Bowel prolapse after hysterectomy

This is a form of pelvic organ prolapse, not the bowel falling out of the body. Symptoms can include vaginal pressure, a bulge, difficulty emptying the bowel, or the need to press around the vagina or perineum to pass stool.

A rectocele occurs when the rectum bulges against the back wall of the vagina. An enterocele occurs when small bowel pushes into the upper vagina, and vaginal vault prolapse means the top of the vagina has lost support after the uterus and cervix were removed.

Constipation, repeated straining, chronic coughing, heavy lifting, childbirth-related pelvic floor injury, and changes in supporting tissues may contribute. A pelvic examination is needed because these problems can overlap and symptoms alone cannot identify the exact type.

Arrange a gynaecology, pelvic floor, or colorectal assessment if a bulge, pressure, or bowel-emptying problem persists. Note when symptoms occur and whether coughing, lifting, constipation, or prolonged standing makes them worse.

Management depends on the prolapse and its effect on daily life. Options may include treating constipation, changing lifting technique, supervised pelvic floor physiotherapy, a vaginal support pessary, or surgery. Avoid repeated straining; use fluids, fibre, movement, and any prescribed bowel medicine to keep stools easier to pass.

Seek urgent medical care for severe or rapidly worsening abdominal or pelvic pain, persistent vomiting, a swollen abdomen, inability to pass stool or gas, heavy vaginal bleeding, fever with feeling very unwell, or tissue outside the vagina that becomes very painful, dark, or cannot be gently reduced.

Book a routine appointment for a new vaginal bulge, repeated incomplete bowel emptying, bleeding from the rectum, unexplained weight loss, or a sustained change in bowel habits. Rectal bleeding and bowel changes need their own assessment rather than being assumed to come from prolapse.

Ask which pelvic structures are affected, whether constipation or another bowel disorder is contributing, whether pelvic floor physiotherapy or a pessary is suitable, and what benefits and risks apply if surgery is considered.