Women's Health Services | Prolapse Surgery

Prolapse Conditions  |  Hospital Stay  |  Post Surgery  |  FAQs  |  Specialists

Pelvic organ prolapse means that the uterus and/or the vagina have fallen down from its normal position in the pelvis.

Prolapse Surgery

This prolapse is probably caused by injuries sustained during childbirth, aging, a woman's tissue composition, chronic coughing and heavy lifting.  

Prolapse Conditions 

Dropped Bladder
Normally there is a ‘hammock’ (we call it a layer of ‘fascia’) that lies between the bladder and the vagina, and supports the bladder. When this ‘hammock’ stretches or tears, then the bladder bulges or presses into the vagina. You may feel this as a ‘bulge’ coming down into the vagina, and/or you may notice vaginal pressure or pulling. When the bladder is dropped very low, you may have trouble going to the bathroom. You may have to ‘push’ the bladder back up in order to start the urine stream.

Surgery attempts to restore that ‘hammock’. Sometimes if the ‘hammock’/tissue is just torn, we can sew it back together with stitches. Sometimes if the ‘hammock’/tissue is very weak and damaged, we substitute it with a graft and ‘replace’ your hammock. The graft may be made of porcine (pig) skin or intestine, or human cadaver skin. This material is used for other surgeries such as hernia repairs or orthopedic procedures, too. The graft may also be a mesh (similar to nylon) material (most often used in hernia repairs.)

The way we do the surgery is to make an incision (make a cut) in the lining of the vagina under the bladder. We find the torn edges of your hammock and sew them back together. We then sew the vaginal lining back together. If your ‘hammock’ is very weak and poor quality then we may place a graft between the bladder and vagina. We then sew the vaginal edges closed again so that the graft is completely covered. Usually the graft is anchored to the muscles of the pelvic floor.

Generally this surgery is not very painful. You may feel as if you have been ‘riding on a horseback’. You will have some discomfort and pain, so please do not hesitate to take pain medication.

Bulging Rectum
The rectum lies underneath the vagina. Normally there is a layer/‘hammock’ (we call it ‘fascia’) between the vagina and the rectum that keeps the rectum flat. When this ‘hammock’ tears or stretches, then the rectum ‘pouches’ or ‘bulges’ into the vagina. You may notice this as a ‘bulge’ in the vagina that you see or feel when you wipe with the toilet paper. Or you may have a tough time getting the stool out during a bowel movement. You may feel as if the stool gets ‘stuck’ in the rectum. You may need to press and push with your hand to get the stool out.

Surgery attempts to restore that ‘hammock’. Sometimes if the ‘hammock’/tissue is just torn, we can sew it back together with stitches. Sometimes if the ‘hammock’/tissue is very weak and damaged, we substitute it with a graft and essentially replace your hammock. The graft may be made of porcine (pig) skin or intestine, or skin from a human cadaver. This material is used for other surgeries such as hernia repairs or orthopedic procedures, too. The graft may also be a mesh material (most often used in hernia repairs.)

The way we do the surgery is to make an incision (make a cut) in the lining of the vagina above the rectum. We find the torn edges of your hammock and sew them back together. We then sew the vaginal lining back together. If your ‘hammock’ is very weak and poor quality then we may place a graft between the rectum and vagina. We then sew the vaginal edges closed again so that the graft is completely covered. Usually the graft is anchored to the muscles of the pelvic floor.

Vaginal Suspension
The top of your vagina has dropped! Normally, there are ‘ligaments’ that hold the vagina up in normal position. These ligaments attach from the top of the vagina towards the back-bone. When these ligaments stretch or break, then the top of the vagina begins to drop.

Sometimes when the top of the vagina drops, it pulls some of the intestines down with it! (called an ‘enterocele’ or ‘bowel-hernia’). You may feel a vaginal bulge and you may have a vaginal ‘ache’ or discomfort.

The way we do the surgery is to open up (make an incision) the lining of the vagina and re-attach it to the ligaments that are supposed to hold the vagina up. Sometimes we have to push the intestines up and out of our way to find the ligaments. Sometimes we have to put some additional stitches in place to prevent the intestines from dropping down again. When this is the case, you may feel very ‘gassy’ after the surgery is done.

Sometimes, the ligaments that were supposed to hold the vagina up are so very weak, that we need to find a different ligament to use (called the ‘sacrospinous-ligament’). This ligament lies near the buttock/ rear-end muscles so that you may have some pain-in-the-rear-end after the surgery!

Dropped Uterus
Your uterus has ‘dropped’. This is usually a result of vaginal childbirth. It has happened because the normal ligaments that support or ‘hold-up’ the uterus have stretched or torn. You may feel or see a bulge in the vagina. When the uterus is very dropped, you may need to push it back up to make yourself more comfortable.

We will do a vaginal hysterectomy (remove the uterus and cervix through the vagina.) This means there will be no incisions or scars on your abdomen. The vaginal approach makes it easier for you to recover after surgery. You will be able to walk more easily and eat more quickly with less pain.

Once the uterus is removed, we cannot just stop there. We then need to put some additional stitches in to support the top of the vagina, so that the top of the vagina doesn’t drop in the future! We need to re-attach the top of the vagina back up to the ligaments that will hold it in place. Sometimes we also put some stitches in to prevent the bowel from dropping in the future, now that the uterus is no longer there.

Back to Top


Hospital Stay

You will likely be in the hospital 1 night after this kind of surgery.

Risks of surgery include, but are not limited to, injury to internal organs (such as bladder, ureters (which are the tubes that bring the urine from the kidneys into the bladder), bowel, blood vessels, nerves, bleeding that requires transfusion, complications from the graft that may require re-operation, infection and failure of the procedure.

We are all very skilled surgeons, but sometimes surgery can be very difficult since anatomy may be very distorted. You will receive antibiotics through the IV in order to try and prevent infection. We look inside your bladder (cystoscopy) to make sure there are no stitches or holes in the bladder, and that both ureters are working properly. Your legs/hips/back may be sore and stiff from the position you are in during the surgery (your legs are raised so that we can have space to operate in the vagina.)

Bladders are not easy to re-support perfectly. The success rate of this surgery is approximately 85%. This means that for every 100 women who have this surgery, 85 will have acceptable results. Fifteen out of the 100 women will have the bladder ‘drop’ again, (time frames range from 1 year to 10 years after the initial surgery) although it may be mild and may not require a second surgery

During your hospital stay after this type of surgery, you will have a catheter tube in the bladder that drains the urine from the bladder into a bag. This catheter will be left in overnight (sometimes we keep it in 2 nights) while you are in the hospital to allow the bladder to rest. Before you leave the hospital, we check to see if you are able to pass your urine easily or not. The nurses will do “voiding-trials”. They will fill your bladder (through the catheter tube) with sterile water until you feel a strong urge to go to the bathroom. Then, they remove the catheter and have you try to empty your bladder in the bathroom like usual. If you are able to empty most or all of the water that they put into the bladder, then you “PASS!” your voiding trial. If not, the nurses may try again, or they may put the catheter tube back into your bladder.

About half of our patients are NOT able to pass their urine after surgery, so don’t feel too badly if you are not able to. Sometimes there is a lot of swelling around the bladder, and sometimes the effect of the anesthesia slows down bladder function. If you are not able to pass your urine, you may need to go home with a catheter, but this is temporary and usually not more than 5-7 days. The nurses will teach you how to manage the catheter; it is usually not difficult. If you go home with the catheter tube, we will also send you home with a prescription for antibiotics, to try and prevent you from getting a bladder infection while the catheter tube is in place.

Back to Top


Post Surgery

There will be many stitches in the vagina after this surgery. The stitches will dissolve on their own and do not need to be removed. The stitches take approximately 4-8 weeks to dissolve. As long as they are there you will notice occasional vaginal bleeding or spotting. You may also see some brownish and yellowish discharge that does have a strong odor to it.

This is normal for approximately 4-6 weeks. You do not need to be concerned about this as it is normal. If, however, you have heavy bright red vaginal bleeding that is soaking your pad and does not seem to be stopping, then please call our office.

Usually (but not always), patients who have to go home with the catheter tube in place do NOT have to wear a bag. We show you how to ‘plug’ the end of the catheter tube so that you are not hooked up to a bag. The plug allows the bladder to fill with urine. When you feel the urge to go to the bathroom (this may be after 2-3 hours or so), then you go to the bathroom, sit on the toilet bowl, and un-plug the catheter tube and drain the urine into the toilet bowl. When the catheter stops draining the urine, you just plug it back up. You may hook the catheter tube to a bag for overnight drainage so that you can sleep better through the night if you choose to.

If you are sexually active, please refrain until 8 weeks after surgery. The stitches all need to dissolve. Things will likely feel different for you. Initially, you may experience discomfort because you just had surgery there! Please use some kind of lubricant like KY Jelly, Astroglide or Replens. It may take a few months before you’re comfortable with sexual activity.

Back to Top


Frequently Asked Questions

Q: Can I use stairs?
A: You may go up and down stairs, but limit yourself to no more than 4 times per day for the first 2 weeks.

Q: What are my limitations on bathing?
A: No baths for 4 weeks but showers are fine as soon as you get home.

Q: Can I exercise and swim?
A: No swimming / exercising / weight lifting for approximately 4-6 weeks. If you are a member of a gym, hold your membership for 6-8 weeks.

Q: Is walking okay?
A: Walking is good: walk daily. Start slowly (no more than 10 minutes as a time) and build up to your usual routine over 6 weeks.

Q: How long will I be out of work?
A: Time out of work depends on whether you just had this one procedure done, or if you have had other prolapse surgeries done at the same time. Also, depending on the type of job you have may allow you to return to work sooner or later. The rough estimate is anywhere from 4-8 weeks. Your physician will tell you how long you should expect to be out of work.

Q: Can I drive?
A: You may not drive for approximately 1-2 weeks, but you may be a passenger in a car immediately. If you are still taking narcotic medication, then you should not be driving.

Q: What type of pain medication will I need?
A: For vaginal surgery, you may require narcotic medication for approximately one week. For any abdominal or laparoscopic surgery, you may require narcotic medications for about 2-3 weeks. You may take NSAID’s (ibuprofen, Motrin, Advil, Aleve) or acetaminophen (Tylenol) for up to 3 months after surgery if needed.

Q: Can I have sex?
A: If you are sexually active, please refrain until 8 weeks after surgery. The stitches all need to dissolve. Things will likely feel different for you. Initially, you may experience discomfort because you just had surgery there! Please use some kind of lubricant like KY Jelly, Astroglide or Replens. It may take a few months before you’re comfortable with sexual activity.

Q: Is it safe for me to travel?
A: Air travel should be avoided before 6 weeks, as there may be an increased risk of developing blood clots in the legs and/or lungs after pelvic surgery. This risk may be worsened with air travel. If you are planning a trip that requires air travel, do not plan to fly until at least 6 weeks after your surgery. If you call to ask if you can fly sooner, we will tell you “no”, or “do so at your own risk.”

Back to Top


Physicians specializing in Prolapse Surgery

Name Specialties Location
Kershen, Richard Todd, MD
860.947.8500
  • Urology
  • Female Pelvic Medicine and Reconstructive Surgery
  • Reconstructive Urology
  • Urogynecology
Show Less
  • West Hartford
  • Plainville
Show Less
LaSala, Christine Ann, MD, FACS, FACOG, FFPMRS
860.972.4338
  • Female Pelvic Medicine and Reconstructive Surgery
  • Urogynecology
Show Less
  • Hartford
  • Avon
  • Glastonbury
Show Less
Steinberg, Adam C., DO, FACS, FACOG, FFPMRS
860.972.4338
  • Female Pelvic Medicine and Reconstructive Surgery
  • Urogynecology
Show Less
  • Hartford
  • Avon
  • Glastonbury
  • West Hartford
Show Less
Tulikangas, Paul Kevin, MD, FACOG, FACS, FFPMRS
860.972.4338
  • Female Pelvic Medicine and Reconstructive Surgery
  • Urogynecology
Show Less
  • Hartford
  • Avon
  • Glastonbury
  • West Hartford
Show Less
Tunitsky-Bitton, Elena, MD, FACOG, FFPMRS
860.972.4338
  • Female Pelvic Medicine and Reconstructive Surgery
  • Urogynecology
Show Less
  • Hartford
  • Avon
  • Glastonbury
  • West Hartford
Show Less

Women's Health Services


Expecting?

Women's Health Services Newsletter Ad

Sign up now for a free weekly email for expectant & new parents.

Sign Up