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Treatment options for pelvic organ prolapse

What determines if treatment is needed for Prolapse?

The two main reasons to have surgery for prolapse are:

  • Bothersome symptoms – i.e. a woman decides herself when the symptoms caused by the prolapse are bothersome enough to need treatment
  • Complications related to the prolapse such as:
    • Blockage of the flow of urine resulting in poor bladder emptying or retention of urine (inability to pass urine)
    • Blockage of the drainage of the kidneys which can result in worsening kidney function
    • Urinary tract infections caused by poor bladder emptying secondary to the prolapse

For the vast majority of women with prolapse, the decision to have treatment is elective i.e. a woman decides if she wants to have treatment because her symptoms are bothersome enough.

What happens if a Prolapse is left untreated?

In many women prolapse will gradually worsen with time. This is usually a slow change. In other women, their prolapse can remain stable without progression.

Once present, prolapse does not generally improve without surgical treatment (except for the prolapse that can occur immediately after childbirth which usually improves in the first 6 months). Not all prolapse inevitably progresses to the stage that surgery or other treatment is required.

The presence of symptoms, the effect of the prolapse on a woman’s quality of life and whether a woman wishes to have treatment are the key factors that determine if a prolapse should be treated.

What are the treatment options for Prolapse?

There are essentially 3 types of treatment options for prolapse:

  • Observation
  • Vaginal pessary
    • A pessary is a small plastic device inserted into the vagina to support the prolapsed organs and return them to their correct position.
  • Prolapse surgery
    • There are many different types of surgery available to treat vaginal prolapse which vary according to
      • The type of prolapse – which organs are involved
      • The severity of the prolapse
      • Whether the uterus is present
      • The woman’s desire to have further children
      • The woman’s preferences regarding type of surgery
      • The surgeon’s preference and experience
      • Whether previous surgery has been performed for prolapse
    • Prolapse surgery treatment is individualised to each woman.

Which treatment is right for me?

The correct treatment for any individual can only be determined after thorough evaluation of the prolapse and consideration of multiple factors including prolapse severity, symptom severity, desire for further children or patient preference in retaining the uterus, previous surgery performed for prolapse, and consideration of the potential risks and complications of any treatment.

All these factors and issues will be discussed by Dr McKertich in order to determine which are the best treatment options available in any individual’s situation.