Conservative and surgical treatment of vaginal prolapse is available and the risk and benefits of each must be discussed.
Once prolapse is present pelvic floor exercises are likely to be of little benefit. Pessaries are often effective in holding the prolapse reduced. Many types of pessaries are available and common varieties are pictured. The pessaries come in a variety of sizes and can be inserted by your gynaecologist. In the first 24 hour period the pessary may fall out. This is not a problem and the pessary should be placed in a plastic bag to return to your gynaecologist where a larger pessary can be sited. Very rarely if too large a pessary is inserted you may have trouble passing your urine later that day. If you are unable to pass your urine or you experience abdominal pain the pessary may need to be removed and your gynaecologist contacted. The pessary is normally left in position and changed every 3-4 months by your gynaecologist. The pessary can be left in place during intercourse. If the pessary causes pressure in the vagina an erosion of the vaginal skin may occur. This would normally necessitate the pessary being removed. Your gynaecologist will often recommend using topical oestrogen in the vagina while using the pessary.
Pelvic floor exercises and pessaries very rarely cause significant side-effects and if effective in treating the problem without being to inconvenient are an appropriate and safe treatment.
Surgical treatment of prolapse.
The aim of reconstructive surgery is
- correction of all anatomical defects
- the maintenance or restoration of bladder function
- the maintenance or restoration of bowel function
- the maintenance of coital function.
Prolapse surgery needs to be flexible to accommodate individual requirements like the desire to remain fertile or to preserve the uterus.