Recurrent prolapse means that vaginal prolapse has returned after previous treatment, pessary use, or surgery. It may return in the same area as before, or appear in a different compartment of the vagina that was not adequately supported during the original procedure.

Prolapse can return because pelvic tissues remain under strain from ageing, menopause, childbirth history, constipation, chronic cough, heavy lifting, or underlying connective tissue weakness. It does not always mean the original surgery was performed incorrectly. In some cases, the apical (top) compartment was not adequately supported at the time of the original repair, which can cause further prolapse in the front or back wall over time.

No. I will consider non-surgical options first where appropriate, including pelvic floor physiotherapy, vaginal oestrogen, lifestyle modifications, and pessary treatment. Surgery is considered when symptoms are significant and conservative options are not suitable or have not provided adequate relief. The decision is based on your symptoms and priorities, not on examination findings alone.

Yes, it can be. Previous surgery may leave scar tissue that alters tissue planes and makes dissection more difficult. Altered anatomy — for example after hysterectomy or previous vault repair — affects the surgical approach. Recurrent prolapse may also involve bladder, bowel, or sexual symptoms that need to be assessed and addressed as part of the same plan, making pre-operative assessment and planning more detailed than for a primary procedure.

Yes. A pessary can provide mechanical support for the prolapse and may reduce dragging, bulge, or pressure symptoms effectively. It is a useful option if you want to avoid surgery, delay surgery, or test whether supporting the prolapse improves your symptoms before committing to an operation. Pessary fitting for recurrent prolapse may require a different size or type from the pessary used previously.

There is no single best operation for every woman. The appropriate procedure depends on which compartment has prolapsed, what surgery you have had previously, whether the vaginal vault or top of the vagina needs support (apical support), and whether bladder or bowel symptoms are present. In many cases, the correct approach for recurrent prolapse is different from the original procedure — particularly if apical support was not addressed the first time.

Apical support refers to the structural support of the uterus, cervix, or top of the vagina. The apex is the keystone of pelvic floor support. If this area is weak or inadequately repaired, the front and back walls of the vagina are more likely to prolapse again despite previous repair. I assess apical support carefully in all women presenting with recurrent prolapse, as addressing it is often the critical step that was missed in the original procedure.

Yes. Prolapse after hysterectomy is called vaginal vault prolapse. It happens when the top of the vagina loses support and descends. This is one of the most common forms of recurrent prolapse seen in clinical practice. It may develop months or years after the hysterectomy and is treated with specific procedures designed to re-suspend the vaginal vault, such as sacrospinous fixation or laparoscopic sacrocolpopexy.

It can. Some women with recurrent prolapse develop or notice urinary urgency, leakage, difficulty emptying the bladder, constipation, or difficulty emptying the bowel. These symptoms should be assessed carefully before deciding on treatment, as they may influence which procedure is most appropriate and whether additional investigations such as urodynamics are needed before surgery.

Yes, recurrence is possible after any prolapse treatment, including revision surgery. I will discuss realistic expectations, the estimated risk of further recurrence for the procedure being considered, and the steps you can take to reduce strain on the pelvic floor after treatment — such as long-term pelvic floor physiotherapy, bowel management, weight, and vaginal oestrogen where appropriate.

Transvaginal mesh for prolapse repair is now highly restricted in the UK and is not used in my private practice. For laparoscopic sacrocolpopexy — a procedure for vault or apical prolapse — an abdominal graft is placed via keyhole surgery through the abdomen rather than vaginally. This is a distinct approach with a different risk profile. I will explain whether this or any other procedure is relevant to your situation, what the alternatives are, and what the risks and expected outcomes are before any decision is made.

You should seek specialist advice if you have a new or returning vaginal bulge, worsening pelvic dragging or pressure, bladder or bowel symptoms that were not present before, a pessary that is no longer comfortable or that is being repeatedly expelled, pain, bleeding, or any concerns following previous prolapse surgery. No GP referral is required for a private consultation.