Treatment will be based on which pelvic organs have prolapsed, how severe your symptoms are and whether other medical conditions are present.

Lifestyle changes

If your symptoms are mild, changes to your lifestyle may be effective in slowing down the progression of prolapse. These lifestyle changes include the following:

1. Do pelvic strengthening exercises (Kegel exercises) every day. These exercises help strengthen the muscles of the pelvis.
2. Maintain an ideal body weight. Excessive weight gain increases pressure on the pelvic floor
3. Avoid lifting heavy things.
4. Quit smoking. The chronic cough associated with smoking may worsen an existing prolapse.
5. Correct constipation. Increase your daily consumption of dietary fibre to combat constipation. The chronic straining caused by constipation weakens and damages the connective tissue and muscles in the pelvis.
6. Cut back on caffeine if you have a urinary problem. Caffeine acts as a diuretic and can cause you to urinate more often.

Non-surgical treatment

A pelvic support device in the form of a pessary can be fitted to support the prolapsed organ. It is a removable device that is placed in your vagina and helps to hold the pelvic organ in place. Regular change of the pessary is needed to prevent infection. A pessary is suitable in a woman who has not completed her family, or is not fit for surgery.

Surgical treatment

You may want to consider surgery if:

• The prolapsed organ is causing you a lot of discomfort.
• You have a problem with your bladder or bowel control.
• The prolapse makes it difficult for you to have sexual intercourse.
• Non-surgical options have failed to improve your symptoms

Types of surgery for pelvic organ prolapse include:

• Surgery to repair the vaginal tissue that supports a prolapsed organ, such as the bladder/rectum
• Surgery to hitch up the upper part of the vagina
• Surgery to remove the prolapsed womb, especially if the womb is diseased or the family is complete
• Surgery to treat urinary leakage
• Surgery to close up the vaginal canal

Pelvic organ prolapse is common and often involves more than one organ. In mild prolapse, preventive measures are available to slow down its progression. Surgery may be indicated in symptomatic women when conservative management does not help.

The SGH PFDS is a joint initiative by the Departments of Colorectal Surgery, Urology and Obstetrics & Gynaecology. It was established in 2008 to provide integrated and holistic care to patients with pelvic floor disorders.

Ref: R14