Non-Surgical Treatment Options for Pelvic Organ Prolapse

Pessary

A pessary is a device made out of silicone that is placed in the vagina to help support the prolapsed vaginal tissue. There are different sizes and types of pessary to accommodate different pelvic problems. All women who have a pessary placed will require ongoing follow up with a medical professional to remove, clean, and replace the pessary at regular intervals.
 

Kegel Exercises

Women who can successfully perform kegel exercises may notice improvement in their pelvic organ symptoms.  This is especially true for women with mild pelvic organ prolapse.

Diet/Lifestyle Changes

Some women notice that they are less likely to have symptoms if they prevent themselves from getting constipated or straining on the toilet. Some women also notice improvement if they avoid lifting heavy objects or activities that involve significant straining. 

Non-Surgical Treatment options for Urinary Incontinence

Anticholinergic Medications

These medications are indicated for urge urinary incontinence.  Examples of such medicines include Vesicare, Trospium, Enablex, Oxybutynin, or Toviaz. These medications help to prevent bladder spasms and may be taken in the evening to help decrease night time symptoms and decrease side effects of the medication. Side effects of these medications may include dry mouth, dry eye, constipation, feeling flush, and mental status change in the elderly.  These medications should not be taken by people with closed angle glaucoma or urinary retention.
 

Beta-3 Agonist Medications

These medications are indicated for urge urinary incontinence. Examples of such medications include Myrbetriq. These medications help to encourage bladder relaxation and decrease bladder spasms. They can be taken any time of day with full glass of water. Side effects with this class of medication are rare but may include runny nose and blood pressure changes.  We generally recommend checking blood pressures at home after medication started to ensure no significant change.   

Tibial Nerve Stimulation

This is a treatment for urge urinary incontinence and is an office based weekly treatment. Treatment involves placement of a tiny needle (an acupuncture type needle) by the posterior tibial nerve in the ankle and mildly stimulating the nerve for about 20 minutes with each treatment. It is comfortable for most patients.  After initial 12 sessions follow up treatments generally range between every 4-8 weeks.
 

Kegel Exercises/Pelvic Rehabilitation

Women who can successfully perform kegel exercises may notice improvement in their urinary incontinence.  This can improve both stress and urge urinary incontinence.  When performed with a specialized nurse/physical therapist, outcomes can be significantly improved.

Diet/Lifestyle Changes

Decreased caffeine intake and decreased smoking has been associated with improvement in urge, as well as stress incontinence symptoms. Moderate weight loss amongst overweight patients has also been associated with significant improvement in stress related urinary incontinence. 

Timed Voiding

Some women may benefit from regularly emptying the bladder every 2-3 hours during the day to help prevent the number and severity of urinary incontinence events. 

Non-Surgical Treatment for Fecal Issues

Pelvic Rehabilitation

Pelvic rehabilitation involves the evaluation and treatment of pelvic floor dysfunction in women. It can be performed by a specially trained nurse or PT and is usually overseen by a physician. It is an individualized program involving assessment of pelvic floor muscle tone, use, and functional evaluation.   From this a personalized treatment plan is developed for each patient, including therapeutic exercise, relaxation techniques, manual therapy, education, and modalities as indicated.

Loperamide

Loperamide is a medication that increases anal sphincter tone and can be used to minimize fecal incontinence.  Women should avoid use of loperamide if they have infectious/bloody dirarrhea.

Diet Changes/Fiber Intake

Fiber can help women with bowel issues by making  bowel movements softer and more regular. Adding fiber to your diet can help with problems including constipation, hemorrhoids, and diarrhea. Plus, it can help prevent “accidents” if you have trouble controlling your bowel movements.  Using the right kind of fiber and correct amount is important for benefit.

Oral Probiotics

Using oral probiotics (such as culturelle, activia yogurt, etc....) can help fecal habits.  In general, these agents act by helping the natural bacteria in the gut to improve growth of advantageous colonies and improve function. These are especially beneficial after antibiotic exposure.
 

Stool Softeners

Using stool softeners, such as Colace or Miralax, can help with constipation issues. In general, these agents help to bring water into the stool and decrease the hard stools that many people suffer from. These may serve as an adjunct to oral fiber and your doctor should know if you are on these regularly. These are different then stimulant laxatives, such as dulcolax or the like, which should not be used on a daily or routine basis unless directed by your doctor.
 

Other

Your care team will discuss any other appropriate treatment options available to you.