Conservative Management of Prolapse

For women with pelvic organ prolapse, the lifestyle changes associated with being at home during COVID-19 are having a big impact on their symptoms.  Women are home with their kids more, and doing heavier house and garden work.  As the gyms and pools are closed, many have also turned to running or high impact online exercise programs, all of which are contributing.  Given the strong evidence base for conservative management of mild-moderate pelvic organ prolapse, we would like to share 5 conservative treatment options.

1. Pelvic Floor Muscle Training

The pelvic floor muscles play a crucial role in pelvic organ support, and are vital in prevention and management of prolapse.  A weak pelvic floor leads to stretching and eventual tearing of the ligaments and fascia supporting the pelvic organs.  Pelvic floor muscle training is the Grade A recommended first line treatment for prolapse by the International Continence Society1, with Level 1A evidence that pelvic floor muscle training prescribed based on an assessment of the muscle function by a specifically trained practitioner can effectively reduce symptoms of prolapse.  
 

2. Pessaries

During COVID-19 we have been fitting more pessaries than ever before! At WMHP we are trained to fit ring (with and without support) and dish pessaries, or can provide follow up care for patients whom you have fitted a pessary.  Pessaries are particularly helpful for women who are not wanting to pursue surgery, have not finished with their childbearing, are unfit for surgery, or want to be able to participate in higher levels of exercise. 
 

3. Lifestyle Modification 

Addressing the many lifestyle factors contributing to prolapse makes a huge difference in prolapse symptom severity.  The most common factors we typically address are constipation, heavy lifting, and high impact exercise.  Empowering women by educating them regarding how to empty their bowels without straining, how to modify their ADL’s, and how to exercise safely enables women to live rich and full lives, whilst being safe for their prolapse. 
 

4. Reassurance 

Women can be very fearful of prolapse. They have often heard horror stories from older family and friends, and have many misconceptions about what a prolapse is, and its prognosis.  As we know from pain science research, fear creates a heightened symptom experience.  Educating women about their prolapse without using scary or threatening language can make a huge and immediate difference in overall symptom experience, and also positively impact a woman’s self-esteem. 
 

5. Stress & Anxiety Management

Heightened levels of stress and anxiety can also exacerbate a woman’s prolapse symptom experience.  Although this is an ‘evidence-free zone’, clinically, we see a high correlation between anxious women and prolapse symptoms which are not necessarily consistent with prolapse severity.  This has been particularly evident during the COVID-19 pandemic.  For these women, addressing stress and anxiety in a biopsychosocial treatment approach is extremely helpful.

 

References 
Incontinence, 6th Edition 2017. Editors Paul Abrams, Linda Cardozo, Adrian Wagg, Alan Wein. 6th International Consultation on Incontinence, Tokyo, September 2016.