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Prolapse and the pelvic floor after a hysterectomy | CION Cancer Clinics
Prolapse can happen after a hysterectomy, but for most women it does not. It usually appears years later, not weeks, and it is far more likely in women whose pelvic floor was already weak before the operation. This page explains what holds everything up, what strains it, the one sign that needs same-day care, and the exercises that lower the risk. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Can things drop down after a hysterectomy?
- Five things that push the pelvic floor down
- How to find and strengthen the pelvic floor
- When to start what after the operation
- Four things women tell us, and what is actually true
- What this page cannot tell you, and what to ask
- Common questions about prolapse and the pelvic floor
The short answer
Can things drop down after a hysterectomy?
They can, but for most women they do not. Prolapse after a hysterectomy means the top of the vagina, or the bladder or bowel next to it, sags down into the space the womb used to fill. It is uncommon, usually appears years rather than weeks later, and is far more likely if the pelvic floor was already weak before the operation.
What holds everything up
The pelvic floor is a sling of muscle running from the pubic bone at the front to the tailbone at the back. Ligaments above it tie the womb, bladder and bowel to the pelvis. When the womb is removed, the surgeon stitches the top of the vagina to those same ligaments. The muscle sling underneath is yours to keep strong.
Who is more at risk
Women who have had several vaginal births, who already had some sagging before surgery, who are heavily built, who strain on the toilet or who have a long-standing cough carry more risk. Age and low oestrogen add to it. If none of these apply to you, the chance is small, though never zero.
Radiotherapy after the operation can weaken tissue. Your team will tell you if that applies to you.What strains the floor
Five things that push the pelvic floor down
Most of these are within your control. That is the good news on this page.
Constipation and straining
Pushing hard on the toilet forces everything in the pelvis downward, against healing stitches. Pain medicines after surgery make constipation worse, so manage it from the first week.
What helps
- Water, fruit and vegetables every day
- A stool softener if your surgeon suggests one
- Feet on a low stool, elbows on knees
Heavy lifting too soon
Lifting a bucket of water, a grandchild or a gas cylinder raises pressure inside the belly, and in the early weeks that lands on the healing top of the vagina. Ask your surgeon what weight is reasonable, and for how long.
A long-standing cough
Every cough is a downward push. Smoking, asthma and untreated allergies keep the floor under strain all day. Treating a cough protects the pelvis as much as the chest.
Body weight
Extra weight around the middle presses down on the pelvic floor constantly. Losing even a little, once you are cleared to move, lowers the load.
Low oestrogen
After menopause, or after the ovaries are removed, the tissues of the vagina and pelvic floor become thinner and less elastic. Your oncologist can say whether a local oestrogen cream is an option for you.
Not sure whether this applies to you?
Ask an oncologist
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One thing that cannot wait
A sudden gush of watery fluid or fresh blood from the vagina, sharp pain low in the belly after straining or sex, or something soft appearing at the opening of the vagina in the weeks after surgery can mean the stitched top of the vagina has opened. Go to the nearest emergency department the same day and say you have had a hysterectomy. Do not push anything back, and do not wait to see if it settles.
The exercise that matters
How to find and strengthen the pelvic floor
Find the muscles
Sit or lie down. Imagine you are stopping yourself passing wind, then stopping the flow of urine at the same time. The feeling is a lift and squeeze inside, not a push. Your belly, thighs and buttocks should stay relaxed.
The long hold
Squeeze and lift, hold for as long as you can while breathing normally, then let go fully. Rest for the same length of time. Build the hold up gradually over weeks. Letting go completely matters as much as the squeeze.
The quick squeezes
Now squeeze and release quickly, several times in a row. These train the muscles to react when you cough, sneeze or lift, which is when leaks and strain happen.
Make it a habit
Do a set of long holds and quick squeezes a few times a day, tied to something you already do, such as after each meal. Nobody can see you doing them. Most women feel a difference in a few months, not days.
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Stage by stage
When to start what after the operation
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In hospital
Deep breathing, moving your ankles and walking to the toilet and back. Gentle pelvic floor squeezes are usually fine once the catheter is out, but ask your surgeon or physiotherapist first.
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The first weeks at home
Short walks, growing a little each day. No heavy lifting, no straining and no exercise that makes you hold your breath. Keep motions soft. This is when the top of the vagina is healing.
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After your surgeon clears you
Usually at the first follow-up visit. Pelvic floor exercises become a daily habit. Walking gets longer. Housework returns in stages, lightest tasks first.
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The months that follow
Swimming, cycling and yoga are usually fine once cleared. Heavy weights, sit-ups and jumping put the most pressure on the floor, so ask before returning to them. A pelvic floor physiotherapist can check your technique.
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Years later
Prolapse, if it comes, usually comes late. A dragging or bulging feeling, or a lump at the vaginal opening, needs a check but is not an emergency. The exercises remain useful for life.
Commonly believed
Four things women tell us, and what is actually true
"Once the womb is gone there is nothing left to fall down."
The bladder, the bowel and the top of the vagina are still there, and any of them can sag if the floor beneath weakens. Removing the womb does not remove the need to look after the pelvic floor.
"Pelvic floor exercises are pointless after surgery."
They matter more, not less. The muscle sling is the one support you can strengthen yourself. Done properly and regularly, the exercises reduce leaks, ease the dragging feeling and lower the chance of prolapse getting worse.
"A prolapse means the surgeon did a bad job."
Prolapse years later reflects the tissue you were born with, the births you have had and the strain the floor has carried since, far more than the operation. It is a known long-term possibility after any hysterectomy.
"I must never lift anything again."
Not true. The restriction is for the healing weeks. After that, lifting with a tight pelvic floor and a straight back is part of normal life. What to avoid long term is repeated heavy straining.
Being straight with you
What this page cannot tell you, and what to ask
This page cannot tell you whether you will develop a prolapse. Nobody can. It can tell you the chance is small for most women, and that a prolapse, if it comes, can be treated.
If a prolapse does happen
The usual signs are a dragging feeling, a bulge you can feel or see at the vaginal opening, trouble emptying the bladder or bowel, or a sense that something is in the way. Pelvic floor physiotherapy is the first treatment. A soft ring called a pessary, fitted in clinic, holds things up without an operation. Surgery exists for the minority who need it.
Questions worth asking your surgeon
Ask when you may start pelvic floor exercises. Ask what weight you may lift, and from when. Ask whether radiotherapy is planned, because it changes the advice. Ask whether a pelvic floor physiotherapist is available.
Leaking urine when you cough or laugh in the first months is common and usually improves with the exercises. Mention it at follow-up rather than putting up with it.Questions we are asked
Common questions about prolapse and the pelvic floor
How likely is a prolapse after hysterectomy?
Uncommon for most women, and usually years away if it comes at all. The risk is higher if you already had some sagging before the operation, have had several vaginal births, are heavily built or strain often. Your surgeon, who has examined you, can say where you sit.
What does a prolapse feel like?
A heavy, dragging feeling low down, worse by evening or after standing a long time. Some women feel or see a soft bulge at the vaginal opening. Others notice the bladder does not empty fully, or that they need to press near the vagina to pass a motion.
When can I start pelvic floor exercises?
Gentle squeezes are often fine within days, once the catheter is out, but ask your surgeon or physiotherapist before starting. Build up gradually. The exercises should never hurt or make you strain. If you cannot feel the muscles working, ask a physiotherapist to check.
I am leaking urine when I cough. Is that a prolapse?
Usually not. Leaking with a cough, sneeze or laugh in the early months is common after pelvic surgery and comes from a tired, bruised pelvic floor. It generally improves with the exercises. If it is not improving by your follow-up, say so, because there are other treatments.
Can I carry my grandchild or a bucket of water?
Not in the first weeks, while the top of the vagina heals. After your surgeon clears you, lift with a tight pelvic floor, bent knees and a straight back, and keep the load close to your body. Your surgeon will say what weight is sensible.
Does radiotherapy make prolapse more likely?
Radiotherapy to the pelvis can make the tissues of the vagina and the floor thinner and stiffer over time, which can add to the risk. Your team will tell you if it applies to you. Dilators and the exercises help keep the tissue supple.
Can a prolapse be fixed without another operation?
Often, yes. Pelvic floor physiotherapy improves mild prolapse and the symptoms that go with it. A pessary, a soft ring placed in the vagina in clinic, supports the walls and can be used for years. Surgery is kept for women these do not help.
Is pelvic floor physiotherapy available in Hyderabad?
Yes, though not every centre has a physiotherapist trained in it, so ask specifically. It is usually a short series of sessions with a home programme. Call the helpline and we will tell you what is available through your nearest CION centre.
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Sources
- NHS — Pelvic organ prolapse
- NHS — Hysterectomy: recovery
- NHS — Hysterectomy: risks
- Cancer Research UK — Surgery for womb cancer
- Macmillan Cancer Support — Cancer information and support
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Lifting and Housework After HysterectomyWhat you may do, and from whenBladder and Bowel ChangesLeaks and constipation in the early weeksVaginal Cuff HealingThe stitched top of the vagina and how it healsComplications and Red FlagsEvery sign after surgery that needs a same-day callRecovery, Eating and Getting Back to LifeThe bigger picture of recovering from cancer surgery
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Worried about a dragging feeling or a bulge?
Call the helpline or send us a message. A member of the gynaecological oncology team will tell you whether it needs a visit and how soon. One helpline serves every CION centre.