Pelvic Floor Disorders [3]
TREATMENT
If prolapse is mild, performing Kegel exercises can help by strengthening the pelvic floor muscles. Kegel exercises target the muscles around the vagina, urethra, and rectum-the muscles used to stop a stream of urine. These muscles are tightly squeezed, held tight for about 10 seconds, then relaxed for about 10 seconds. The exercise is repeated 10 to 20 times in a row. Performing the exercises several times a day is recommended. Women can do Kegel exercises when sitting, standing, or lying down.
If prolapse is severe, a pessary may be used to support the pelvic organs. A pessary may be shaped like a diaphragm, cube, or doughnut. Pessaries are especially useful for women who are waiting for surgery or who cannot have surgery. A doctor fits the pessary to the woman by inserting and removing different sizes until the right one is found. A pessary can be worn for many weeks before it needs to be removed and cleaned with soap and water. Women are taught how to insert and remove the pessary for monthly cleaning. If they prefer, they may go to the doctor's office periodically to have the pessary cleaned. Pessaries can irritate the vaginal tissues and cause a foul-smelling discharge. Women who have this problem can use a vaginal deodorizer to mask the odor. As long as no other problems occur, these women may continue to use the pessary, removing it for cleaning each month. These women should also see their doctor every 6 to 12 months.
Estrogen vaginal suppositories or cream may be used. These preparations can help keep vaginal tissues healthy and can prevent sores from forming.
Surgery is often needed but is usually performed only after a woman has decided not to have any more children. Surgery usually involves inserting instruments into the vagina. The weakened area is located, and the tissues around it are built up to prevent the organ from dropping through the weakened area.
For severe prolapse of the uterus or vagina, the surgery may require an incision in the abdomen. The upper part of the vagina is attached with stitches to a nearby bone in the pelvis. Often, a catheter is inserted to drain the urine for 1 to 2 days. If urinary incontinence is a problem or would occur after prolapse of the uterus is repaired, surgery to correct incontinence can usually be performed at the same time. In such cases, the catheter may be left in place longer. Heavy lifting, straining, and standing for a long time should be avoided for at least 3 months after surgery.
If prolapse of the rectum makes having a bowel movement difficult, surgery may be necessary.