Vaginal Hysterectomy

Dear Alice,

I am about to have a vaginal hysterectomy. I have heard that your stomach and intestines can drop causing you to have a big pouch. What are the reasons for them to drop, how can you avoid it, and is there anything that can be done if it does happen?

Dear Reader,

Having a vaginal hysterectomy is certainly a noteworthy procedure that carries some risk and side effects. Yet with vaginal hysterectomies, standard surgical protocol involves securing the space of the uterus being removed to ensure that the intestines and surrounding organs stay in place and do not drop down.

Vaginal hysterectomies are advised as a remedy to a number of different female-specific medical conditions, including endometriosis, uterine fibroids, chronic pelvic inflammatory disease, or heavy, debilitating menstrual periods. Vaginal hysterectomies are a way to perform a hysterectomy that avoids an external incision, because the uterus is removed through the vagina. As the uterus and cervix are removed, blood vessels are tied off to effectively "close" the area, thus preventing the intestines from dropping down into the uterine space. This technique also prevents infection of the uterine cavity and surrounding organs.

For some women undergoing hysterectomies, a condition called vaginal vault prolapse may be a concern, which sounds like the condition you are describing. Because the uterus provides muscular support for the top of the vagina, its removal may cause the top of the vagina to slowly fall towards the vagina opening. Vaginal vault prolapse is one of many possible side effects of hysterectomies along with another type of prolapse called enterocele, or a herniated small bowel. When this type of prolapse occurs, it may cause the intestines to push against the vaginal skin. With either condition, there is no indication that, even if you were to develop it, would result in a visible pouch on the outside of your body. As is the case with any surgery targeting a specific part of the body, focused exercise may help with recovery from your hysterectomy. You may want to have a conversation with your surgeon about vaginal muscle exercises you can do post-operation.

Along these lines, before having your hysterectomy, it is essential to discuss concerns and possible complications with your primary health care provider and your surgeon, if possible. While talking openly with a specialist or surgeon may not be the easiest about such a sensitive area of your body, doing so will equip you with necessary knowledge that is likely to speed your recovery. Check out What You Need to Know About a Hysterectomy from the Cleveland Clinic for complete information about hysterectomies. Also see Hysterectomy: Frequently Asked Questions from womenshealth.gov, a comprehensive health information site for women.

Gathering knowledge about any possible side effects pre-operation will help you recover more quickly and easily. Best of luck with your procedure.

Last updated Mar 27, 2015
Originally published Jul 09, 2010

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