Pessaries & Non-Surgical Options for Prolapse
Appeared in the May, 2013 issue of Quality Care®
Mild pelvic organ prolapse that is asymptomatic does not require treatment.
Some prolapse will improve on its own with watchful waiting, although it is not possible to identify whose POP will improve with time. One non-surgical options for treatment of symptomatic POP are pessaries.
Pessaries are silicon devices that come in a variety of shapes and sizes and are placed in the vagina to provide support to the pelvic organs. Since women come in all shapes and sizes, pessaries need to be fitted to the individual. There are many different types of pessaries and multiple sizes of each type. Fitting is by trial and error. A successful pessary is one that is comfortable, is retained with Valsalva and treats POP symptoms adequately. Pessaries do require upkeep and need to be removed and cleaned on a regular basis. Most women can learn to care for their pessaries themselves, however, women who cannot care for their pessaries need to have the pessary removed and cleaned on a regular basis by their provider. For many, local vaginal estrogen is prescribed for use in conjunction with a pessary for comfort, lubrication to reduce the risk of irritation or ulceration, and a lower incidence of urinary tract infections.
Although there are limited non-surgical management options for POP, there is emerging information that pelvic floor exercises, or Kegels, may have some limited effectiveness in addressing symptoms of POP. For assistance in performing the exercises correctly and consistently, consider ordering the Women’s Pelvic Floor Muscle Exercises Instruction Kit from NAFC. It includes a manual with descriptions and detailed drawings, a motivational video and instructional audio recording. Instruction by a physical therapist or other expert may be necessary, as well as the help of biofeedback in locating the muscles to contract.