Name of the Condition

• Prolapse of Vaginal Vault after Hysterectomy (ICD N99.3)
• Also known as vaginal vault prolapse or post-hysterectomy prolapse.

Summary

• Prolapse of the vaginal vault is a condition where the top of the vagina loses its support and descends after a hysterectomy. This can lead to discomfort and affect a woman’s quality of life.

Causes

• The primary cause is the loss of structural support after the removal of the uterus. This can be exacerbated by weakened pelvic floor muscles or connective tissues.

Risk Factors

• Increased age, multiple vaginal childbirths, a history of pelvic surgery, genetic predisposition to weak connective tissue, obesity, and chronic straining (such as from constipation) can increase the risk.

Symptoms

• Sensation of pelvic pressure or fullness.
• A noticeable bulge in the vaginal area.
• Difficulties with urinary or bowel function.
• Discomfort or pain during intercourse.

Diagnosis

• Physical examination by a healthcare provider is often sufficient.
• Imaging studies or specialized tests, such as pelvic floor ultrasound, may be used for a comprehensive assessment.

Treatment Options

• Pelvic Floor Physical Therapy: Strengthens supporting muscles.
• Pessary Devices: Help support the vaginal walls.
• Surgery: Options include sacrocolpopexy or uterosacral ligament suspension to restore pelvic support.

Prognosis and Follow-Up

• With appropriate treatment, many women experience significant symptom improvement. Long-term success often depends on patient adherence to follow-up care and lifestyle modifications.

Complications

• If untreated, prolapse can lead to urinary incontinence, recurrent urinary tract infections, and impaired bowel function.

Lifestyle & Prevention

• Maintaining a healthy weight, performing regular pelvic floor exercises, and avoiding heavy lifting can help reduce risk or manage mild cases.

When to Seek Professional Help

• Seek medical attention if you experience a new or worsening sensation of pelvic pressure, pain, or changes in urinary or bowel habits.

Additional Resources

• American Urogynecologic Society (AUGS): www.augs.org
• Pelvic Floor Disorders Network: pfdnetwork.org

Tips for Medical Coders

• Verify hysterectomy status to accurately code N99.3.
• Be aware of similar codes for different types of prolapse to avoid errors.
• Review accompanying documentation for post-surgical details to ensure correct coding.