Nonsurgical Treatment for Pelvic Organ Prolapse

Many women are afraid to seek consultation for pelvic organ prolapse because they incorrectly believe that surgery is the only option to treat prolapse.  Surgery for pelvic organ prolapse is certainly an option, but it is not the only one.  It is important to understand all options for treatment before deciding which option to choose, because every woman is unique.  Some women do very well with nonsurgical treatments, while others do not.  Taking each individual’s needs into account is important when determining the proper course of action.

One nonsurgical option for pelvic organ prolapse is observation or expectant management, which simply means periodic checkups and no active treatment at all.  There is no evidence that this is likely to cause more problems than treating prolapse, unless the prolapse is severe enough to cause poor bladder or bowel evacuation or irritation of prolapsing tissues.  Although data show that prolapse is likely to worsen over time for most women, there is no current method to accurately predict who is likely to develop worsening prolapse, so treatment may simply not be necessary at all for women with lesser degrees of prolapse.  Another treatment option includes pelvic floor physical therapy.  In this instance, treatment is designed to improve the muscular support of and blood flow to the pelvis, which may then result in reduced symptoms.  Many times this will improve bladder and bowel symptoms as well.  Working with a trained pelvic floor physical therapist is more likely to result in improvement than observation or home “Kegel” exercises alone.  There is also a new device approved for home use:  InTone (R), which is designed to allow a woman to perform her pelvic floor training at home on a daily basis with regular feedback.  Finally, the oldest and best known nonsurgical treatment of prolapse is a device called a pessary.  A pessary is a device worn inside the vagina which supports the bladder, vagina or uterine apex, and rectum.  There are many types of pessaries available, the most commonly used is a “Ring with Support”, which somewhat resembles a diaphragm used for birth control, except that it is a bit stiffer and flat rather than dome-shaped, and has perforations in the support membrane to allow for circulation of vaginal fluids and let the tissue “breathe”.  Another common pessary includes a dome with ballast type called a Gellhorn.  The appropriate type of pessary is best determined by the physician or healthcare provider trained in the proper assessment and fitting of the pessary.  Once this is done, instructions regarding self-care and/or intermittent visits with office care of the pessary will be given.  Many women achieve satisfactory treatment of prolapse with a pessary, and choose to continue this course of therapy indefinitely.  While it is natural to develop some increase in vaginal discharge, as long as it is not disagreeable and manageable, this is usually acceptable.  Sometimes, the pessary can cause irritation or erosion of vaginal tissues due to rubbing against the vaginal tissues.  Often this can be corrected by increasing the amount of lubricant, or occasionally leaving the pessary out for a short period of time.  A small number of women will develop a vaginal infection and become unable or unwilling to use a pessary.  Normally, however, when properly fitted a pessary should be a “silent passenger”, and a woman wearing a pessary should be totally unaware of it.

If nonsurgical treatment does not provide adequate relief of symptoms or if it is simply not an option, then choosing a surgical option becomes appropriate.  Surgical treatments for pelvic organ prolapse will be discussed in the next entry.

For more information regarding nonsurgical or surgical treatment of pelvic organ prolapse, you may call 561-701-2841.

Author

Linda Kiley, MD

Dr. Kiley is a Board Certified subspecialist in Female Pelvic Medicine and Reconstructive Surgery, and is also Board Certified in general Obstetrics and Gynecology.

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