Avoid prolapse worsening and prolapse surgery with the 2 proven Physiotherapy prolapse treatments for women with pelvic organ prolapse. Pelvic Floor Physiotherapist Michelle Kenway https://www.pelvicexercises.com.au shows how pessary devices and pelvic floor exercises are evidence-based prolapse treatments that can reduce prolapse symptoms, prolapse worsening and avoid prolapse surgery in some women.
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Pelvic organ prolapse occurs when pelvic organs such as bladder, uterus, or rectum descend into the vaginal walls due to weakened vaginal support after childbirth or menopause. Uterine prolapse symptoms include bulging sensation, difficulty inserting tampons, or challenges with intimacy.
1. Support Pessary Devices
Support pessaries are proven non-surgical treatment for prolapse. These mechanical devices are designed to support the vagina and hold prolapsed organs, like the bladder or uterus, in their anatomically correct positions. By doing so, they can reduce prolapse symptoms and help some women avoid or delay prolapse surgery.
Typically, women start with a trial of a ring pessary, which is fitted inside the vagina by a pelvic floor physiotherapist or gynecologist. The pessary's role in supporting the prolapsed organs reduces the downward stretch on the pelvic floor, potentially making PFMT more effective. However, it may take some trial and error to find the right size and type of pessary.
According to a Cochrane review, pessaries combined with PFMT may improve women's prolapse symptoms and quality of life (Bugge et al., 2020). Pessary use may come with an increased risk of adverse events, requiring regular follow-ups by a health professional. Women with thin vaginal walls may need to use vaginal estrogen to thicken the walls before pessary fitting, reducing the risk of irritation or wear on the vaginal tissues. Regular check-ups with a gynecologist or pelvic floor physical therapist can ensure the pessary's continued suitability and safety.
2. Pelvic Floor Exercises (Kegel Exercises)
Pelvic floor muscle training (PFMT) including Kegel exercises, is an evidence-based non-surgical treatment for prolapse. Kegel exercises train the pelvic floor muscles, which help support the pelvic organs.
Research has shown that physiotherapy-supervised PFMT can effectively reduce prolapse symptoms and may delay or prevent the need for prolapse surgery in women with mild to moderate prolapse (stage I-III). Brækken et al. (2010) conducted a randomized controlled trial demonstrating that a course of supervised pelvic floor exercises, performed at an appropriate dosage, can improve pelvic organ support and alleviate symptoms in some women. Proper pelvic floor exercise technique and sufficient dosage are crucial for the success of PFMT (Brækken et al., 2010; Hagen & Stark, 2011).
Support pessary devices and pelvic floor exercises can offer effective non-surgical treatment options for managing prolapse. These conservative treatments may help women avoid or delay prolapse surgery and reduce prolapse symptoms. Pessary use in conjunction with pelvic floor exercises can enhance prolapse treatment. Women considering these non-surgical prolapse treatments should consult with a pelvic floor physiotherapist or gynecologist.
Music
‘Launch’ by Aiden Kenway with permission
References
Brækken, I. H., Majida, M., & Bø, K. (2010). Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. American Journal of Obstetrics and Gynecology, 203(2), 170.e1-170.e7
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Bugge, C., Adams, E. et al. (2020). Pessaries (mechanical devices) for managing pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, 11, CD004010. https://doi.org/10.1002/14651858.CD004010.pub4
Hagen, S. & Stark, D. (2011). Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, (12), CD003882.
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