Medications

Although taking or applying the hormone estrogen will not cure an existing pelvic organ prolapse, it is sometimes prescribed for women during menopause to preserve or strengthen the tissues of the pelvis, which may help prevent prolapse. Estrogen prevents drying and thinning of the vaginal tissues (vaginal atrophy) and improves your ability to effectively use a support device for your vagina (pessary).

Studies have shown that taking estrogen replacement therapy (ERT) or hormone replacement therapy (HRT) can increase risks of serious diseases.⁴ Estrogen as a low-dose vaginal cream is not thought to pose the same risks to women's health. Talk to your doctor about taking or applying estrogen.

Surgery

If you have pain and discomfort from pelvic organ prolapse that does not respond to nonsurgical treatment and lifestyle changes, you may want to consider surgery. The choice of surgery depends upon which organs are involved, how bad your symptoms are, and what other medical conditions are present. Also, your surgeon may have experience with and preference for a certain procedure. The goals of surgery are to relieve your symptoms and restore the normal functioning of your pelvic organs.

There are several types of surgery to correct stress urinary incontinence. These can be done at the same time as surgery to repair prolapse. These surgeries lift the urethra and/or bladder into their normal position. To learn more about these surgical procedures, see the topic Urinary Incontinence in Women.

Pelvic Organ Prolapse: Should I Have Surgery?

Surgery Choices

Surgical procedures used to correct different types of pelvic organ prolapse include:

• Repair of the prolapsed bladder (cystocele) or urethra (urethrocele).
• Removal of the uterus (hysterectomy).
• Repair of the rectum (rectocele) and small bowel (enterocele).
• Repair of the vaginal wall (vaginal vault suspension).
• Closure of the vagina (vaginal obliteration).

What To Think About

Surgeries are designed to treat specific symptoms, so you may still have other symptoms after surgery. An examination while you have a pessary in your vagina may help the doctor see if urinary incontinence would be a problem after surgery. If the pessary test shows that urinary incontinence will be a problem, another surgery can be done at the same time to fix the problem.

Surgery in one part of your pelvis often makes a prolapse in another part worse, possibly requiring separate treatment in the future.⁵

Pelvic organ prolapse can come back after surgery. Doing Kegel exercises after surgery has been shown to improve symptoms of pelvic organ prolapse more than surgery alone. Other exercises recommended by a physical therapist, when done after surgery, can have the same result.⁶

Pelvic organ prolapse is strongly linked to labor and vaginal delivery, so you may want to delay surgery if you plan to have children.