Vaginal Prolapse: Treatment Options
There are both non-surgical and surgical treatment options available for vaginal prolapse. Options vary depending on the stage of prolapse. It is recommended that conservative treatment measures be considered when symptoms are first detected. Women should postpone surgery till they feel their condition has progressed enough that they no longer respond to conservative treatment measures or if conservative measures do not appeal to them. While the surgical treatment options are minimally invasive, a one-night hospital stay is usually required.
Non-surgical treatment options include:
Kegel exercises strengthen the pelvic floor muscles. These exercises can help control stress urinary incontinence, urge urinary incontinence, overactive bladder, fecal incontinence and can help slow the progression of vaginal prolapse. Kegel exercises must be done correctly and regularly to work.
Pelvic floor therapy
Pelvic floor therapy consists of a series of visits to a physical therapist with specialized training in the treatment of pelvic floor problems. The physical therapist uses a combination of the techniques listed below depending on the type of urogynecological condition present. With vaginal prolapse the goal of pelvic floor therapy is to strengthen the pelvic floor so as to provide support to the vagina and pelvic organs. Below are four treatment options available for pelvic floor therapy.
Biofeedback – an intravaginal device used to train the pelvic floor muscles to contract or relax correctly.
Functional electrical stimulation – a device that can be used intravaginally or externally that delivers a gentle electrical current to activate or relax the nerves and muscles in the pelvis.
Manual therapy – pressure applied to and released from muscles in spasm to relax them and increase blood flow to the area for healing. Often, women with prolapse subconsciously perform excessive pelvic floor contractions to the point of creating pelvic floor muscle spasms. This may creat a painful condition called pelvic floor dysfunction which in turn may lead to pelvic pain, painful sex and difficulties with urination and defecation.
Joint and tissue mobilization – gentle manipulation to help calm the muscles and nerves of the pelvis.
A vaginal pessary is a removable, diaphragm-like device worn in the vagina to support vaginal prolapse and/or decrease stress urinary incontinence. There are a variety of types and sizes of pessaries available. A pessary fitting includes two or more office visits to find a type and size of pessary that will work for you.
Surgical treatment options include:
An anterior colporrhaphy repairs the wall between the vagina and the bladder. A pliable piece of material called a “graft” can be placed between the vagina and bladder to strengthen the repair. There are many types of grafts available.
Paravaginal defect repair
A paravaginal defect repair is a type of surgery to repair an anterior vaginal wall prolapse. This surgery reattaches the sides of the vagina to their normal attachments in the pelvis. This procedure can be performed vaginally or abdominally.
A posterior colporrhaphy repairs the wall between the vagina and the rectum. As with an anterior colporrhaphy, graft material can be used to strengthen this type of repair. This procedure is performed vaginally.
A perineorrhaphy is the surgical repair of a weakened perineum (the area between the vaginal opening and the anus). This procedure is sometimes done at the same time as a posterior repair.
Vaginal vault suspension
A vaginal vault suspension is the surgical repair of a vaginal vault prolapse by attaching the top of the vagina to ligaments in the pelvis with permanent sutures or graft material. This procedure can be performed vaginally or abdominally.
A hysterectomy is the surgical removal of the uterus. This is the surgery done to repair a severe uterine prolapse. A hysterectomy can be done through a vaginal or abdominal incision.
Elevate™ is a minimally invasive type of surgery to repair any type of vaginal prolapse. Specifically shaped pieces of synthetic graft material are inserted through an incision in the vagina and positioned with needle-like surgical instruments. An Anterior Elevate™ and/or Posterior Elevate™ is performed depending on the type of prolapse present. Elevate™ can be done following a hysterectomy or as a form of Uterine Preservation surgery. these are minimally invasive out-patient procedures.