gynecology and obstetrics
Anterior and Posterior Vaginal Wall Prolapse
Treatment of Vaginal Wall Prolapse
Pelvic floor exercises (eg, Kegel exercises) Pessary Surgical repair of supporting structures if necessary Treatment of vaginal wall prolapse is individualized, based on a patient's symptoms, and it aims to improve quality of life. Symptomatic treatment may consist of pelvic floor exercises, a pessary, and, if these measures are unsuccessful or if the patient prefers, surgical repair. Pessaries are devices that are inserted in the vagina to maintain normal anatomy and reduction of the prolapsed structures. Pessaries are typically made of silicone and vary in shape and size; some are inflatable. They may cause vaginal ulceration if they are not correctly sized and routinely cleansed (at least monthly if not more frequently). Pessaries can be fitted by health care practitioners; in some countries, pessaries may be available over the counter. Pelvic floor exercises (including Kegel exercises) may be recommended. Kegel exercises involve isometric contractions of the pubococcygeus muscle. These muscles are contracted tightly for about 1 or 2 seconds, then relaxed for about 10 seconds. Gradually, contractions are held for about 10 seconds each. The exercise is repeated about 10 times in a row. Doing the exercises several times a day is recommended. Exercises can be facilitated by Use of weighted vaginal cones (which help patients focus on contracting the correct muscle) Biofeedback devices Electrical stimulation, which causes the muscle to contract Pelvic floor exercises can lessen bothersome symptoms of prolapse (and stress incontinence) but do not appear to reduce the severity of prolapse. Surgical repair can help relieve symptoms that are severe or do not resolve with nonsurgical treatment. The surgical approach used depends on the type of prolapse, the clinical situation, and the patient's age and comorbidities. Surgery may include one (or a combination) of the following procedures Anterior or posterior colporrhaphy (vaginal repair) Vaginal apex suspension or repair Colpocleisis (closure of the vagina after removal of the uterus or with the uterus in place [Le Fort procedure]) Perineorrhaphy (surgical shortening and tightening of the perineum) is traditionally done but does not help resolve pelvic organ prolapse. Surgical repair of the vagina is usually deferred, if possible, until future childbearing is no longer desired because subsequent vaginal delivery may disrupt the repair. After surgery, patients should avoid heavy lifting for at least 6 weeks. After surgery to repair a cystocele or cystourethrocele, a urethral catheter may be used for<24 hours. 