Vaginal prolapse

Treating a pelvic organ prolapse

There areseveral treatment options available for a pelvic organ prolapse, depending on your circumstances.

The treatment most suitable for you depends on:

the severity of your symptoms
theseverity of the prolapse
your age and health
whether you're planning to have children in the future

You may not need any treatment if your prolapse is mild to moderate and not causing any pain or discomfort.

The various treatments forpelvic organ prolapseare outlined below. You can also read a summary of the pros and cons of the treatments for pelvic organ prolapse , allowing you to compare your treatment options.

Self care advice

If your prolapse is mild, there are some stepsyou can take thatmay help improveit orreduce the risk ofit getting worse.

This mayinclude:

doing regular pelvic floor exercises (see below)
losing weight if you're overweight, or maintaining a healthy weight for your build (you can check your body mass index (BMI) using the healthy weight calculator )
eating a high-fibre diet with plenty of fresh fruit, vegetables and wholegrain bread and cereal to avoid Constipation and straining when going to the toilet
avoiding heavy lifting and standing up for long periods of time

If you smoke, giving up will help, because coughing can make a prolapse worse. Read guidance on stopping smoking for more information.

Pelvic floor exercises

The pelvic floor muscles are a group of muscles that wrap around the underside of the bladder and rectum.

Having weak or damaged pelvic floor muscles can make a prolapse more likely. Recent evidence suggests that pelvic floor exercises may help to improve amild prolapse or reduce the risk of it getting worse.

Pelvic floor exercises are also used to treat urinary incontinence (when you leak urine), so may be useful if this is one of your symptoms.

To helpstrengthen your pelvic floor muscles, sit comfortably on a chair with your knees slightly apart.Squeeze the muscleseight times in a row andperform these contractions three times a day. Don't hold your breath or tighten your stomach, buttock, or thigh muscles at the same time.

When you get used to doing this, you can try holding each squeeze for a few seconds (up to 10 seconds). Every week, you can add more squeezes, but be careful not to overdo it and always have a rest inbetween sets of squeezes.

Your doctor may refer you to a physiotherapist , who can teach you how to do pelvic floor exercises. Itusually takes at least three months before you notice any improvement.

Hormone replacement therapy (HRT)

While there's little evidence that hormone replacement therapy (HRT) can directly treat pelvic organ prolapse, it can relieve some of the symptoms associated with prolapse, such as vaginal dryness or discomfort during sex.

HRT increases the level of oestrogen in women who have been through the menopause .

HRT medication is available as:

a creamyou apply to your vagina
a tabletyou insert into your vagina
a patchyou stick on your skin
an implantinserted under your skin

HRT is used for womenwith prolapseaftermenopause who have the symptoms described above. Creams, tablets or pessaries may be used for a short time to improve these symptoms.

Vaginal pessaries

A vaginal ring pessary is a deviceinserted into the vagina to hold the prolapse back. It works by holding the vaginal walls in place. Ring pessaries are usually made of latex (rubber) or silicone and come in different shapes and sizes.

Ring pessaries may be an option if your prolapse is more severe, but you would prefer not to have surgery. A gynaecologist (a specialist in treating conditions of the female reproductive system) or a specialist nurse usually fits a pessary.

The pessary may need to be removed and replaced everyfour to sixmonths.

Side effects

Ring pessaries can occasionally cause vaginal discharge, some irritation and possibly bleeding and sores inside your vagina. Other side effects include:

passing a small amount of urine when you cough, sneeze or exercise ( stress incontinence )
difficulty with bowel movements
interference with having sex,although most women can have intercourse without any problems
an imbalance of the usual bacteria found in your vagina ( bacterial vaginosis )

These side effects can usually be treated.

Surgery

Surgery may be an option for treating a prolapseif it's felt the possible benefits outweigh the risks.

Surgery for pelvic organ prolapse isrelatively common. It's estimated that 1 in 10 women will have surgery for prolapse by the time they're 80 years old.

These procedures are outlined below.

Surgicalrepair

One of the main surgical treatments for pelvic organ prolapse involves improvingsupport for the pelvic organs.

This may involve stitching prolapsed organs back into place and supporting theexisting tissues to make them stronger.

Pelvic organ repairmay be done through cuts (incisions) in the vagina. It's usually carried out under general anaesthetic , so you'll be asleep during the operation and won't feel any pain.

If you're planning to have children and have a prolapse, your doctors maysuggest delayingsurgery until you're sure you no longer want to have any more children. This is because pregnancy can cause the prolapse to recur.

Vaginal mesh

Surgery for pelvic organ prolapse may not always be successful and the prolapse can return.

For this reason, synthetic (non-absorbable) and biological (absorbable) meshes have been introducedto support the vaginal wall and/or internal organs. About 1,500 such operations are carried out in the UK each year.

The majority of women treated with mesh respond well to this treatment. However, the Medicines & Healthcare products Regulatory Agency (MHRA) has received reports of complications associated with vaginal meshes. These are mostly regarding persistent pain, sexual problems, mesh exposure through vaginal tissues and occasionally injury to nearby organs, such as the bladder or bowel.

If you've recently had vaginal mesh inserted and think there may be complications, or you want to find out about the risks involved, speak to your GP. You can also report a problem with a medicine or medical device on the GOV.UK website.

If you're thinking about having vaginal mesh inserted,you may want to ask your surgeon some of these questions before you proceed:

What are the alternatives?
What are the chances of success with the use of mesh versus use of other procedures?
What are the pros and cons of using mesh, and what are the pros and cons of alternative procedures?
What experience have you had with implanting mesh?
What have been the outcomes from the people you have treated?
What has been your experience in dealing with any complications that might occur?
What if the mesh doesn't correct my problems?
If I have a complication related to the mesh, can it be removed and what are the consequences associated with this?
Do you know what happens to the mesh over time?

Hysterectomy

If the womb (uterus) is prolapsed, then removing it during an operation calleda hysterectomy often helps the surgeon to give better support to the rest of the vagina and reduce the chance of a prolapse returning.

A hysterectomy will usually only be considered in women who don't wish to have any more children, asyou can't get pregnant after having a hysterectomy.

Methods to elevate and support the uterus without removing it do exist, but these need to be discussed with your doctor.

Complications from surgery

All types of surgery carry some risks. Your surgeon will explain these in more detail, but possible complications could include:

risks associated with anaesthesia
bleeding, which mayrequire a blood transfusion
damage to the surrounding organs, such as your bladder orbowel
an infection you may be given antibiotics to take during and after surgery to reduce the risk of infection
pain during sex, usually caused bynarrowing of the vagina
vaginal discharge and bleeding
experiencing more prolapse symptoms,which may require further surgery
a blood clot forming in one of your veins (for example, in your leg)you may be given medication to help reduce this risk after surgery (see deep vein thrombosis (DVT) for more information)

Recovering from surgery

Most prolapse operations require an overnight stay in hospital. More major operations, such as a hysterectomy, may requirea few nights in hospital.

If you need to stay in hospital, you may have a drip in your arm to provide fluids and a thin plastic tube called a catheter to drain urine from your bladder. Some gauzemay be placed inside your vagina to act as a bandage for the first 24 hours. This may be slightly uncomfortable. Your stitches will usually dissolve on their own after a few weeks.

For the first few days or weeks after your operation, you may have some vaginal bleedingsimilar to a period. You may also have some vaginal discharge. This may last three or four weeks. During this time, you should use sanitary towels rather than tampons.

Enhanced recovery

Enhanced recovery is an NHS initiative to improve patient outcomes after surgery and speed up recovery.

This involves careful planning and preparation before surgery, as well as reducing the stress of surgery, by:

using pain relief to minimise pain
avoiding unnecessary drips, tubes and drains
enabling you to eat and drink straight after your operation
encouraging early mobilisation

Post-surgery advice

Even with enhanced recovery, there may still be some activities you need to avoid while you recover from surgery. Your care team can advise about activities you may need to avoid, such as heavy lifting and strenuous exercise, and for how long.

Generally, most people are advised tomove around as soon as possible,with good rests every few hours.

You can usually shower and bathe as normal after leaving hospital, but you may need to avoid swimming for a few weeks.

It's best to avoid having sex for around four to six weeks, until you've healed completely.

Your care team will adviseabout when you can return to work.