Prolapse Treatment Options

Jun 20, 2023

Women's Health, Pelvic Health

Pelvic Floor Physical Therapy

This is going to be the most conservative option, meaning that it will not involve surgery or the insertion of a pessary. Pelvic floor PT will address the reason the prolapse is happening in the first place. Some people have a weak pelvic floor that is no longer supporting the organs. Other people have difficulty with pressure management, which leads to an increase in pressure on the pelvic floor. There are also other reasons, but the above two issues are the most common we see.

Along with this, we notice that often it is a combination of reasons. A lot of people are “ab grippers”, usually from years of trying to suck it in. This usually creates downward pressure on the pelvic floor due to the upper abs being contracted all the time. This makes the pelvic floor muscles work overtime. They are forced to work even harder to hold the organs of the pelvis up. Eventually, they fatigue, which leads to more prolapse.

Grades 1 and 2 prolapse respond well to physical therapy without use of a pessary or surgery. Pelvic organ prolapse is usually not considered to be reversible; however, there are exceptions to every rule. If a person has mild (Grade 1 or 2) prolapse right after birth or when they are breastfeeding, there is a chance that the tissues will heal back in their original position due to everything shrinking back down and there still being relaxin in the system. This gives the person an advantage because their body is still adapting after giving birth. This is the most common scenario of the potential for the prolapse to reverse.

Pessary Fitting

A pessary is a device that is inserted into the vaginal canal that can support the bladder, rectum, or uterus. The type of pessary depends on the type of prolapse you have. If you want to know more about the different types of prolapse, find our previous post on pelvic organ prolapse. An OB/GYN or a specially trained pelvic floor physical therapist can fit a pessary. Note that there are differences in the way that a doctor will fit a pessary and the way a PT will fit a pessary. PTs are more focused on the activity of the muscles of the pelvic floor and how we can aid in the support of the organs with a pessary. This does not mean that you will not get treatment to get to the root cause, but it does mean that you have some extra support. I have used a ring pessary, which is more for cystocele, as well as a cube pessary, which can be used for more severe prolapse such as a combination of cystocele and rectocele, or uterine prolapse.

Surgery

At Revive PT, we recommend physical therapy, but surgery is an option. We don’t like people to opt for surgery unless they have a Grade 4 and in some cases a Grade 3. Keep in mind that surgery is not an end-all be-all for prolapse. If the issue that is causing it is not addressed, it is likely that the prolapse will come back and another surgery will be necessary. Surgery does have a high success rate, but not everybody wants to have surgery.

Conclusion

There are a variety of treatment options for pelvic organ prolapse. Some may be more appealing than others, but the best treatment usually involves pelvic floor physical therapy to address the cause of the prolapse regardless of having surgery, pessary fitting, or neither of those options.

If you have prolapse and want to address it, visit Revive Physical Therapy to be assessed by a pelvic floor physical therapist!