Conservative treatemnt of genital prolpase

 How best to plan the treatment of women with pelvic organ prolapse -? What points to consider??

There are several techniques employed to manage different kinds of pelvic organ prolapse over the years and the techniques have evolved over a period of time each of which have been tailor -made and best suited for the A)  type of prolapse, B) the age and C) parity of the patient, D) severity of the presenting symptoms, E)  the desire for menstrual, child bearing and sexual functions of the patient.

Conservative management for prolapse: when ?  Ans:  Several indications can make conservative line of management of prolapse necessary. It is of absolute importance to choose the correct candidate to manage the POP conservatively. Factors such as 1) pregnancy, 2) prolapse during lactation, medical or local contraindications of surgery such as 3) Uncontrolled  diabetes, 4) Severe hypertension,  5) heart disease, 6)active tuberculosis, 7) decubitus ulcers till healing is complete and Cx biopsy is negative for malignancy . Similarly all women must be properly prepared for surgery adequately . Therefore one should not rush for surgery as soon as genital prolapse is diagnosed.  Preop planning for kind of operation is also important and some kinds of prolapse warrants abdominal repair though most will be benefited by corrective surgery by vaginal 

route. 

What is the aim of Conservative management??  Ans: However, the goal of conservative management is to A)  improve symptoms, B) reduce progression rate , C) and avoid or delay surgical treatment.

Medical Management options for women with symptomatic pelvic organ prolapse include observation, 1)  pelvic floor muscle training, and 2) mechanical support (pessaries).

1)       Pelvic muscle floor training Pelvic floor muscle training, the systematic contraction of the muscles of the pelvic floor, may improve pelvic function. These exercises, commonly known as Kegel exercises, can be accomplished by conscious contractions, electrical stimulation, or via biofeedback training.   2)       The use of Kegel cones (weighted cones used to help women isolate pelvic floor muscles) can also help. However, the effectiveness of pelvic floor muscle training in reversing or treating pelvic organ prolapse has not been studied. Pelvic floor muscle training has been shown to significantly improve symptoms associated with stress, urge, and mixed urinary incontinence.       How helpful are pessaries?? Unfortunately, there are no randomized trials to guide pessary selection for any particular type of device, indications, pattern of replacement, follow-up care, or degree of pelvic organ prolapse. Traditionally, pessaries have been used for short-term symptom relief in women awaiting surgery or for long­ term treatment in women with higher stages of prolapse, who are poor surgical candidates, or who have declined surgery. However, pessaries can be used in almost all cases, when a nonsurgical option is desired,  less frequent follow-up may also be safe if she resides near the clinic. Patients should be asked if they have experienced any vaginal discharge, bleeding, pain, or discomfort. The pessary is palpated in situ then removed to check the vagina for ulcerations or erosions. The pessary can be washed with soap and water, dried, and reinserted. If vaginal lesions are noted, the pessary should be removed until the lesions have healed. Although there is no evidence on the effectiveness of vaginal estrogen creams in the treatment of pelvic organ prolapse, it may be appropriate for postmenopausal women who have significant vaginal atrophy if no contraindications exist.

Medical Management options for women with symptomatic pelvic organ prolapse include observation, 1)  pelvic floor muscle training, and 2) mechanical support (pessaries).

 

1)       Pelvic muscle floor training Pelvic floor muscle training, the systematic contraction of the muscles of the pelvic floor, may improve pelvic function. These exercises, commonly known as Kegel exercises, can be accomplished by conscious contractions, electrical stimulation, or via biofeedback training.

 

2)       The use of Kegel cones (weighted cones used to help women isolate pelvic floor muscles) can also help. However, the effectiveness of pelvic floor muscle training in reversing or treating pelvic organ prolapse has not been studied. Pelvic floor muscle training has been shown to significantly improve symptoms associated with stress, urge, and mixed urinary incontinence.

 

 

 

How helpful are pessaries?? Unfortunately, there are no randomized trials to guide pessary selection for any particular type of device, indications, pattern of replacement, follow-up care, or degree of pelvic organ prolapse.

Traditionally, pessaries have been used for short-term symptom relief in women awaiting surgery or for long­ term treatment in women with higher stages of prolapse, who are poor surgical candidates, or who have declined surgery. However, pessaries can be used in almost all cases, when a nonsurgical option is desired,  less frequent follow-up may also be safe if she resides near the clinic. Patients should be asked if they have experienced any vaginal discharge, bleeding, pain, or discomfort. The pessary is palpated in situ then removed to check the vagina for ulcerations or erosions. The pessary can be washed with soap and water, dried, and reinserted. If vaginal lesions are noted, the pessary should be removed until the lesions have healed. Although there is no evidence on the effectiveness of vaginal estrogen creams in the treatment of pelvic organ prolapse, it may be appropriate for postmenopausal women who have significant vaginal atrophy if no contraindications exist.