Pelvic organ prolapse may be treated with a variety of non-surgical and surgical options, depending on the severity of the condition and the patient's wishes.
Non-surgical treatments:
Kegel exercises:
- These exercises are best used for mild cases of prolapse; with severe prolapse, the benefit is limited.
- Kegel exercises are used to strengthen the muscles of the pelvic floor. As these muscles grow stronger, they are better equipped to support the pelvic organs and slow the progression of prolapse.
- In addition, these exercises can help control stress urinary incontinence, urge urinary incontinence, overactive bladder, and fecal incontinence.
- As with any exercise program, Kegel exercises must be done correctly and regularly in order to work.
Pelvic floor therapy:
- Pelvic floor therapy consists of visits to a physical therapist with specialized training in pelvic floor disorders.
- These specialized physical therapists utilize various techniques, depending on the condition they are treating.
- With pelvic organ prolapse, the goal of pelvic floor therapy is to strengthen the pelvic floor in order to support the vagina and pelvic organs.
- Four treatment options commonly used in pelvic floor therapy are listed below.
- Biofeedback: Biofeedback uses an intravaginal device to train pelvic floor muscles to contract and relax properly.
- Functional electrical stimulation: Functional electrical stimulation utilizes a device that can be used intravaginally or externally, delivering a gentle electrical current to activate or relax the nerves and muscles in the pelvis.
- Manual therapy: Manual therapy uses pressure applied to and released from muscles in spasm, in order to relax them and increase blood flow to the area for healing. Often, women with prolapse subconsciously contract their pelvic floor muscles to the point of creating muscles spasms. These spasms may cause a painful condition called pelvic floor dysfunction, which can cause pelvic pain, painful sex, and difficulties with urination and defecation.
- Joint and tissue mobilization: This therapy involves gentle manipulation to help calm the muscles and nerves of the pelvis.
Vaginal pessary:
- A vaginal pessary is a removable, diaphragm-like device worn within the vagina to support the bladder or other organs that are prolapsing through the vagina.
- A vaginal pessary may also be used to decrease stress urinary incontinence.
- Pessaries come in a variety of types and sizes. Pessary fitting may require two or more office visits in order to select the proper type and size of pessary that will work for you.
Surgical treatments:
1. Traditional "Native-Tissue" Prolapse Repair:
a. Anterior Colporrhaphy:
A vaginal surgery using the patients' existing connective tissue to shore up support of the bladder / vagina.
b. Posterior Colporrhaphy:
A vaginal surgery using the the patient's existing connective tissue to shore up support of the rectum / vagina.
c. Perineorrhaphy:
the surgical repair of a weakened perineum (the area between the vaginal opening and the anus).
d. Vaginal Vault Suspension/Uterine Resuspension:
the suspension of the top (or "apex" ) of the vagina to a ligament in the pelvic – usually either the sacrospinous ligament or the uterosacral ligaments.
e. Hysterectomy (removal of the uterus):
Some type of hysterectomy (either vaginal, laparoscopic or sometimes abdominal) is often performed as the first step of a POP repair, because doing so often allows for a better suspension of the vagina to the surrounding support structures.
2. Graft-Augmented Prolapse Repairs:
When the patient's existing connective tissue is thought to be too weak to allow for a successful prolapse repair, the surgeon will offer "graft augmentation" with either synthetic mesh or some biologic graft material. Any of the above mentioned "native tissue" surgeries can be enhanced by the use of a graft material. Additionally, there are several surgical approaches where the placement of the graft is the main goal of the surgery:
a. Laparoscopic Sacrocolpopexy
(with or without Robotic Assistance): First described in 1962 as an open abdominal surgery, the sacrocolpopexy has been the "gold-standard" prolapse repair ever since. Since about 2000, sacrocolpopexies have usually been performed laparoscopically, because doing so results much less discomfort during the healing process. This operation involves fashioning a 'custom-made' Y-shaped mesh that will reconstruct the entire support system of the pelvic organs through attachment to a ligament near the back bone in the pelvis.
