Vaginal Hysterectomy for Prolapse
Prolapse of the uterus (or womb) and vaginal walls is a condition which affects many women during their lifetime. Around 11% of women will need to undergo surgery to correct the problems occurring due to prolapse.
Prolapse occurs for a number of reasons, including childbirth, damage from heaving lifting or excessive straining (for example from constipation), through chronic coughing, or simply due to the ageing process or being obese. In some cases, there is an underlying genetic cause which results in weakening of the supportive tissues around the vagina.
Common symptoms of prolapse is a dragging, heavy, full feeling and a bulge down past the vaginal opening. In advanced cases of prolapse, the cervix can even bulge down past the vagina entrance.
This is the surgical removal of the uterus, through the vagina. It is frequently carried out in combination with other forms of treatment for prolapse, including bladder repair.
This procedure is carried out under general anaesthetic, or spinal anaesthesia, which can be with/without sedation. During the surgery an incision is made around the cervix. The surgeon will then move the bladder and bowel away from the uterus. The blood vessels of the uterus and the tissue around it are clamped, cut and tied up. The surgeon will then remove the uterus and stitch the top of the vagina closed – this is called the vaginal vault.
Your surgeon might decide to include additional supporting stitches, which are attached to the vaginal vault during surgery. These are attached to the uterosacral ligaments and work to give the uterus extra support (named uterosacral ligament suspension), or to support the structures at the side of the uterus (sacrospinous ligament suspension or ileococcygeus suspension). In some cases, the ovaries are removed, but this is only if it is totally necessary to do so.
Your doctor will discuss exactly how they are going to carry out your individual surgery, based on your particular requirements.
Preparing for vaginal hysterectomy
Your doctor will carry out a full medical history and check-up. You may be required to undergo several tests, including scans, x-rays and blood tests to ensure you are healthy and suitable for the procedure.
It is advised that patients stop taking blood-thinning medicines like Aspirin before undergoing surgery, because these can cause excessive bleeding or bruising during or after the surgical procedure.
You might also be asked to prepare your bowels before the surgery. All of this will be discussed properly with patients beforehand.
You will wake up in the hospital with a drip in your arm and, in some patients, a catheter attached to the bladder. Some people will also have a pack placed on the vagina which helps to compress the bleeding and bruising which often occurs during this type of surgery. These are normally removed within 48 hours.
Most patients will be able to eat and drink straight after the operation. You will also be prescribed with anti-nausea medication and pain relief. Most patients will be in the hospital for 1-3 days.
A creamy, brownish discharge, which is sometimes bloody too, is common for up to six weeks, and will gradually disappear as the stitches begin to absorb.
It is important to keep moving around after you have undergone a vaginal hysterectomy surgery because immobility can lead to blood clots in the legs. As such, light walking and house work can be carried out, but patients should not undergo strenuous activities such as exercise and heavy lifting for the first six weeks, so that you can properly heal.
It is common for people to feel fatigued after the surgery, so you should make sure you get lots of rest for the first few weeks. Most people will be off work for between 2-6 weeks, but this depends on the extent of the surgery and the nature of your work.
Sexual intercourse is not recommended for the first six weeks after surgery, and only then if the patient feels up to it.
The success rates for vaginal hysterectomy are very positive, with 85% of women being permanently cured of their uterine prolapse. The remaining 15% will experience vaginal vault prolapse again in the future.
All surgical procedures carry some type of risk. For vaginal hysterectomy, these include:
- Anaesthetic issues, but this is very rare.
- Clots, also known as embolism, can occur after pelvic surgery in the legs or lungs. However, this is rare and can the risks can be reduced by wearing support stockings and taking blood thinning medication.
- Severe blood less and hematoma. There is a small chance (0-10%) of blood loss which requires blood transfusion occurring. 10% of women undergoing this type of surgery will develop a haematoma, which is a small collection of blood around the vaginal vault. In most cases, this will clear within 7-10 days, but some people may need to have it drained surgically.
- Infection in/around the vagina or pelvis can occur and is normally noticeable by a foul smelling discharge and a fever.
- Around 6-20% of women will get a urinary tract infection, but this is more common in those who have had a catheter fitted too.
- Organ injury – up to 2% of those who have undergone a vaginal hysterectomy may experience complications which result in damage to nearby organs; the bladder, ureters or rectum. A very rare risk is the development of a vaginal fistula.
- 10-15% of people experience difficulties when trying to pass urine can occur for the first few days following the procedure, which is why a catheter might be fitted to help pass urine.