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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  1. I have had a sacrocolpopexy, three years ago now. Is there any exercise that will put this procedure at risk? I can’t find any information anywhere.

  2. sorry Linda – must have accidentally pressed something on the pc before I finished. I have last night ordered an abdominal belt to help support the lower area around ligaments (I had one after my last pregnancy – big baby, soft ligaments – ouch) and I remember it helped me. It’s position also reminded me to be careful and it impeded bending down! Will some heat/cold help? as I said – meds are not really going to work well for me unless I want to be fainting around the house. I really have learned a lesson and I will share this via another post with others!

  3. I had TAB inc ovaries, fallopian tubs & cervix so quite worried about the support system left in there for organs etc. I had op 30/10 and was recovering as I expected to (thanks to info on this site) although very tired I think in part to blood loss during op.
    My query is regarding ligaments. Day before yesterday I think I overdid it as I was feeling ok on painkillers and I bent quite a few times (washing machine, tumble drier, dishwasher and to get toys off floor for dog). Next day I had excrutiating pains in both sides near site of inner hips and pelvic bone. Now, I had ligament damage many years ago following a motor cycle accident where I landed on my hip and I think I recognise this pulling and burning sensation as being tight/damaged ligaments? Is there anything I can do to help myself? I intend to take to my bed to lie down quite a bit today and for how many days it takes to get an improvement but it hurts even lying down. I do have some codeine that I haven’t used and I think I am going to have to take it. I’m not good on meds – I metabolise them too quickly apparently (makes me hyper and faint

  4. It may be a minor infection that is adding to the problem so would be worth getting it checked out Lesley.

  5. I had a vaginal hysterectomy 6 weeks ago. At first, I seemed to have no control over my bladder. I have done pelvic floor exercises religiously but I have felt so anxious about it. I seemed to have better control about 5 weeks but I am still having leakages. Is this normal or is it a problem I should really be concerned about?

    Many thanks, Lesley.