Many women do not need treatment for their PFD. However, treatment can often help when symptoms are bothersome or restrict a woman’s activities.1, 2 In addition, women can take actions on their own or along with treatment to help reduce or ease symptoms.
Nonsurgical treatments commonly used for PFDs include:
- Pelvic floor muscle training (PFMT). Also called Kegel (pronounced KEY-guhl) exercises, PFMT involves squeezing and relaxing the pelvic floor muscles. If performed correctly and routinely, PFMT may improve the symptoms of prolapse. However, PFMT cannot correct prolapse. Biofeedback is sometimes used to help teach women which muscle group to squeeze.2
- Injections for problems with bladder control. "Bulking agents" can be injected near the bladder neck and urethra to make the tissues thicker and close the bladder opening. Repeat injections may be needed over time.3
- Medicine. Medicine is sometimes prescribed to treat certain bladder control problems2 or to prevent loose stools or frequent bowel movements.4
- Vaginal pessary (pronounced PES-uh-ree). This plastic device is used to treat some types of prolapse and improve bladder control. A woman inserts the pessary into the vagina to help support the pelvic organs. A woman’s doctor will fit her for a pessary that is a comfortable shape and size and instruct her on how to use and care for it.5
In some cases, surgery is the best treatment option, especially when other treatments are not helpful.1, 6 Some surgical treatments can be performed as outpatient procedures.
- For prolapse. Surgery involves repairing the prolapse and building back pelvic floor support. There are many ways to do this, depending on the type of prolapse and other factors. Women with uterine prolapse may also have the uterus removed (hysterectomy). Women who have surgery to repair prolapse often have surgery at the same time to prevent bladder control problems. Some women choose to have colpocleisis (pronounced kol-poh-KLEE-sis). This surgery treats prolapse by narrowing and shortening the vagina. It works well and carries a low risk, but it is not a good choice for women who want to be able to have vaginal intercourse.1
- For bladder control problems. Surgery works well to treat problems holding in urine that occur because of pressure on the bladder (stress incontinence).5 The two types of surgery used most often are:
- Mid-urethral sling. The surgeon places a mesh strap or "sling" to hold the bladder in its normal position.6
- Colposuspension. The surgeon puts the bladder back in its correct position and holds it in place by securing it to the vaginal wall and pelvic floor tissues.6
- For bowel control problems. Surgery may be needed to repair a damaged anal sphincter muscle or repair certain types of prolapse.3
Not all women are good candidates for surgery. In general, women who want to have children should not have pelvic surgery.1 Also, prolapse can occur even after surgery is performed to correct it.1 Developing low-risk procedures and devices that work well in treating pelvic floor problems is a topic of intense research. Researchers are also comparing treatment methods to see what works best.
"Combination" can mean a woman is getting treated for more than one type of PFD, such as a treatment for both uterine prolapse and urinary incontinence. It can also mean using different treatments together to address PFDs, such as using PFMT and a surgical treatment to treat a woman’s symptoms.
Researchers are studying combination treatments to determine how to get the best outcomes for women with PFDs. For instance the Outcomes Following Vaginal Prolapse Repair and Mid-Urethral Sling (OPUS) study is evaluating if adding a procedure to treat stress incontinence at the time of surgery for pelvic organ prolapse in women who don't have symptoms of stress incontinence can help to prevent stress incontinence from occurring after surgery and without increasing risk.
- Kuncharapu, I., Majeroni, B. A., & Johnson, D. W. (2010). Pelvic organ prolapse. American Family Physician, 81, 1111-1117. [top]
- Shamliyan, T., Wyman, J., & Kane, R. (2012). Nonsurgical treatments for urinary incontinence in adult women: Diagnosis and comparative effectiveness. Comparative effectiveness review no. 36. Rockville, MD: Agency for Healthcare Research and Quality. [top]
- National Kidney and Urologic Diseases Information Clearinghouse. (2010). Urinary incontinence in women. Retrieved May 21, 2012, from http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/index.aspx#treatment [top]
- American Urogynecologic Society. (2008). Fecal incontinence. Retrieved May 21, 2012, from http://www.voicesforpfd.org/p/cm/ld/fid=20 [top]
- American Urogynecologic Society. (2008). Vaginal pessaries. Retrieved May 21, 2012, from http://www.voicesforpfd.org/p/cm/ld/fid=15 [top]
- American Urogynecologic Society. (2008). Surgery, Retrieved May 21, 2012, from http://www.voicesforpfd.org/p/cm/ld/fid=28 [top]