Treatment for Vaginal Prolapse
Treatment for vaginal prolapse depends on the cause of the condition and the severity of the symptoms. In many cases, the condition gradually worsens over time and eventually requires surgery. Pelvic organ prolapse usually is treated by a urologist, a gynecologist, a urogynecologist, or a physical therapist.
In mild cases, the health care provider may recommend activity modification (e.g., avoiding heavy lifting), Kegel exercises (to strengthen the pelvic floor muscles), the use of vaginal pessaries, and estrogen replacement therapy (ERT).
Kegel exercises can help to improve pelvic organ prolapse, depending on the severity, and may slow progression of the condition. Success of these exercises depends in part on proper execution. First, the patient must be able to locate the correct muscle group by stopping or slowing the flow of urine without tensing leg muscles, or the patient can visualize squeezing the rectal muscles as if to prevent a bowel movement.
There are two types of Kegel exercise:
- Quick contractions–rapidly tighten and relax the sphincter muscle
- Slow contractions–contract the sphincter muscle and hold to a count of 3, gradually increasing to a count of 10
Exercises should be performed 10 to 15 times per session, at least 3 times each day. Kegel exercises should not be performed while urinating, because urine retention may occur.
Biofeedback may be used with Kegel exercises to reinforce proper technique. Patients visualize and identify the pelvic floor and abdominal muscles that are contracted during the exercises.
A simple instrument records small electrical signals that are produced when the muscles contract. The signals are instantly converted into audio and/or visual signs that help patients gain greater control over urinary and bowel muscle activity. Weak muscles can be activated on demand, tense muscles can be relaxed, and muscle activity can be coordinated using biofeedback.
Neuromuscular electrical stimulation (NMES) may be used, in some cases, to retrain and strengthen weak pelvic floor muscles, which can improve bladder control. Electrical stimulation of nerves in the pelvic area (e.g., the pudendal nerve) causes pelvic floor and urethral and anal sphincter muscles to contract. A probe is inserted into the vagina and a current is passed through the probe at a level below the pain threshold, causing a contraction. The patient is instructed to squeeze the muscles when the current is on. After the contraction, the current is switched off for 5 to 10 seconds. Treatment sessions lasts approximately 20 to 30 minutes.
The use of Kegel exercises, biofeedback, and electrical stimulation often are taught and monitored by a skilled physical therapist.
Vaginal pessaries are silicone or latex devices inserted into the vagina to compress the urethra, support the bladder neck, and hold the uterus in place (for uterine prolapse). Pessaries are available in different shapes and sizes and usually are fitted and inserted by a gynecologist. The largest size that can be worn comfortably is usually the most effective. Patients who are sensitive to latex or silicone cannot use these devices.
Frequent follow-up care is required when using vaginal pessaries to check for infection, pressure sores, and allergic reactions. Pressure sores are more common in post-menopausal women and estrogen cream can be used to improve the integrity of the vaginal mucosa. Tissue damage is managed by removing the pessary until the skin heals, and infections are treated with antibiotics. At each follow-up examination, the pessary is removed and cleaned thoroughly.
In women who have had a hysterectomy or in post-menopausal women, estrogen replacement therapy (ERT), which also may be combined with a progestin, may be used to improve the support structure of the pelvic area. ERT is available in pill form (oral), as a patch (transdermal), as a vaginal ring, or as a cream or gel (topical). ERT may increase the risk for stroke, blood clots, gallstones, and ovarian cancer, and should not be used in women who smoke.
Vaginal Prolapse Prevention
Vaginal prolapse cannot be prevented in every case. Women who are at increased risk for developing the condition should perform Kegel exercises regularly, should avoid heavy lifting, and should maintain a healthy weight.