Pelvic Organ Prolapse

Conservative management options include:

• Pelvic floor exercises There is a role for pelvic floor exercises in younger women with mild prolapse who find intravaginal ring pessaries unacceptable and are not yet willing to consider surgery, especially if they have not yet completed their family.
• Intravaginal ring pessaries Ring pessaries vary in size and are fitted to each patient according to her vaginal size. It lies within the vagina and has to be changed every four to six months.

Surgical options vary according to the type and degree of prolapse:

• Pelvic floor repairs
  If the urethra, bladder, rectum or intestines protrude through the vaginal wall, the pelvic floor will be repaired and strengthened with sutures to correct the prolapse and replace the organs back to their original position.
• Vaginal hysterectomy
  This is indicated when the uterus protrudes through the vaginal opening. The uterus is removed via the vaginal route.
• Mesh repair
  This may be indicated in cases of severe prolapse, to enhance the degree of support to the pelvic floor, preventing a future recurrence. A synthetic mesh is placed beneath the vaginal skin after reducing the pelvic organs back to their original position.
• Sacrospinous ligament fixation
  This is done in cases of severe uterine prolapse, to suspend the vaginal vault to the sacrospinous ligament and thus reduce the chance of prolapse recurrence.

There are a myriad of surgical techniques and this list is by no means exhaustive. The specific surgical procedure can only be advised by a urogynaecologist after assessing the patient.