Genitourinary prolapse treatment options

Frequently asked questions

No treatment (a wait and see approach)

Pelvic floor exercises

Physiotherapy

A vaginal ring pessary

An operation

How does it work?

If the prolapse is not troubling you then treatment may not be needed. The prolapse does not necessarily become any worse, so you can wait and see. If your symptoms become any worse, you could then opt for treatment.

Regular exercising of muscles makes them stronger. Specific exercises to strengthen the muscles around the vagina can improve symptoms of prolapse as they tighten up.

This adds to pelvic floor muscle training. Muscles may be stimulated electrically. Electronic feedback shows how effective the exercise is. Weights which help strengthen muscles around the vaginal wall may also be used.

This is a device which is placed inside the vagina to hold the muscle walls back. This stops the pelvic organs dropping down through the vagina.

Various operations are done for prolapse. Choice depends on which type of prolapse and how severe it is. The general theme is to tighten up the loose tissue so that the pelvic organs are held in place. A mesh may or may not be used to reinforce your own tissues.

How effective is it?

Prolapse usually doesn’t improve without treatment; however, for some women things can improve. If you are overweight and can lose weight, the prolapse is more likely to improve.

There is evidence to show that prolapse is reduced and symptoms are improved by pelvic floor exercises. However, it is difficult for studies to define exactly how effective this option is.

Pelvic floor exercises with help and advice from a physiotherapist have been shown to be more beneficial than pelvic floor exercises done without extra help.

Ring pessaries are effective in about 6 out of 10 women who use them.

This varies depending on which operation and which surgeon. Usually there is improvement. A prolapse returns at some point in 29 out of 100 women who have had the operation.

What are the advantages of this option?

There are no risks or side-effects as long as the prolapse is mild and not causing problems.

This is a safe option with no risks or side-effects. You can do pelvic floor exercises yourself without being referred to a specialist. No vaginal examinations are required by health professionals. Pelvic floor exercises take very little time (approximately two minutes three times a day).

This option makes pelvic floor exercises more effective. It may save you having to have an operation.

This may save you having to have an operation. Complications from ring pessaries are uncommon. Some women can manage ring pessaries themselves - replacing them as needed without needing a health professional to do so.

An operation may be a more lasting cure for prolapse. It may work where the other treatments have failed. For severe prolapse there may be no other effective option.

What are the disadvantages of this option?

If your prolapse is causing you symptoms, this option is unlikely to help.

If your prolapse is quite severe, pelvic floor exercises may not control it. You may need to continue doing pelvic floor exercises every day for life to keep the muscles strong.

You may find it embarrassing to have a physiotherapist examining your vagina. You may not wish for the electrical stimulation or feedback methods which may be used, or the weight training option.

It can be uncomfortable or painful having a ring pessary put in or taken out. It is usually replaced every six months. You may prefer a more permanent treatment. Occasionally a ring pessary can put you more at risk of an infection in your vagina. Occasionally ring pessaries cause bleeding or problems passing urine or stools. They may cause a vaginal discharge.

Surgery always carries some risk. The anaesthetic has risks and you may be more likely to have a blood clot (thrombosis) after an operation. Complications may occur in some women. If considering an operation, talk to the surgeon about all the possible risks. Find out if a mesh will be used; if so, ask the surgeon about pros and cons of mesh repairs. Prolapse may return in years to come after an operation.

How long will it take to work?

Occasionally prolapse improves over time. It is more likely to stay the same or become worse.

You will need to do regular pelvic floor exercises for at least three months and possibly continue them for life.

This is likely to take a number of sessions over a few weeks. An average number of sessions with a physiotherapist would be six. You would be advised to continue pelvic floor exercises afterwards.

If the fit is correct, you should notice an immediate improvement. Sometimes it may take two or three attempts to get the right size so it is comfortable and effective for you.

The operation improves the prolapse immediately but it can take some time to recover from the operation. Depending on which operation you have, this may take up to six weeks.