Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed March 2026
Pelvic Organ Prolapse After Hysterectomy
If you’ve had a hysterectomy and are now experiencing pelvic pressure, a vaginal bulge, or a feeling that something is falling out, you may be dealing with vaginal vault prolapse. This occurs when the top of the vagina — which was previously supported by the uterus and its ligaments — loses its support and begins to descend.
Why This Happens
During a hysterectomy, the uterus is removed, but the vagina remains. The ligaments that previously held the uterus in place are the same ones that support the top of the vagina. Over time, if these ligaments weaken, the vaginal vault can descend — sometimes bringing the bladder (cystocele) or rectum (rectocele) with it.
This doesn’t mean your hysterectomy was done incorrectly. Vault prolapse is a known long-term possibility that reflects the ongoing effects of gravity, aging, and tissue changes on the pelvic floor.
Dr. Stewart explains: “Vaginal vault prolapse after hysterectomy is more common than many women realize. The good news is that we have excellent repair options — in many ways, post-hysterectomy prolapse is actually more straightforward to repair because we can focus entirely on supporting the vaginal apex.”
Signs You Should Seek Help
- A feeling of pressure or fullness in the pelvis
- A visible or palpable bulge at the vaginal opening
- Difficulty with bowel movements or feeling of incomplete emptying
- Urinary symptoms — leaking, urgency, or difficulty starting a stream
- Discomfort during physical activity or prolonged standing
- Changes in sexual function
Treatment Options
Conservative:
- Pelvic floor physical therapy to strengthen supporting muscles
- Pessary — a removable device to support the vaginal vault
Surgical:
- Sacrocolpopexy — the gold standard for vault prolapse repair. A mesh graft connects the top of the vagina to the sacral bone, providing durable support. Often performed robotically
- Vaginal vault suspension — native tissue approaches to re-suspend the vaginal apex
Dr. Stewart notes: “Sacrocolpopexy is particularly well-suited for vault prolapse after hysterectomy. It provides excellent, long-lasting support and is one of the most well-studied procedures in urogynecology.”
Your Next Steps
If you’ve had a hysterectomy and are experiencing new pelvic symptoms, don’t hesitate to seek evaluation. These symptoms are treatable, and early assessment gives you more options.
Learn more about pelvic organ prolapse
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