Treatments

Physiotherapy

Physiotherapy can be helpful in many ways. If your prolapse can be managed without the need for a pessary or surgery, you may be referred to a physiotherapist in order to strengthen the pelvic floor muscles.

If you do have any other treatments, physiotherapy may still be recommended as it can help by improving control over bladder and bowel function, improving existing prolapse or reducing the risk of prolapse, and improved recovery from childbirth and surgery.

Vaginal pessaries

Vaginal pessaries are used to alleviate symptoms of pelvic prolapse and support the vaginal walls. Pessaries come in all different shapes and sizes used on a trial-and-error basis to find the patients correct fit depending on their prolapse and lifestyle. Pessaries are either PVC or silicone and are placed into the vagina.This device should be comfortable and help improve quality of life.

Vaginal estrogen is offered during pessary management to keep vaginal tissues well moisturised.

Surgery for prolapse

There are several different surgical treatments for pelvic organ prolapse. This can include surgical repair, hysterectomy or closing the vagina.

Surgical repairs

Surgical repairs are usually done by making cuts in the wall of the vagina under general anaesthetic. Anterior wall repair is where the bladder bulges into the vagina from the front wall of the vagina. Posterior wall repair is where the bowel bulges forward into the back wall of the vagina.

These operations can involve lifting and supporting the pelvic organs. This could be by stitching them into place or supporting the existing tissues to make them stronger. Typically, a BMI under 30 is preferred for surgical management.

Hysterectomy

For women with a prolapsed womb who have been through the menopause or do not wish to have any more children, a doctor may recommend surgery to remove the womb (hysterectomy).

It can help to relieve pressure on the walls of the vagina and reduce the chance of a prolapse returning. 

Closing the vagina

Occasionally, an operation that closes part or all the vagina may be an option. This treatment is only offered to women who have advanced prolapse, when other treatments have not worked and they're sure they do not want to have sex again in the future.

This operation can be a good option for frail women who would not be able to have more complex surgery.

Urinary incontinence 

Urinary incontinence is when the normal process of storing and passing urine is disrupted causing involuntary leakage of urine.

This can happen for several reasons such as:

• weakened muscles such as your pelvic floor and urethral sphincter; problems with these muscles may be caused by damage during childbirth
• increased pressure on tummy (pregnant or obese)
• certain medicines
• damage to the bladder or nearby area during surgery, connective tissue disorders or other neurological conditions

Bladder pain  

Painful bladder syndrome or bladder pain syndrome, also commonly known as interstitial cystitis, is a chronic inflammation of the bladder wall. It is not caused by bacteria and does not respond to conventional antibiotic therapy. It can affect both women and men, although it is more common in women.

Treatments include medication, topical treatment and bladder instillations.

Bladder training 

Bladder training combined with pelvic floor muscle training can be helpful with incontinence symptoms. It involves learning techniques to increase the length of time between feeling the need to urinate and passing urine.

The course will usually last for at least six weeks.

Medication 

Medication can be offered as treatment for overactive bladder and or continence symptoms, these will need to be prescribed.

Solifenacin, tolterodine and mirabegron are all medicines which help to relax your bladder, or the muscles around it, so it can hold more liquid and you do not need to pee as often or as urgently.

Patients who are suitable for anticholinergic medication should be started on solifenacin. If there is little to no improvement, patients should then be considered for mirabegron, after trialling at least two medications. If again no improvements are made, patients should be referred to urogynaecology.

Cystoscopy with bladder Botox

Cystoscopy Is a test where a cystoscope is passed into the bladder by a healthcare professional to have a look into the bladder to again confirm or determine whether there is any under lying conditions causing urinary symptoms. During cystoscopy, injections into the bladder may be offered to help relax the bladder wall. This can then reduce urinary urgency and frequency, reducing urinary incontinence. Improvements are usually noticed three to four days after treatment. This is an outpatient procedure. 

Surgery for incontinence

If non-surgical treatments for urinary incontinence are unsuccessful or unsuitable, surgery or other procedures may be recommended.

Colposuspension involves making a cut in your lower abdomen, lifting the neck of your bladder, and stitching it in this lifted position.

Sling surgery involves making a cut in your lower tummy (abdomen) and vagina so a sling can be placed around the neck of the bladder to support it and prevent urine leaking.

Urethral bulking agent is a substance that's injected into the walls of the urethra in people with stress incontinence who have a vagina. This increases the size of the urethral walls and allows the urethra to stay closed with more force. As well as Sacral nerve stimulation.