Pelvic Organ Prolapse
Treatment for Pelvic Organ Prolapse
Most worsening pelvic organ prolapses can only be fully corrected with surgery. However, the type of treatment that is appropriate to treat prolapse depends on factors such as the cause and severity of the prolapse, whether the woman is sexually active, and the woman’s treatment preference.
- Nonsurgical options may be most appropriate for women who are not sexually active, cannot undergo surgery because of medical reasons, or experience few or no symptoms associated with the condition.
- Surgery is the treatment option that most sexually active women who develop prolapse choose because the procedure is usually effective.
Home Care for Pelvic Organ Prolapse
Home treatments for vaginal prolapse include one or a combination of the following:
- Activity modification: For a prolapse that causes minor or no symptoms, the doctor may recommend activity modification such as avoiding heavy lifting or straining.
- Pessary: A pessary is a small device, usually made of vinyl, that is placed within the vagina for support. Pessaries come in several varieties. This nonsurgical treatment option may be the most appropriate for women who are not sexually active, cannot have surgery, or plan to have surgery but need a temporary nonsurgical option until surgery can be performed (such as women who are pregnant or in poor health). Pessaries must be removed and cleaned at regular intervals to prevent infection. Some pessaries are designed to allow the woman to do this herself. A doctor must remove and clean other types. Estrogen cream is commonly used along with a pessary to help prevent infection and vaginal wall erosion. Some women find that pessaries are uncomfortable or that they easily fall out.
Kegel exercises: These are exercises used to tighten the muscles of the pelvic floor. Kegel exercises might be used to treat mild-to-moderate cases of prolapse or to supplement other treatments for prolapses that are more serious.
Medical Treatment for Prolapse
Many women with prolapse may benefit from estrogen replacement therapy. Estrogen helps strengthen and maintain muscles in the vagina.
Medications for Pelvic Organ Prolapse
Estrogen replacement therapy may be used to help the body strengthen the muscles in and around the vagina. The therapy may not be an option for some women (such as in those with certain types of cancer). Women’s bodies stop creating estrogen naturally after menopause, and the muscles of the vagina may weaken as a result. In mild cases of prolapse, estrogen may be prescribed in an attempt to reverse prolapse symptoms, such as vaginal weakening and incontinence. For more severe prolapses, estrogen replacement therapy may be used along with other types of treatment.
Pelvic Organ Prolapse Surgery
A generalized weakness of the vaginal muscles and ligaments is much more likely to develop than are isolated defects. If a woman develops symptoms of one type of pelvic organ prolapse, she is likely to have or develop other types as well. Therefore, a thorough physical exam is necessary for the surgeon to detail what steps are necessary to correct the prolapse completely. The typical surgical strategy is to correct all vaginal weaknesses at once.
Surgery is usually performed while the woman is under general anesthesia. Some women receive a spinal epidural. The type of anesthesia given usually depends on how invasive and lengthy the surgery is expected to be.
Laparoscopic surgery is a minimally invasive surgical procedure that involves slender instruments and advanced camera systems. This surgical technique is becoming more common for securing the vaginal vault after a hysterectomy and correcting some types of prolapse such as enteroceles or uterine prolapses.
- Vaginal vault prolapse: This is a defect that occurs high in the vagina, so it may entail a surgical approach through the vagina or abdomen. The surgical correction of this condition usually involves a technique called a vaginal vault suspension, in which the surgeon attaches the vagina to strong tissue in the pelvis or to a bone called the sacrum, which is located at the base of the spine.
- Prolapsed uterus: For women who are postmenopausal or do not want to have more children, a prolapsed uterus is usually corrected with a hysterectomy. The common approach for this procedure is through the vagina.
- Cystocele and rectocele: These are corrected through the vagina. Typically, the surgeon makes an incision in the vaginal wall and pushes the organ up. The surgeon then secures the vaginal wall to secure the organ in its normal position. Any excess tissue is then removed, and the vaginal wall is closed. If urinary incontinence is present, the surgeon may need to support the urethra. This usually involves a procedure called a bladder neck suspension.
- In some select cases a woman may no longer desire to retain the ability to have intercourse. There is a surgery called a LeForte procedure in which the internal vagina is sutured closed. This narrowing of the vagina pushes up the prolasping organs.
Women who undergo surgery for pelvic organ prolapse repair should normally expect to spend two to four days in the hospital depending on the type and extent of surgery involved. After surgery, women are usually advised to avoid heavy lifting for approximately six to nine weeks.