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Question
I’d like to know what the NWHN thinks about the devices and surgeries available for women (mostly older women) who have pelvic organ prolapse. The organs in question would be uterus and/or bladder, the devices are pessaries of various shapes and sizes, the surgeries involve providing some sort of mesh sling or the removal of the uterus.
Answer
Certain lifestyle changes can help prevent pelvic organ prolapse from occurring or worsening. These changes include doing kegel exercises, managing your weight, and avoiding constipation. If lifestyle changes are not enough, there are also many treatment options for pelvic organ prolapse.
A safe non-surgical treatment option includes the use of a vaginal pessary, which is offered in a variety of shapes and sizes depending on your individual needs. Per the Global Library of Women’s Medicine (GLOWM), there are two types of vaginal pessaries: support and space filling. Different pessaries are better suited for different kinds and stages of prolapse. Types of support pessaries include the ring, which can be used in all stages of prolapse, and the gehrung, which can be used with or without uterine descent. Types of space occupying pessaries include the gellhorn, shaatz, donut, and cube, which can all be used to treat advanced prolapse. You may need to try a variety of shapes and sizes before finding the pessary that is right for you. Pessaries can also be used to manage bladder incontinence. According to GLOWM, pessary use side effects include increased vaginal discharge and odor. Other potential risks include the breakdown of vaginal tissue and vaginal bleeding.
Hysterectomies are a common surgical procedure used to treat pelvic organ prolapse; however, NWHN believes hysterectomies are often unnecessary and put women at risk. We feel that alternatives to hysterectomies should be explored before resorting to life-changing operations. This may require visiting more than one health care professional prior to finding the treatment option that is best for you.
Another treatment option for pelvic organ prolapse is implanting surgical mesh into the vagina. In January 2016, the FDA started to require clinical trials for surgical mesh to test the safety of the procedure. Clinical trials provide women with information regarding potential risks associated with surgical mesh. Now that there are studies to provide women with information about the safety and efficacy of surgical mesh, they can make an informed decision about whether it is their best treatment option for pelvic organ prolapse. NWHN wrote an article supporting the reclassification of surgical mesh as a Class III device and believes requiring clinical trials is important for women’s health and safety.
Choosing your treatment option will depend on a few things, including the severity of your condition, your lifestyle, and your personal comfort level. Nonsurgical options include lifestyle changes, such as kegel exercises, and vaginal pessaries. Surgical options include implanting surgical mesh or as a last resort, having a hysterectomy. It is best to consult with your health care provider to ensure you are making the health decision that is right for you.
For more information on pelvic organ prolapse, please refer to these resources:
- Pelvic organ prolapse info and treatment options – https://www.nwhn.org/pelvic-organ-prolapse-ending-the-epidemic-of-unnecessary-hysterectomies/
- Information on hysterectomies – https://www.nwhn.org/hysterectomy/
- How to use a pessary – http://www.aafp.org/afp/2000/0501/p2729.html
*Information updated in 2023. The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained on or available through this website is for general information purposes only.
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