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Repair of Vaginal Wall Prolapse (Vaginal Vault Prolapse)

Repair of Vaginal Wall Prolapse (Vaginal Vault Prolapse)

Surgery Overview

Vaginal vault prolapse occurs when the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or outside of the vagina. It may occur alone or along with prolapse of the bladder (cystocele), urethra (urethrocele), rectum (rectocele), or small bowel (enterocele). Vaginal vault prolapse is usually caused by weakness of the pelvic and vaginal tissues and muscles.

Symptoms of vaginal vault prolapse include:

  • Pelvic heaviness.
  • Backache.
  • A mass bulging into the vaginal canal or out of the vagina that may make standing and walking difficult.
  • Involuntary release of urine (incontinence).
  • Vaginal bleeding.

During surgery, the top of the vagina is attached to the lower abdominal (belly) wall, the lower back (lumbar) spine, or the ligaments of the pelvis. Vaginal vault prolapse is usually repaired through the vagina or an abdominal incision and may involve use of either your tissue or artificial material.

What To Expect After Surgery

General anesthesia is usually used for vaginal vault prolapse repair. You may stay in the hospital from 1 to 2 days. You will probably be able to return to your normal activities in about 6 weeks. Avoid strenuous activity for the first 6 weeks. And increase your activity level gradually.

Most women are able to resume sexual intercourse in about 6 weeks.

Why It Is Done

Repair of a vaginal vault prolapse is done to manage symptoms such as sagging or drooping of the top of the vagina into the vaginal canal, urinary incontinence, and painful intercourse.

Vaginal vault prolapse often occurs with other pelvic organ prolapse. So tell your doctor about other symptoms you may be having. If your doctor finds prolapse of other pelvic organs during your pelvic exam, that problem may also be repaired during surgery.

Your doctor may do an examination while you have a pessary in your vagina. This exam will help him or her see if urinary incontinence would be a problem after surgery. If the exam shows that urinary incontinence will be a problem, another surgery can be done at the same time to fix the problem.

How Well It Works

There are many surgical ways to fix a vaginal vault prolapse. The kind of surgery you have will depend on the doctor performing it, where you have it done, and your unique health situation. Experts disagree about which surgery gives patients the best results.footnote 1

Risks

Complications of surgery for vaginal vault prolapse are uncommon but include:

  • Bleeding.
  • Mild buttock pain for 1 to 2 months following surgery.
  • Urinary incontinence.
  • Urinary retention.
  • Infection.
  • Formation of an abnormal opening or connection between organs or body parts (fistula).

What To Think About

Surgical repair may relieve some, but not all, of the problems caused by a vaginal vault prolapse. If pelvic pain, low back pain, or pain with intercourse is present before surgery, the pain may persist after surgery. Symptoms of urinary retention may return or get worse following surgery.

You can control many of the activities that may have contributed to your vaginal vault prolapse or made it worse. After surgery:

  • Avoid smoking.
  • Stay at a healthy weight for your height.
  • Avoid constipation.
  • Avoid activities that put strain on the lower pelvic muscles, such as heavy lifting or long periods of standing.

References

Citations

  1. Lentz GM (2012). Anatomic defects of the abdominal wall and pelvic floor. In GM Lentz et al., eds., Comprehensive Gynecology, 6th ed., pp. 453–474. Philadelphia: Mosby Elsevier.

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