Pelvic floor exercises and vaginal pessaries
Regular pelvic floor exercises can improve problems caused by a pelvic organ prolapse. Vaginal pessaries can also help, but they aren’t suitable for every woman.
In mild or moderate cases (first- to third-degree prolapse), surgery can often be avoided. Sometimes the organs move back into the correct position on their own, or at least don’t drop down further. Many women find that doing pelvic floor exercises and/or using a vaginal pessary is enough to improve the symptoms.
But there’s no guarantee that these treatments will make the symptoms go away. Especially pelvic floor exercises have their limits if the organs have slipped down far. In studies on pelvic floor exercises, between 3 and 10 out of 100 women ended up deciding to have surgery after all.
Our decision aid can help you to decide whether or not surgery is a suitable option for you. It summarizes the main pros and cons of the different treatment options.
What are pelvic floor exercises?
Pelvic floor exercises – sometimes also called Kegel exercises – strengthen the muscles in the lower part of the pelvis. They are particularly suitable for women who have mild bladder leakage (stress incontinence) and feelings of pressure in their abdomen. In pelvic floor exercises, you learn how to actively tense (squeeze) the muscles in the pelvic floor. This involves various short exercises that can easily be done in everyday life, for instance three times a day. It’s best to learn the exercises from a physiotherapist so that they are right for your specific symptoms. In Germany, statutory health insurers pay for this.
How effective are pelvic floor exercises?
Pelvic floor exercises can improve the symptoms in mild and moderate cases (first- to third-degree prolapse) and sometimes also prevent the organs from slipping down further. The beneficial effects may already be noticeable after a few weeks. But these exercises don’t always help. Some women still have problems despite doing them. To increase the chances of success, it’s important to do them as instructed – and especially to do them regularly. To prevent pelvic floor problems from returning, you have to continue doing the exercises in the long term. So it’s best to make them an integral part of your daily life. They don’t usually have any negative effects.
Pelvic floor exercises are more effective if the prolapsed organs are in the front part of the pelvis, where the bladder and urethra (urine tube) are found. If you have had prolapse surgery, pelvic floor exercises probably won’t help much more – at least not in the first few years after the operation. Studies in this area have found that pelvic floor exercises don’t make a difference in women who have already had prolapse surgery. But it’s not clear whether the exercises might prevent the organs from dropping down again in the long term.
What are vaginal pessaries?
Vaginal pessaries for the treatment of prolapse – not to be confused with contraceptive pessaries – are small cubes, rings or saucer-shaped devices made of rubber or silicone. They are inserted into the vagina with the aim of providing the pelvic organs with support. So although pessaries don’t treat the cause of the prolapse, they can keep the affected organs in their natural position. Doctors also think that using a pessary might help to strengthen the pelvic floor muscles.
Pessaries are available in different shapes and sizes. People often have to try out a number of different pessaries before finding one that works. If possible, doctors usually prescribe cube pessaries that women can insert, remove and clean themselves. If other types of pessaries are used, these steps have to be performed by a doctor – typically every 6 to 8 weeks.
From top to bottom: “saucer-shaped” ring pessary with support, ring pessary without support, and cube pessary.
How effective are pessaries?
Well-fitting pessaries can support the pelvic organs in a way that reduces bladder and bowel problems or even makes them go away completely. They don’t fix prolapses. But women don’t always find a suitable pessary that is effective enough.
The use of a pessary is considered if, for instance, a woman wishes to avoid or delay surgery. About half of all women who use a pessary get by with it so well that they use it for several years or more. Pessaries can also be a good idea if pelvic floor exercises don’t help enough on their own.
Do pessaries have disadvantages?
Women who use a vaginal pessary need regular appointments to have the pessary checked and their vaginal area examined by a doctor.
Because pessaries push against the lining of the vagina, they can irritate the mucous membranes there and even lead to pressure sores. These cause symptoms such as pain and bleeding. Pessaries can also lead to problems with bowel movements. With some pessaries, it’s not possible to have sex – with others it is, but they might cause discomfort. Cube pessaries can be removed before having sex.
To avoid side effects, it’s important that the pessary is well positioned and also changed and cleaned regularly. A lubricant gel can make it easier to insert the pessary. After menopause, women who use a pessary are advised to protect the lining of their vagina with a hormone cream – unless they have already had cancer of the reproductive organs or breast cancer.
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Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG), Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). Diagnostik und Therapie des weiblichen Descensus genitalis (S2e-Leitlinie). AWMF-Registernr.: 015-006. April 2016. (AWMF Leitlinien).
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