TREATMENT FOR PELVIC ORGAN PROLAPSE
Non-Surgical
There are a number
of non-surgical treatments for prolapse depending on the type and severity of
your prolapse, the severity of your symptoms, your age, your general health, and
your personal preferences. Consider which symptoms you most want to improve and
the results that would make treatment successful for you. This information will
help you and your physician determine the treatment plan that is right for you.
He/she will discuss the risks, benefits, and success rates of each of the
treatment options.
Physical Therapy
A physical therapist
can evaluate the strength and weakness in your pelvic floor muscles, and create
pelvic floor exercises that will strengthen weak muscles. He/she may also work
on soft tissue mobilization to help you relax a tightened pelvic floor. This
will prevent your pelvic floor muscles from becoming overly fatigued. Once the
muscles can relax, the tightening during a Kegel exercise will be more
effective. Physical therapy may keep the prolapse from getting worse and may
reduce some of your symptoms. The physical therapist may suggest biofeedback or
electrical stimulation if indicated.
Pessary
A
pessary is a plastic device, similar to a diaphragm,
which fits into the vagina to help support the uterus, bladder or rectum. It
may be used to support a prolapse (bulge) temporarily while a woman awaits
surgery, or as a permanent alternative to surgery by women who either do not
wish surgical correction for their prolapse or are not good surgical
candidates. Approximately 50% of women will continue wearing a pessary 2 years
after initial fitting. 25% of women will stop using the pessary and opt for
surgery 2 years after initial fitting. The remaining 25% stop using the pessary
and don’t have surgery.
Hormone Replacement
Therapy
For post-menopausal
women, hormone replacement therapy may help strengthen the vaginal walls and
pelvic floor muscles by increasing the estrogen and collagen levels in your
body. There are also herbal products that claim action similar to Estrogen.
You should discuss these options with your physician. See
Prevention of
Prolapse for more information.
Surgical
Untreated prolapse
almost always gets worse. When the symptoms of prolapse interfere with your
quality of life, or interfere with urinating or emptying your rectum, you may
decide to discuss surgical options for the treatment of prolapse. Other reasons
for choosing a surgical option for the treatment of prolapse include the
inability to wear a pessary or new onset of urinary incontinence when the
pessary is in place. This is a very individual decision and only you can
determine when the symptoms are bothersome enough to warrant surgery.
It is wise to
consider your expectations for surgery, which symptoms you hope will change, and
what will define a successful treatment outcome. Your physician can tell you if
your expectations are realistic. As with all surgery, the degree of success
depends on many factors. Surgery may completely repair the prolapse, but not
“cure” some of your symptoms. After your physician has evaluated your pelvic
floor strengths and weaknesses, and reviewed your symptoms and expectations for
treatment, he/she will discuss the options. You will be told the risks,
benefits, and typical outcomes of each treatment choice. The two of you will
then decide the best treatment for you.
You may have heard
“horror” stories about women who have undergone unsuccessful or repeated surgery
for prolapse. While there is no way to absolutely predict success, try not to
transfer other people’s experiences to your own. There are too many factors
that differ between others’ surgeries and yours that may explain the poor
outcomes. It seems as though there are major technological advances developing
to treat pelvic organ prolapse on a monthly basis.
Research shows that
approximately 5-30 percent of prolapse surgeries will be unsuccessful. This
may be due to progression of the underlying cause of the prolapse, such as
damage to the nerves and muscles as a result of vaginal childbirth. It is
important for you to remember that your surgeon is not correcting pre-existing
nerve and muscle damage in the operating room during prolapse repair.
Unfortunately, medical technology has not advanced to the point where
pre-existing nerve and muscle damage can be repaired. You will leave the
operating room with the same nerve and muscle damage as you entered the
operating room.
You
may have a friend with similar symptoms who underwent a surgical procedure
different than the one recommended to you. This may explain why her surgery
failed and yours is less likely to do so. After evaluating your specific
situation, your physician will base his/her recommendations on experience and
training, and also on the latest research available in the field. According to
the only two studies comparing vaginal to abdominal pelvic reconstructive
surgery for the treatment of pelvic organ prolapse, abdominal surgery is more
successful in repairing the prolapse and improving symptoms. In one study, the
authors concluded that each technique provided similar results yet their data
supported a higher rate of recurrent cystocele with the vaginal approach. The
other study clearly showed that abdominal pelvic reconstructive surgery was
superior compared to vaginal reconstructive surgery based on the author’s
definitions of optimal outcomes.
An ongoing study
suggests the addition of a procedure to correct urinary incontinence, even if a
woman is not experiencing incontinence before surgery. Performing abdominal
surgery through a laparoscopic approach significantly speeds post operative
recovery and holds great promise; however there have been no long term studies
to evaluate its success compared to abdominal surgery.
This explains why
surgical success also depends on how carefully you adhere to the post-operative
recommendations. You will be given written instructions after surgery.
Following these instructions for the full 12-weeks after surgery will provide
you with the best chance for surgical success. Taking care to properly fuel
your body, rest when your body tells you, and not put unnecessary pressure on
your pelvic floor muscles will help post-operative healing. When the time
comes, your physician will provide you with a more
detailed explanation of the
surgery you will have and answer your questions.
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