Nonsurgical Treatment for Pelvic Organ Prolapse

Often the first treatment recommended to women with pelvic organ prolapse, a vaginal pessary is a removable device made of rubber or silicone that is placed into the vagina to hold prolapsed, or fallen, organs in place. It is frequently recommended for use in women who have mild-to-moderate prolapse. NYU Langone doctors sometimes recommend a pessary to women who don’t want surgery, either because they want to become pregnant in the future or they have other reasons for not choosing a surgical treatment.

The pessary can be removed prior to sex and for regular cleaning. Your doctor can fit a pessary to your body, teach you how to insert and remove it, and show you how to care for it. For women who aren’t sexually active or those who prefer not to manage a pessary, a specially designed pessary that stays in for two to three months at a time can be fitted and managed by your doctor.

Your doctor may prescribe topical estrogen to help prevent any irritation caused by the pessary. Topical estrogen is available as a lotion or gel and is applied directly to the affected areas.

Pelvic floor muscle exercises are designed to strengthen the muscles and ligaments of the pelvis and vagina. These include Kegel exercises, in which you tighten and release pelvic floor muscles. Pelvic floor exercises can help to ease the pain and discomfort of prolapse by strengthening muscles to provide more support to the pelvic organs. For rectal prolapse, your doctor may recommend bowel movement retraining, which helps prevent strain by using relaxation exercises.

Your doctor can teach you how to identify, tighten, and release your pelvic floor muscles. He or she can also tell you how often to perform these exercises, which are typically done twice a day. Your doctor may refer you to the physical therapists at NYU Langone’s Rusk Rehabilitation for additional support.