Vaginal vault prolapse: causes, symptoms, and treatment after hysterectomy

It is normal to have some discomfort as you recover from a hysterectomy, a major surgery that removes the uterus (and sometimes also the ovaries and uterine tubes). Temporary bladder, bowel, and pelvic floor changes are almost expected after this type of procedure. But if you notice a feeling of heaviness, pressure, or a bulge in your vagina, it can feel concerning. 

One possible cause is vaginal vault prolapse, a condition where the upper portion of the vagina (the “vault”) shifts downward from its usual position, moving towards or out of the vaginal opening. This can create a sensation of fullness or pressure in your pelvis. 

These symptoms can make everyday movements feel uncomfortable, but know that you don’t have to just deal with this discomfort. There are effective ways to reduce symptoms, such as exercise therapy and simple lifestyle adjustments.

Learn what causes vaginal vault prolapse after hysterectomy, along with common symptoms, and practical strategies to manage them, including targeted exercises recommended by Hinge Health physical therapists.

What is vaginal vault prolapse?

Vaginal vault prolapse happens when the upper portion of the vagina, known as the vaginal vault, shifts down from its usual position and moves towards or out of the vaginal opening. This type of pelvic organ prolapse most often occurs after a hysterectomy, because removing the uterus changes the support structures that help hold this area of the vagina in place. 

Vaginal vault prolapse can also occur alongside other types of pelvic organ prolapse, including:

• Cystocele: The bladder presses on the front wall of the vagina, moving it towards or out of the vaginal opening. 

• Rectocele: The rectum presses on the back wall of the vagina, moving it towards or out of the vaginal opening.

• Enterocele: The small intestines move down between the back wall of the vagina and the rectum, or straight down on the upper portion of the vagina.

Causes of vaginal vault prolapse

Vaginal vault prolapse most often develops due to changes in pelvic support after a hysterectomy. Normally, the top of the vagina is held in place by its connection to the uterus. When the uterus and cervix (the lower part of the uterus that connects the uterus to the vagina) are removed, the top of the vagina is stitched closed and usually anchored to surrounding ligaments or the sacrum. 

If those support structures are weakened or strained, the vaginal vault may shift downward over time. “In most cases, the top of the vaginal cuff is anchored to either the sacrospinous or uterosacral ligaments. However, if the cuff is not anchored to a ligament, there is a great chance of it moving downward towards the vaginal opening,” says Dr. McGee. 

Several factors can increase your risk, especially when combined with these structural changes:

• Pelvic floor changes. Your pelvic floor is a group of muscles and connective tissues that support your pelvic organs, stretching from your pubic bone in the front to your tailbone. Like the foundation of a house, your pelvic floor helps support structures above it, such as your vagina, uterus, bladder and rectum. After a hysterectomy, these tissues may lose strength or become less coordinated, which can contribute to symptoms like prolapse.

• Pregnancy and vaginal delivery. Your body is resilient, but sometimes pregnancy and childbirth place more stress on your pelvic floor than your body is equipped to handle. Factors like multiple deliveries, prolonged labor, or delivering a larger baby can affect these support structures and increase your risk of vaginal vault prolapse later on.

• Aging and menopause. As you age, and especially after menopause, estrogen levels decline. This can affect tissue strength and elasticity, making pelvic support structures more susceptible to shift or weaken over time.

• Prolonged pressure on your abdomen. Frequent strain — from chronic coughing, constipation, or heavy lifting when your body isn’t prepared for it — increases pressure on the pelvic floor and can contribute to prolapse.

• Genetics. Some people naturally have more flexible or weaker connective tissue, which can make them more likely to develop pelvic organ prolapse.

Symptoms of vaginal vault prolapse

Symptoms of vaginal vault prolapse after hysterectomy vary depending on severity. Some individuals may not experience any symptoms, while others may notice:

• Heaviness, fullness, or pressure in your pelvis or vagina

• The sensation that something is bulging or falling out of your vagina 

• Painful sex

• Constipation and hard bowel movements

• Urination problems, including leakage (urinary incontinence), the need to pee frequently (urinary frequency), or sudden urges to pee (urinary urgency)

• Lower back or pelvic pain

How movement can help vaginal vault prolapse 

After vaginal vault prolapse, you may understandably be concerned about exercising. But gentle, targeted movement, especially when paired with pelvic floor physical therapy, can help improve pelvic floor support and ease symptoms.

“Pelvic floor physical therapy can help strengthen the pelvic floor and surrounding muscles, which can better support the vaginal walls,” says Ken McGee, PT, DPT, a physical therapist at Hinge Health.

A physical therapist (PT) can also recommend pelvic floor exercises that improve coordination and reduce tension, which can ease symptoms like pelvic heaviness or pressure. These targeted movements may also improve urinary leakage or bowel symptoms connected to vaginal vault prolapse.

Over time, improving how these muscles function can help reduce strain on the pelvic area and support better daily comfort.

How soon after a hysterectomy can you do pelvic floor exercises? 

Everyone recovers from surgery differently. The type of hysterectomy you had and the surgical method (such as abdominal or laparoscopic) can factor into your recovery time. That said, most people can begin gentle pelvic floor exercises around six weeks after a hysterectomy, once cleared by their doctor. As a general rule, always check with your provider before beginning or restarting exercise after hysterectomy.

These exercises work together to improve strength, coordination, and pressure management — all key for supporting your pelvic floor. Kegels and sit-to-stands help you engage these muscles during daily activities, while strengthening exercises like bridges, clamshells, and straight leg raises build support around the pelvis. Breathing exercises, such as diaphragmatic breathing, help reduce strain and improve how your muscles work together, which can make everyday movement feel more comfortable.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for vaginal vault prolapse after hysterectomy

Treatment depends on your symptoms and how much they’re affecting your daily life. Your provider may recommend a combination of pelvic floor physical therapy, targeted exercises, or a vaginal pessary (a device that helps support pelvic organs).  Lifestyle strategies — like managing abdominal pressure and supporting bowel health — can also play an important role in reducing symptoms. Here’s a closer look at these options:

• Try pelvic floor physical therapy and targeted exercises. Targeted exercises can help strengthen and support your pelvic floor muscles, which reduces risk of vaginal vault prolapse after hysterectomy and helps manage symptoms for those experiencing it. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Try a vaginal pessary. A pessary is a removable silicone device that you place inside your vagina to support your pelvic organs and tissues, which can help reduce symptoms. Your provider can fit you for one. Some options are also available over the counter, but it’s a good idea to check with a provider first following a hysterectomy to get clearance before inserting anything into the vaginal canal.

• Ease abdominal pressure. Another way to think of this? Let your breath guide you as you lift things up around your home. Exhale during moments of effort instead of holding your breath and keep objects you're lifting close to your body. (This helps reduce the downward pressure on the pelvic floor.) For example, breathe out as you lift a suitcase or push a heavy door. If you have a chronic cough, treating it can help reduce repeated strain in your pelvic area.

• Manage constipation. Constipation after surgery is common, and it can increase pressure on your pelvic floor. To help keep things moving smoothly, try to eat at least 25-35 grams of fiber daily, preferably from whole foods like fruits, vegetables, beans, and whole grains, and stay well hydrated to support regular bowel movements.

• Ask your doctor about surgery. If your symptoms are severe or don't improve with the treatments above, surgery may be an option. Your provider can help determine which approach is right for you. Two common types of vaginal vault prolapse surgery include:

  • Sacrospinous fixation. This vaginal procedure attaches the top of the vagina to a strong pelvic ligament called the sacrospinous ligament, helping restore support without the use of mesh.

  • Sacrocolpopexy. This procedure, typically done laparoscopically, uses a small piece of mesh to secure the top of the vagina to the tailbone area (sacrum).

When to see a doctor

Vaginal vault prolapse can feel unpleasant or even painful at times, but it is not medically dangerous and can often be managed with treatments like pelvic floor physical therapy. But if your symptoms are severe, getting worse, persistent, causing difficulty with daily activities, or you have more questions, please see a healthcare provider. It’s also a good idea to get care if you have:

• New or unexplained vaginal bleeding

• Severe pelvic or vaginal pain

• Inability to empty your bowel or bladder

• A bulge that is getting larger or more uncomfortable

• Trouble passing urine or stool

PT tip: Your life can still look the same

Vaginal vault prolapse can feel isolating, especially since it’s not something people often talk about. But with the right support, you can stay active and continue doing the things you enjoy.

“Many women with vaginal vault prolapse lead fulfilling lives,” says Dr. McGee. Working with a pelvic floor physical therapist and your healthcare provider can help you find strategies to manage your symptoms, so you can move comfortably, exercise, and maintain intimacy with confidence.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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