|
Pelvic organ prolapse — Non-surgical treatments There are a number of surgical and non-surgical options available to treat prolapse. The choice of treatment depends on a variety of factors such as the type of prolapse you have, the severity of your symptoms, your age and other health issues, whether or not you want to have children in the future, and your personal preference. Before you decide on a treatment, talk to your doctor about the risks, benefits and success rates of the treatments you are considering. This section describes the non-surgical treatments available for prolapse. Physiotherapy If your prolapse is mild to moderate, you may be referred to a physiotherapist for treatment. A physiotherapist will work with you to create an individualised treatment plan based on pelvic floor exercises (see pelvic floor exercises). These exercises, also called Kegel exercises, may help keep the prolapse from getting worse and may help reduce backache, pelvic pain and incontinence. It may take a few months before you notice any improvement. |
|
If you're unsure whether you're doing the exercises correctly, a physiotherapist may be able to help, either through coaching or by using a biofeedback machine. Hormone Replacement Therapy (HRT) Women with prolapse who are experiencing, or are past, the menopause may benefit from HRT, either as a treatment on its own (for mild prolapse) or together with another treatment (for more advanced prolapse). Hormone replacement therapy may help strengthen the vaginal walls and pelvic floor muscles by increasing the oestrogen and collagen levels in your body, but there is little evidence as to whether it is effective in treating prolapse. Before you make a decision about whether or not to use HRT, discuss the risks and benefits with your doctor. Vaginal Pessaries A vaginal pessary is a small device, similar to a diaphragm or cervical cap, which is inserted into the vagina to hold the prolapsed organ(s) in place. Pessaries are made of latex or silicone and come in many different shapes and sizes. Ring pessaries are the most common, but may not be right for every woman.
Pessaries need to be individually fitted and you may need to try a few different shapes and sizes before you find one that feels comfortable and stays in place. Your doctor should have a variety of pessaries for you to try. During your fitting, your doctor will insert the pessary and ask you to walk around, sit, squat, cough and strain to test if it's comfortable and remains in place. If you feel uncomfortable doing this in front of your doctor, ask for a minute or two of privacy while you test the pessary's staying power. Tell the doctor if it doesn't feel right, even if it's the second, third or fourth pessary you've tried. Once you've found the best fit, you will be asked to try it for a month or two before returning for a follow-up appointment. If you have any difficulties or concerns during this period, contact your doctor for an earlier appointment. If your pessary is not working or is causing problems, you can either try a different pessary or a different treatment option entirely. If the pessary is relieving your symptoms and you're not having difficulties with it, you'll be scheduled for follow-up visits every 3 to 6 months. At your follow-ups the doctor will remove the pessary, check whether it's causing any internal problems and whether your prolapse is getting worse, and will insert a new pessary. Follow-up visits are also a good opportunity for you to talk to your doctor about any changes you've noticed or concerns you may have. If your pessary becomes less effective at relieving symptoms you may need to be fitted with a different type or size. This is common. If you have any difficulties with the pessary or if you have any unusual discharge, bleeding or pain, contact your doctor immediately — do not wait for your next appointment. Inserting, removing and cleaning your pessary Recommendations about how often a pessary should be removed range from once a week (for an overnight period) to once every three months or more. In the UK, standard practice is for pessaries to be inserted and removed by your doctor or nurse every 3 to 6 months. But in the USA, women are advised to remove, clean and reinsert their own pessaries more regularly. If you would like to have the option of removing and inserting your own pessary between your scheduled follow-up visits, talk to your doctor about it. She or he may be able to teach you how to insert the pessary yourself. It will probably take a bit of practice to get used to placing it correctly and while some women may be comfortable with this, others may find it too difficult or too much of a nuisance. Double pessaries for severe prolapse Women with severe prolapse who don't want or are advised against surgery may be able to use two ring pessaries together. The double-ring technique is new but an initial study shows it relieves symptoms of severe prolapse, with the exception of rectocele and enterocele. Things to consider before deciding to use a pessary
Some women experience a bad-smelling discharge when they use a pessary. If this happens, contact your doctor, as the pessary may be causing an infection. If a pessary doesn't fit right or is left in place for too long it can irritate the vaginal walls and cause raw, open sores (ulcers). If this happens, the pessary should be removed and oestrogen cream applied to the vagina until the sores have healed. Some people are allergic to latex or develop allergies after using latex products. Tell your doctor if you think you have a latex allergy. If you have any difficulties with your pessary, or have any unusual bleeding or pain, contact your doctor. |
|
|
Written by Tamara Beus and published in printed format (2003) by Women's Health
|
|
Pessaries are generally recommended as treatment for women who are waiting for surgery, women who are pregnant or want to have more children in the future, and women who are unable or choose not to have surgery.
Some pessaries may interfere with sexual intercourse. A ring pessary may be left in place during sex — if it's comfortable for you — but other pessaries may literally get in the way. There is no published information about whether pessaries affect other sexual activity (such as oral sex) or a woman's ability to achieve orgasm. You (and your partner) may want to explore what's comfortable and pleasurable for you both. See