Treatment

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Pelvic organ prolapse (POP) is not a dangerous medical condition and the need for treatment will be based on a woman's satisfaction with her quality of life. Treatment options range from doing nothing and observing your condition over time to surgery to correct the prolapse. The choice of treatment typically depends on how your POP affects your quality of life, on your overall health and on your physician's expertise.

Nonsurgical options

• Observation. If you're not having symptoms, or your symptoms are not interfering with your quality of life, you may choose a wait-and-see approach. Every year, you undergo a complete examination to evaluate your POP. Just make sure you contact your health care professional if your condition changes during the year.
• Addressing symptoms. Another option is to address any symptoms you have without actually "fixing" the underlying prolapse. For instance, if you're experience urinary or fecal incontinence, your doctor may recommend Kegel exercises (described below) or medication. If you are constipated and straining with bowel movements, then changing your diet, adding fiber supplements or taking medications such as laxatives may help.
• Kegel exercises. These exercises strengthen your pelvic floor, which can help strengthen your organs in the pelvic region and may relieve pressure from prolapse. To perform Kegels, pull in or squeeze your pelvic muscles as if you were trying to stop the flow of urine or keep from passing gas. Count to 10 as you hold the contraction, relax and then repeat. Aim for at least three sets of 10 contractions a day.
• Pessaries. Pessaries are small devices placed in the vagina to support the pelvic organs. They are commonly used in women with POP to reduce the frequency and severity of symptoms, delay or avoid surgery and prevent the condition from getting worse. A pessary should not be used if you're not able to take care of it yourself (removing and cleaning it).

  Most pessaries are made from silicone, plastic or medical-grade rubber. Silicone is probably best, since it is nonallergenic, doesn't absorb odors or secretions, can be repeatedly cleaned and is pliable and soft. You typically remove the pessary at bedtime and replace it in the morning, although you can arrange to remove it less often. Most doctors prescribe vaginal estrogen with a pessary to prevent any irritation of the vaginal walls.

Surgery

The goal of surgery for pelvic organ prolapse (POP) is to improve your symptoms by addressing the underlying cause. Surgery can be reconstructive, which corrects the prolapsed vagina while maintaining or improving sexual function and relieving symptoms, or obliterative, which moves the organs back into the pelvis and partially or totally closing off the vaginal canal. About 200,000 inpatient surgical procedures are performed every year in the United States for POP.

Surgery may involve repairs to any pelvic organs, including the various parts of the vagina, the perineum (the region between your vagina and anus), bladder neck and anal sphincter (anus). The goal of surgery is to reposition the prolapsed organs and secure them to the surrounding tissues and ligaments. Sometimes synthetic mesh is used to hold the organs in place.

Although hysterectomy is still commonly performed in women with symptomatic POP, several other surgical procedures are available. Which your doctor recommends depends on your condition and the specific type of prolapse. Surgeries can be performed through an abdominal incision, laparoscopically (through small incisions in your belly) or vaginally.

Studies find that the vaginal approach results in fewer wound complications, less postoperative pain and shorter hospital stays than with abdominal surgery. Today, about 90 percent of POP surgeries are performed vaginally. However, all forms carry a risk of relapse.

In terms of the surgery itself, two common procedures used for correcting prolapse at the top of the vagina have been compared in several studies. The abdominal sacral colpopexy uses synthetic mesh to suspend the upper vagina from the tailbone, while the vaginal sacrospinous ligament suspension attaches either the upper vagina or cervix to the tailbone. The studies found that the abdominal sacral colpopexy led to lower relapse rates but required longer operating times and hospital stays and resulted in more surgical and postsurgical complications. However, the procedure is now being performed laparoscopically more often, reducing blood loss and in-patient hospital time; many women who have a laparoscopic procedure can go home the next day.