women s health issues
Pelvic Organ Prolapse (POP)
Treatment of Pelvic Organ Prolapse
Observation Pelvic floor exercises A pessary Surgery Treatment of pelvic organ prolapse is based on the woman's symptoms. Treatment aims to improve quality of life. Doctors start by closely monitoring the woman and her symptoms. If symptoms are bothersome, treatment may include pelvic floor exercises, a pessary, and, if symptoms are severe, surgery. If women do not have symptoms or symptoms are mild, no treatment is needed. However, follow-up visits are needed to monitor the progression of the prolapse. Doctors also treat problems with completely emptying the bladder ( Treatment ) or Pelvic floor exercises, such as Kegel exercises, can lessen bothersome symptoms, including stress incontinence, but do not affect prolapse itself. They tend to be most helpful if prolapse is mild. These exercises help by strengthening the pelvic floor muscles. Kegel exercises target the muscles around the vagina, urethra, and rectum—the muscles used to stop a stream of urine. These muscles are tightly squeezed, held tight for about 1 or 2 seconds, then relaxed for about 10 seconds. Gradually, contractions are lengthened to about 10 seconds each. The exercise is repeated about 10 times in a row. Doing the exercises several times a day is recommended. Women can do Kegel exercises when sitting, standing, or lying down. Some women have difficulty contracting the correct muscles. To determine whether they are contracting the correct muscles, women can contract pelvic floor muscles two or three times while urinating. If they contract the correct muscles, the flow of urine stops in midstream. If women need additional help, pelvic floor physical therapy may be recommended. Pelvic floor therapy includes techniques that make learning the exercises easier, such as the following: Cone-shaped inserts placed in the vagina, which help women focus on contracting the correct muscle Biofeedback devices, which may use special sensors that show pelvic floor muscle contractions on a computer screen Electrical stimulation (a health care practitioner inserts a probe, which transmits an electrical current to make the correct muscle contract) If prolapse is causing symptoms, a device called a pessary may be inserted into the vagina to support the pelvic organs. Pessaries are especially useful for women who are waiting for surgery or who do not want or cannot have surgery. The pessary can lessen symptoms but is not a cure. A pessary is usually made of silicone. They may be shaped like a diaphragm, cube, or doughnut. Some can be inflated. A doctor fits the pessary to the woman by inserting and removing different sizes until the right size is found. In some countries, pessaries may be available over the counter. A pessary must be periodically removed and cleaned with soap and water. Women are taught how to insert and remove the pessary for cleaning. If they prefer or if they are unable to clean and replace the pessary themselves, they may go to the doctor's office periodically to have the pessary cleaned. Some pessaries should be removed during intercourse. Also, women may choose to remove them during intercourse. Women should also leave the pessary out overnight at regular intervals as recommended by their doctor. Pessaries sometimes irritate the vaginal tissues and cause a foul-smelling discharge. The discharge can sometimes be controlled by regularly cleaning the pessary, changing the type of pessary, or using a vaginal jelly. Some doctors recommend using an estrogen cream to control the discharge. Women who use a pessary should see their doctor periodically as their doctor recommends. Surgery is done if symptoms persist after women have tried pelvic floor exercises and a pessary. Surgery is also an option for women who do not wish to use a pessary. Surgery is usually done only after a woman has decided not to have any more children. One of the following types of surgery is used: Vaginal surgery:Surgery is done through the vagina rather than the abdomen. In such cases, no external incision is needed. Abdominal surgery:One or more incisions are made in the abdomen. Abdominal surgery includes the following: Laparotomy:An incision that is several inches long is made in the abdomen. Laparoscopic surgery:A viewing tube (laparoscope) and surgical instruments are inserted through several tiny incisions in the lower part of the abdomen. The weakened area is located, and the tissues around it are built up to prevent the organ from dropping through the weakened area. Forrectoceles, enteroceles, cystoceles, and cystourethroceles,procedures may include the following: Repair of the tissues that normally support the vagina (colporrhaphy). Repair of the tissues between the opening of the vagina and the anus (perineorrhaphy). For these two procedures, surgery is done through the vagina. These procedures do not require an incision in the abdomen. Forsevere prolapse of the uterus or vagina,treatment may include Removal of the uterus, if still present (hysterectomy) Repair of the tissues that support the uterus and vagina (colporrhaphy) Repair the tissues between the opening of the vagina and the anus (perineorrhaphy) Attachment of the upper part of the vagina (with stitches) to a nearby stable structure, such as a bone or strong ligament in the pelvis (sacrospinous ligament fixation) Closure of the vagina (colpocleisis) after removal of the uterus or with the uterus in place (called the Le Fort procedure) Surgery is delayed until any sores on the protruding vagina have healed. Closure of the vagina (colpocleisis) is an option for women who have severe vaginal prolapse and who do not plan to be sexually active. For this procedure, part of the vagina's lining is removed, and the vagina is stitched shut. Because this procedure can be done quickly and causes few complications, it may be a good choice for women who have conditions that make surgery risky (such as a heart disorder). Also, after closure, prolapse is unlikely to recur. However, vaginal intercourse is no longer possible. After surgery to correct a pelvic organ prolapse, a catheter may be inserted in the bladder until the bladder starts functioning normally. Ideally, the catheter is removed within 24 hours. Recovery time depends on the type of surgery. Most women can gradually resume their normal physical activity over a period of a few weeks, depending on the surgery. Lifting heavy objects (more than 10 pounds) may interfere with healing and should be avoided for at least 6 weeks after surgery to correct pelvic organ prolapse. 