Prolapse Treatment Options

Pelvic Organ Prolapse refers to the bulging or dropping of one or more of the pelvic organs from their normal position into or out of the vagina. The pelvic organs consist of the uterus, vagina, bowel and bladder. These organs are held in place by the pelvic floor, ligaments and fascia (a network of supporting tissue). Pelvic organ prolapse occurs when these muscles, ligaments and fascia that hold these organs in their correct positions become weakened or damaged.

You can read more about prolapse here. 

So if you have a prolapse or if you are worried you might have one, what are your treatment options: 

Do nothing: When you have a diagnosis of prolapse there is always the option to do nothing, depending on how bothersome the symptoms are. A prolapse is only an issue if you find it bothersome or if it is affecting your daily life. Some women will be asymptomatic and sometimes a prolapse can be an incidental finding on a vaginal exam, which in these cases, nothing really needs to be done. Many women will choose not to have any treatment if they have no symptoms or discomfort.

Lifestyle modification: if you want to do something about your prolapse then there are a number of things you can implement in daily life that may help to prevent your prolapse from getting any worse and/or to decrease and eliminate your symptoms. If you have been diagnosed with prolapse then the following may be helpful for you:

• Try to avoid straining when opening your bowels: It’s important to manage the pressure in your abdomen and straining to open your bowels will create a large increase in intra-abdominal pressure, which is not what we want! Ensure your stools are soft and easy to pass. You can do this by ensuring you drink enough water each day and eat a diet rich in fibre (lots of fruits and veggies). Also try to use correct bowel techniques like using a foot stool and leaning forward (as discussed above). Note however that this sitting posture is not always appropriate positioning for your prolapse, so talk to your trusted health care provider about what is appropriate for you.
• Choosing the right exercise: sometimes exercise can worsen your symptoms, but not all exercise is likely to do this. Having an individualised assessment will help you to determine what exercise is appropriate for you and how to progress back to the type of exercise you want to be doing be that running, HITT, yoga, dance, pilates, etc.
• Keeping your weight at a healthy range: excess weight can worsen your prolapse symptoms so trying to manage your weight with diet and appropriate exercise will help to manage you symptoms.

Pelvic floor exercises (or 'kegels' if you know them by this name): Often prolapse symptoms can be assisted by working your pelvic floor whether that be working on your strength, endurance or co-ordination. Keeping your pelvic floor strong and active will help to assist in symptom management and potentially in avoiding any worsening of the prolapse. A pelvic floor physio will be able to individualise a program that is right for you. It's important to ensure that you can contract and relax the pelvic floor properly but also that you are doing the right number of sets and reps, so ideally you seek individual advice for this.

Pessaries: Pessaries are vaginal devices that come in various shapes and sizes. If a pessary is appropriate it will be fitted by a health care professional who will teach you how and when to use it. Fitting a pessary can sometimes require some trial and error to discover which device and size is right for you, so there is no one size fits all approach. Pessaries work by providing mechanical support to the prolapsed organs, which can help to relive symptoms. A pelvic floor physiotherapist will be able to fit a pessary for you. You can search for a Pelvic Floor Physio near you using our clinician locator here.

Surgery: In some cases pelvic organ prolapse may require surgery to completely eliminate symptoms or when conservative manage has not been effective. 1 in 9 women will choose to have surgery to correct their prolapse. In this case there is also a role for proper pelvic floor rehab and life style advice post-surgery in order to prevent symptoms from returning and ensuring the pelvic floor stays strong.

Some questions to consider asking your health care provider when discussing prolapse and your treatment options include:

• What are the chances my prolapse will get worse?
• What are the chances my prolapse will get worse if I return to running or high impact sport?
• What are my non-surgical options?
• What are my surgical options?
• Would I be able to improve my symptoms by doing pelvic floor exercises or using a pessary?
• Would you recommend I see a pelvic floor physiotherapist?