There is a range of treatment options available for pelvic organ prolapse. Some are surgical and some are non-surgical.
You may not need any treatment if the prolapse is mild to moderate and not causing any pain or discomfort.
The most suitable treatment will depend on:
- your symptoms and how they affect you
- how severe your prolapse is
- your age and general health
- your plans to have children
You and your GP will decide together what's the best option for you.
Non-surgical treatment options
Your doctor may suggest you try non-surgical options first. These include lifestyle changes, hormone treatment or a vaginal pessary.
Lifestyle changes can:
- reduce your risk of getting pelvic organ prolapse
- help ease the symptoms of mild prolapse
- stop it getting worse
strengthen your muscles with regular pelvic floor exercises
lose weight if you're overweight
have a high-fibre diet to avoid constipation
do not lift heavy objects
do not do high-impact exercise, such as running
do not smoke - it can cause coughing and make the prolapse worse
Hormone (oestrogen) treatment
If you have a mild prolapse and have been through menopause, your GP may recommend treatment with the hormone oestrogen. This is to help ease some of your symptoms, such as discomfort during sex or vaginal dryness.
Oestrogen is available as a:
- cream you apply to your vagina
- tablet you insert into your vagina
A vaginal pessary is a rubber or silicone device that goes into your vagina. It supports your vaginal walls and pelvic organs.
Vaginal pessaries can be used to ease the symptoms of moderate or severe prolapse. They are a good option if you cannot or do not want to have surgery.
Vaginal pessaries come in different shapes and sizes. The most common is called a ring pessary. You may need to try a few different types and sizes to find the one that works best for you.
A gynaecologist, some GPs or a specialist nurse usually fit a pessary. These need to be changed about every 4 to 6 months.
You can still get pregnant if you use a vaginal pessary.
Side effects of vaginal pessaries
Vaginal pessaries can cause:
- unpleasant smelling vaginal discharge
- some irritation and sores inside your vagina, and possibly bleeding
- stress incontinence, where you pass a small amount of urine when you cough, sneeze or exercise
- a urinary tract infection
- problems with sex - but most women do not have issues
Talk to your GP about treatment for these side effects.
If non-surgical options have not worked or the prolapse is more severe, surgery may be an option.
Your doctor will discuss the benefits and risks of the different types of surgery.
Surgical repair involves lifting and supporting the pelvic organs. This could be by stitching them into place or supporting the existing tissues to make them stronger.
Surgical repairs are usually done by making cuts (incisions) in the wall of the vagina. This is done under general anaesthetic. This means you'll be asleep during the operation and will not feel any pain.
You may need 6 to 12 weeks off work to recover, depending on the type of surgery you have.
If you would like to have children in the future, your doctors may suggest delaying surgery. This is because pregnancy can cause the prolapse to happen again.
If you have a prolapsed womb, your doctor may recommend removing your womb (hysterectomy). This is only recommended if you've been through menopause or are not planning to have children.
It can help to relieve pressure on the walls of the vagina and reduce the chance of a prolapse returning.
You cannot get pregnant after having a hysterectomy. If your ovaries are also removed, it will cause early menopause. Your surgeon will discuss your options with you.
You may need 6 to 12 weeks off work to recover from a hysterectomy.
Closing your vagina
An operation that closes part or all your vagina (colpocleisis) may be an option.
This treatment is only an option when:
- you have advanced prolapse
- other treatments have not worked
- you are sure you do not want to have sex again
This operation is less invasive than other surgeries. It can be an option if the risks of having more complex surgery are too high.
Side effects of prolapse surgery
Your surgeon will explain the risks of your surgery in more detail, but possible side effects include:
- damage to the surrounding organs, such as your bladder or bowel
- changes to your sex life, such as discomfort during sex - but this should improve over time
- vaginal discharge and bleeding
- more prolapse symptoms, which may need further surgery
- menopausal symptoms if your ovaries are removed
Urgent advice: Tell your surgeon or GP as soon as possible if
you have any of these symptoms after your surgery:
- a high temperature of 38 degrees Celsius or above
- severe pain in your lower tummy
- heavy vaginal bleeding
- a stinging or burning sensation when you pee
- abnormal vaginal discharge - this may a sign of an infection
Recovering from surgery
You will probably need to stay in hospital overnight or for a few days after your surgery.
When you wake up after surgery you may have:
- a drip in your arm to provide fluids intravenously (into a vein)
- a thin plastic tube (catheter) to drain your bladder
- a gauze bandage in your vagina for 24 hours - this can be uncomfortable
After your surgery, you may have some vaginal bleeding and discharge. This can last 3 to 4 weeks. It's best to use sanitary towels rather than tampons.
Your stitches usually dissolve on their own after a few weeks.
Try to move around as soon as possible but take lots of rests.
You can have a shower and bathe as normal after you leave hospital.
You may need to avoid:
- swimming for a few weeks
- sex for about 4 to 6 weeks
Wait until you've healed completely.
Your care team will let you know when you can return to work.