Skip to main content

Advertisement

SpringerLink
Log in

Recent Developments in the Non-surgical Management of Pelvic Organ Prolapse

  • Pelvic Organ Prolapse (KL Noblett, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Pelvic organ prolapse is a common condition, although not always symptomatic. With the aging population and increased burden on the healthcare, non-surgical management of pelvic organ prolapse is becoming increasingly topical. Recent data show that prolapse appears to fluctuate over time. Regression is possible (3-40 %) and the risk of progression small (11-19 %). This review discusses the various nonsurgical options available, including observation, vaginal oestrogen, lifestyle modifications, physiotherapy, and vaginal ring pessaries. Although evidence from randomised, controlled trials is limited, these options should be discussed with women who do not desire, or are unfit for, surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.

    PubMed  Google Scholar 

  2. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  3. Bradley CS, Zimmerman MB, Qi Y, Nygaard IE. Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol. 2007;109(4):848–54.

    Article  PubMed  Google Scholar 

  4. Miedel A, Tegerstedt G, Maehle-Schmidt M, Nyren O, Hammarstrom M. Nonobstetric risk factors for symptomatic pelvic organ prolapse. Obstet Gynecol. 2009;113(5):1089–97.

    Article  PubMed  Google Scholar 

  5. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet. 2007;369(9566):1027–38.

    Article  PubMed  Google Scholar 

  6. Lince SL, van Kempen LC, Vierhout ME, Kluivers KB. A systematic review of clinical studies on hereditary factors in pelvic organ prolapse. Int Urogynecol J. 2012;23(10):1327–36.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Kerkhof MH, Hendriks L, Brolmann HA. Changes in connective tissue in patients with pelvic organ prolapse–a review of the current literature. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(4):461–74.

    Article  CAS  PubMed  Google Scholar 

  8. Barber MD, Visco AG, Wyman JF, Fantl JA, Bump RC. Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol. 2002;99(2):281–9.

    Article  PubMed  Google Scholar 

  9. Jelovsek JE, Barber MD. Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. Am J Obstet Gynecol. 2006;194(5):1455–61.

    Article  PubMed  Google Scholar 

  10. Samuelsson EC, Victor FT, Tibblin G, Svardsudd KF. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol. 1999;180(2 Pt 1):299–305.

    Article  CAS  PubMed  Google Scholar 

  11. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24(11):1783–90.

    Article  PubMed  Google Scholar 

  12. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.

    Article  PubMed  Google Scholar 

  13. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.

    Article  CAS  PubMed  Google Scholar 

  14. Miedel A, Tegerstedt G, Morlin B, Hammarstrom M. A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1593–601.

    Article  PubMed  Google Scholar 

  15. Chen Z, Wong V, Wang A, Moore KH. Nine-year objective and subjective follow-up of the ultra-lateral anterior repair for cystocele. Int Urogynecol J. 2013.

  16. Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J Obstet Gynecol. 2003;188(1):108–15.

    Article  PubMed  Google Scholar 

  17. Population Division USCB. Projections of the Population by Age and Sex for the United States: 2010 to 2050.

  18. Bland DR, Earle BB, Vitolins MZ, Burke G. Use of the Pelvic Organ Prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons in perimenopausal women. Am J Obstet Gynecol. 1999;181(6):1324–7. discussion 7-8.

    Article  CAS  PubMed  Google Scholar 

  19. Handa VL, Garrett E, Hendrix S, Gold E, Robbins J. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol. 2004;190(1):27–32.

    Article  PubMed  Google Scholar 

  20. Miedel A, Ek M, Tegerstedt G, Maehle-Schmidt M, Nyren O, Hammarstrom M. Short-term natural history in women with symptoms indicative of pelvic organ prolapse. Int Urogynecol J. 2011;22(4):461–8.

    Article  PubMed  Google Scholar 

  21. Gilchrist AS, Campbell W, Steele H, Brazell H, Foote J, Swift S. Outcomes of observation as therapy for pelvic organ prolapse: a study in the natural history of pelvic organ prolapse. Neurourol Urodyn. 2013;32(4):383–6. A study on observational follow up of POP in women symptomatic for POP.

    Article  PubMed  Google Scholar 

  22. Haspels AA, Luisi M, Kicovic PM. Endocrinological and clinical investigations in post-menopausal women following administration of vaginal cream containing oestriol. Maturitas. 1981;3(3–4):321–7.

    Article  CAS  PubMed  Google Scholar 

  23. Griebling TL, Liao Z, Smith PG. Systemic and topical hormone therapies reduce vaginal innervation density in postmenopausal women. Menopauss (New York, NY). 2012;19(6):630–5.

    Article  Google Scholar 

  24. Reay Jones NH, Healy JC, King LJ, Saini S, Shousha S, Allen-Mersh TG. Pelvic connective tissue resilience decreases with vaginal delivery, menopause and uterine prolapse. Br J Surg. 2003;90(4):466–72.

    Article  CAS  PubMed  Google Scholar 

  25. Ismail SI, Bain C, Hagen S. Oestrogens for treatment or prevention of pelvic organ prolapse in postmenopausal women. Cochrane Database Syst Rev. 2010;(9):Cd007063.

  26. Felding C, Mikkelsen AL, Clausen HV, Loft A, Larsen LG. Preoperative treatment with oestradiol in women scheduled for vaginal operation for genital prolapse. A randomised, double-blind trial. Maturitas. 1992;15(3):241–9.

    Article  CAS  PubMed  Google Scholar 

  27. Vardy MD, Lindsay R, Scotti RJ, Mikhail M, Richart RM, Nieves J, et al. Short-term urogenital effects of raloxifene, tamoxifen, and estrogen. Am J Obstet Gynecol. 2003;189(1):81–8.

    Article  CAS  PubMed  Google Scholar 

  28. Valente M, Dettori C, Feraudo E, Re ME. Pelvic floor: new therapeutic approach. Int Urogynaecol J. 2000;11(issue suppl1:s97):11916.

    Google Scholar 

  29. Goldstein SR, Neven P, Zhou L, Taylor YL, Ciaccia AV, Plouffe L. Raloxifene effect on frequency of surgery for pelvic floor relaxation. Obstet Gynecol. 2001;98(1):91–6.

    Article  CAS  PubMed  Google Scholar 

  30. Vaccaro CM, Mutema GK, Fellner AN, Crisp CC, Estanol MV, Kleeman SD, et al. Histologic and cytologic effects of vaginal estrogen in women with pelvic organ prolapse: a randomized controlled trial. Female Pelvic Med Reconstr Surg. 2013;19(1):34–9.

    Article  PubMed  Google Scholar 

  31. Rachaneni S, Latthe P. Role of perioperative low dose vaginal oestrogens in improving the outcomes of pelvic organ prolapse surgery. Med Hypotheses. 2013;81(6):1015–6.

    Article  CAS  PubMed  Google Scholar 

  32. Kudish BI, Iglesia CB, Sokol RJ, Cochrane B, Richter HE, Larson J, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol. 2009;113(1):81–8.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Myers DL, Sung VW, Richter HE, Creasman J, Subak LL. Prolapse symptoms in overweight and obese women before and after weight loss. Female Pelvic MedReconstr Surg. 2012;18(1):55–9.

    Google Scholar 

  34. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;(12):Cd003882.

  35. Hagen S, Stark D, Glazener C, Sinclair L, Ramsay I. A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(1):45–51.

    Article  PubMed  Google Scholar 

  36. Hagen S, Stark D, Glazener C, Dickson S, Barry S, Elders A, et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet. 2014;383(9919):796–806. A large, rigorous multicentre trial comparing pelvic floor muscle training for POP to lifestyle advice.

    Article  PubMed  Google Scholar 

  37. Hyland G, Hay-Smith J, Treharne G. Women's experiences of doing long-term pelvic floor muscle exercises for the treatment of pelvic organ prolapse symptoms. Int Urogynecol J. 2014;25(2):265–71.

    Article  PubMed  Google Scholar 

  38. Shah SM, Sultan AH, Thakar R. The history and evolution of pessaries for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(2):170–5.

    Article  PubMed  Google Scholar 

  39. Bugge C, Adams EJ, Gopinath D, Reid F. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Systema Rev. 2013;2:Cd004010.

    Google Scholar 

  40. Cundiff GW, Weidner AC, Visco AG, Bump RC, Addison WA. A survey of pessary use by members of the American urogynecologic society. Obstet Gynecol. 2000;95(6 Pt 1):931–5.

    Article  CAS  PubMed  Google Scholar 

  41. Khaja A, Freeman RM. How often should shelf/Gellhorn pessaries be changed? A survey of IUGA urogynaecologists. International urogynecology journal. Published online 15th February 2014. An interesting survey on the variety of use and follow up of shelf and Gellhorn pessaries amongst urogyanecologists.

  42. Lone F, Thakar R, Sultan AH, Karamalis G. A 5-year prospective study of vaginal pessary use for pelvic organ prolapse. Int J Gynaecol Obstet: Off Org Int Fed Gynaecol Obstet. 2011;114(1):56–9.

    Article  Google Scholar 

  43. Fernando RJ, Thakar R, Sultan AH, Shah SM, Jones PW. Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol. 2006;108(1):93–9.

    Article  PubMed  Google Scholar 

  44. Handa VL, Jones M. Do pessaries prevent the progression of pelvic organ prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(6):349–51. discussion 52.

    Article  CAS  PubMed  Google Scholar 

  45. Patel M, Mellen C, O'Sullivan DM, LaSala CA. Impact of pessary use on prolapse symptoms, quality of life, and body image. Am J Obstet Gynecol. 2010;20(5):499.e1-4.

    Google Scholar 

  46. Abdool Z, Thakar R, Sultan AH, Oliver RS. Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse. Int Urogynecol J. 2011;22(3):273–8.

    Article  PubMed  Google Scholar 

  47. Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL. Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse. Am J Obstet Gynecol. 2004;190(2):345–50.

    Article  PubMed  Google Scholar 

  48. Singh K, Reid WM. Non-surgical treatment of uterovaginal prolapse using double vaginal rings. BJOG: Int J Obstet Gynaecol. 2001;108(1):112–3.

    CAS  Google Scholar 

  49. Kenton K, Barber M, Wang L, Hsu Y, Rahn D, Whitcomb E, et al. Pelvic floor symptoms improve similarly after pessary and behavioral treatment for stress incontinence. Female Pelvic Med Reconstr Surg. 2012;18(2):118–21.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Moore KH, Foote A, Siva S, King J, Burton G. The use of the bladder neck support prosthesis in combined genuine stress incontinence and detrusor instability. Aust New Zealand J Obstet Gynaecol. 1997;37(4):440–5.

    Article  CAS  Google Scholar 

  51. Moore KH, Foote A, Burton G, King J. An open study of the bladder neck support prosthesis in genuine stress incontinence. Br J Obstet Gynaecol. 1999;106(1):42–9.

    Article  CAS  PubMed  Google Scholar 

  52. Arias BE, Ridgeway B, Barber MD. Complications of neglected vaginal pessaries: case presentation and literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(8):1173–8.

    Article  PubMed  Google Scholar 

  53. Sarma S, Ying T, Moore KH. Long-term vaginal ring pessary use: discontinuation rates and adverse events. BJOG: Int J Obstet Gynaecol. 2009;116(13):1715–21.

    Article  CAS  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Nèvine I.D. te West and Kate H. Moore declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Urogynaecology, Pelvic Floor Unit, St. George Hospital, Belgrave Street, Kogarah, NSW, 2217, Sydney, Australia

    Nèvine I. D. te West

  2. Head of Department of Urogynaecology, University of New South Wales, First Floor, Pitney Clinical Sciences Building, St George Hospital, Gray Street, Kogarah, NSW, 2217, Sydney, Australia

    Kate H. Moore

Authors
  1. Nèvine I. D. te West
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kate H. Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nèvine I. D. te West.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

te West, N.I.D., Moore, K.H. Recent Developments in the Non-surgical Management of Pelvic Organ Prolapse. Curr Obstet Gynecol Rep 3, 172–179 (2014). https://doi.org/10.1007/s13669-014-0087-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13669-014-0087-6

Keywords

Search

Navigation