Pelvic floor prolapses

Pelvic floor prolapse occurs when one or more of the organs in the pelvis (uterus, bowel, bladder) move from their usual position and bulge into the vagina, due to loss of strength of the vaginal walls. This is a very common problem.

A range of treatment are available for prolapses, ranging from conservative (physiotherapy, lifestyle changes, weight loss, mechanical supports) through to surgical repair. These treatment options will be carefully explained to you during your consultation with me, so that you have the information you need to make an informed decision for treatment.

Assessment

Pelvic floor prolapse can be associated with a number of factors, including pregnancy and older age. There are different ways of treating prolapses, and these depend on whether it's just the physical presence of a prolapse that is causing symptoms or whether there is also bladder and/or bowel involvement.

When I meet with you at Sulis Hospital Bath, I will carry out an examination to assess the prolapse. From this examination, and our conversation about your symptoms, we will be able to narrow down potential treatment choices and talk through them.

To manage a prolapse most effectively, you may sometimes need to be referred to a pelvic floor specialist. This is more common if you’ve had a prolapse repair previously, because this will involve a different type of management and will need to be looked at by a specialist.

Treatment

If it is your first presentation with prolapses, then a lot of the time it can be successfully managed with physiotherapy. You will be shown how to do pelvic floor exercises to tone and strengthen the muscles and this can often relieve your symptoms.

I would normally advise physiotherapy for 3-6 months to give it enough time to have an effect. It is also important to realize that even if you are considering going down the line of surgery, optimizing muscle strength and physical strength is really important in the rehabilitation process after surgery.

Even if you don’t see any physical improvement of the prolapse from physiotherapy, there is some good evidence that shows prolapse surgery is more beneficial, and the outcomes are better, if a person has engaged in physiotherapy in advance, so physiotherapy certainly is useful to do in any event.

If physiotherapy fails, we can move to medical management using vaginal pessaries. These are little mechanical supports made of latex or silicone that are placed into the vagina to help ease the symptoms of prolapses. They can help avoid the need for surgery.

Conservative treatment works in potentially delaying the surgery, and they can work well. It is important to remember that surgery isn't always the answer. Having said that, where conservative options have not worked as well as we would like, or when the prolapse is more severe, surgery may be required.

There are a range of surgical options available, including surgical repair, laparoscopic mesh surgery and hysterectomy. The type of surgery done will depend very much on which part of the pelvic floor has lost its support strength, and everything will be discussed with you clearly when we are talking about surgical choices.

As always, if you have any questions about any aspect of your care or treatment options, please do ask during your consultation.

Recovery

You may need to stay in hospital for a day or two after surgery, and this will depend on the surgery carried out. You will be given clear advice about your recovery when you are at Sulis Hospital Bath.

Pelvic floor surgery is an effective treatment, and usually lasts a good amount of time, usually more than 10-15 years, before it may need to be repeated. The more you can engage with physiotherapy and other conservative measures, the less likely you are to need further prolapse surgery in the future.

Lifestyle changes to help avoid prolapse

Simple lifestyle changes can significantly lower your risk of future prolapses. While conservative treatment options, mechanical supports and surgery are available, you can help yourself a lot by managing your weight, eating sensibly, regulating your bowel habit (avoiding straining) and exercising, especially the pelvic floor muscles.

We know that a high box mass index (BMI) is a risk factor for pelvic floor prolapse. Your GP may very well be able to engage you in an exercise programme to help manage your weight. Where appropriate, they can also refer you to a dietitian service for help with eating healthily. A lower body mass index may allow you to avoid surgery altogether, because prolapses can sometimes resolve simply by reducing the pressure in the pelvis.

Help for pelvic floor prolapse

Should you require help for pelvic floor prolapse, please get in touch to arrange a consultation with me here at Sulis Hospital Bath. Any treatment should be focused around what suits you best within your lifestyle choices. With different treatment options, ranging from conservative to surgical, I can help ensure you receive care that is tailored to your exact needs.