uterus is surgically removed through the vagina. This approach is advantageous because it leaves the woman with no abdominal scars.

An open abdominal hysterectomy is done through an incision on the lower section of the abdomen (similar to a C-section incision but smaller). The incision will give the surgeon a clear view of the pelvic organs. This option is used when the uterus is very large or if the patient is expected to have many adhesions in the pelvis from previous surgeries.

The advantage of this procedure is that it allows the doctor to examine and handle the tissues directly for difficult dissections. An abdominal hysterectomy increases the risks of complications, such as bleeding, infections, blood clots and tissue or nerve damage.

Laparoscopic and robotic-assisted hysterectomies only require a few small incisions in the abdomen. In these approaches a small camera is inserted through one of these incisions, which allows the surgeon to see the pelvic organs. Surgical instruments are inserted through the other incisions and the uterus is removed in small pieces.

The advantage of these minimally invasive approaches is the smaller abdominal incisions. A laparoscopic hysterectomy may take longer to perform than an open or vaginal hysterectomy.

Depending on the patient’s medical condition and type of surgery, she will typically be under general or spinal anesthesia, although general anesthesia is used in most cases.

Sometimes the surgeon will place an antiseptic pack in the vagina to prevent bleeding during the surgery. If this option is used, a catheter is also required. Both the pack and the catheter are left in place and removed the next morning.

A hysterectomy for uterine prolapse is frequently combined with prolapse repair of the bladder and/or bowel and sling procedures for urinary incontinence.

Learn more about urinary incontinence

After surgery

When a woman wakes up after surgery, she will be able to eat and drink right way. If needed, we will provide pain and anti-nausea medication. Women should plan for a one night stay in the hospital, depending on their medical conditions. Uterine prolapse surgery patients usually are released when they can pass urine normally.

It is common to feel tired after surgery, so it is helpful to schedule time to rest in the first few weeks. A woman can expect to get back to driving and light walking within a few weeks of surgery. Walking is encouraged to reduce the chance of such complications as blood clots. For 8 weeks after surgery, lifting anything more than 20 pounds is not advised, nor is sexual activity.

For 4-6 weeks after surgery many women experience a creamy, brownish or bloody discharge as a result of vaginal sutures dissolving.

Risks of a hysterectomy for uterine prolapse

As with any surgery there are risks for a hysterectomy for uterine prolapse. Complications may include problems due to the anesthesia, clots forming in the legs or lungs, infection, blood loss, urinary tract infections, urinary retention and injury to adjacent organs.

A hysterectomy will leave a woman unable to carry a child, so this treatment is not recommended for anyone who wants to have children. However, it can be an effective treatment for relieving uterine prolapse symptoms troubling a woman.

Learn more about hysterectomies for non-prolapse cases, such as treating fibroids, from our partners at CU OB-GYN & Family Planning