Pelvic organ prolapse - Treatment

Treatment-Pelvic organ prolapse




There are several treatment options available for pelvic organ prolapse.
The most suitable will depend on:
  • the severity of your symptoms
  • the severity of the prolapse
  • your age and health
  • whether you're planning to have children in the future
You may not need any treatment if the prolapse is mild to moderate and not causing any pain or discomfort.

Lifestyle changes

If you don't have any symptoms, or the prolapse is mild, making some lifestyle changes can ease your symptoms and stop the prolapse getting worse. They can also help to reduce your risk of getting a prolapse in the first place.
They include:
  • doing regular pelvic floor exercises to strengthen your muscles
  • maintaining a healthy weight or losing weight if you're overweight
  • eating a high-fibre diet to avoid constipation
  • avoiding lifting heavy objects
  • avoiding high-impact exercise, such as trampolining
  • quitting smoking – it can cause coughing and make the prolapse worse

Hormone (oestrogen) treatment

If you have a mild prolapse and have been through the menopause, your doctor may recommend treatment with the hormone oestrogen to ease some of your symptoms, such as vaginal dryness or discomfort during sex.
Oestrogen is available as:
  • a cream you apply to your vagina
  • a tablet you insert into your vagina

Vaginal pessaries

A device made of rubber (latex) or silicone is inserted into the vagina and left in place to support the vaginal walls and pelvic organs. Vaginal pessaries allow you to get pregnant in the future.
They can be used to ease the symptoms of moderate or severe prolapses and are a good option if you can't or would prefer not to have surgery.
Vaginal pessaries come in different shapes and sizes depending on your need. The most common is called a ring pessary. You may need to try a few different types and sizes to find the one that works best for you.
A gynaecologist (a specialist in treating conditions of the female reproductive system) or a specialist nurse usually fits a pessary. It may need to be removed, cleaned and replaced regularly.

Side effects of vaginal pessaries

Vaginal pessaries can occasionally cause:
These side effects can usually be treated.

Surgery

If non-surgical options have not worked or the prolapse is more severe, surgery may be an option.
There are several different surgical treatments for pelvic organ prolapse. Your doctor will discuss the benefits and risks of different treatments, and you will decide together which is best for you.

Surgical repair

There are several different types of surgery that involve lifting and supporting the pelvic organs. This could be by stitching them into place or supporting the existing tissues to make them stronger.
Surgical repairs are usually done by making cuts (incisions) in the wall of the vagina under general anaesthetic. This means you'll be asleep during the operation and won't feel any pain.
You may need 6 to 12 weeks off work to recover, depending on the type of surgery you have.
If you would like to have children in the future, your doctors may suggest delaying surgery until you're sure you no longer want to have any more because pregnancy can cause the prolapse to happen again.

Hysterectomy

For women with a prolapsed womb who have been through the menopause or don't wish to have any more children, a doctor may recommend surgery to remove the womb (a hysterectomy).
It can help to relieve pressure on the walls of the vagina and reduce the chance of a prolapse returning.
You can't get pregnant after having a hysterectomy, and sometimes it may cause you to go through the menopause early.
You may need 6 to 12 weeks off work to recover.

Closing the vagina

Occasionally, an operation that closes part or all the vagina (colpocleisis) may be an option.
This treatment is only offered to women who have advanced prolapse, when other treatments haven't worked and they are sure they don't plan on having sexual intercourse again in the future.
This operation can be a good option for frail women who wouldn't be able to have more complex surgery.

Side effects of surgery

Your surgeon will explain the risks of your surgery in more detail, but possible side effects could include:
  • risks associated with anaesthesia
  • bleeding, which may require a blood transfusion
  • damage to the surrounding organs, such as your bladder or bowel
  • an infection – you may be given antibiotics to take during and after surgery to reduce the risk
  • changes to your sex life, such as discomfort during intercourse – but this should improve over time
  • vaginal discharge and bleeding
  • experiencing more prolapse symptoms, which may require further surgery
  • a blood clot forming in one of your veins, such as in your leg – you may be given medication to help reduce this risk after surgery (see deep vein thrombosis for more information)
If you experience any of the following symptoms after your surgery, let your surgeon or GP know as soon as possible:
  • a high temperature (fever) of 38C or more
  • severe pain low in your tummy
  • heavy vaginal bleeding
  • a stinging or burning sensation when you pass urine
  • abnormal vaginal discharge – this may be an infection

Recovering from surgery

You will probably need to stay in hospital overnight or for a few days following surgery.
You may have a drip in your arm to provide fluids, and a thin plastic tube (catheter) to drain urine from your bladder. Some gauze may be placed inside your vagina to act as a bandage for the first 24 hours, which may be slightly uncomfortable.
For the first few days or weeks after your operation, you may have some vaginal bleeding similar to a period, as well as some vaginal discharge. This may last 3 or 4 weeks. During this time, you should use sanitary towels rather than tampons.
Your stitches will usually dissolve on their own after a few weeks.
You should try to move around as soon as possible but with good rests every few hours.
You should be able to have a shower and bathe as normal once you've left hospital, but you may need to avoid swimming for a few weeks.
It's best to avoid having sex for around 4 to 6 weeks, until you've healed completely.
Your care team will advise about when you can return to work.

Use of vaginal mesh

Surgical repair for pelvic organ prolapse may not always be successful, and the prolapse can return.
For this reason, synthetic (non-absorbable) and biological (absorbable) meshes were introduced to support the vaginal wall and/or internal organs.
Most women treated with mesh respond well to this treatment. But the Medicines and Healthcare products Regulatory Agency (MHRA) has received reports of complications associated with meshes. These include:
  • long-lasting pain
  • incontinence
  • constipation
  • sexual problems
  • mesh exposure through vaginal tissues and occasionally injury to nearby organs, such as the bladder or bowel
Since July 11 2018, this type of operation has been paused while extra safety measures are put in place.
The National Institute for Health and Care Excellence (NICE) recommends that mesh should only be used for the treatment of pelvic organ prolapse under research circumstances. If you join a research study, NICE recommends that you're regularly monitored for any complications.
If you're thinking about having vaginal mesh inserted, you may want to ask your surgeon some of these questions before you proceed:
  • what are the alternatives?
  • what are the chances of success with the use of mesh versus use of other procedures?
  • what are the pros and cons of using mesh, and what are the pros and cons of alternative procedures?
  • what experience have you had with implanting mesh?
  • how successful has it been for the people you have treated?
  • what has been your experience in dealing with any complications?
  • what if the mesh doesn't correct my problems?
  • if I have a complication related to the mesh, can it be removed and what are the consequences associated with this?
  • what happens to the mesh over time?
If you've recently had vaginal mesh inserted and think you're experiencing complications, or you want to find out about the risks involved, speak to your GP. You can also report a problem with a medicine or medical device on GOV.UK.
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