MANAGEMENT OF PROLAPSE

1. Preventive 2. Conservative 3. Surgery

1. PREVENTIVE
The following guidelines may be prescribed to prevent or minimize
genital prolapse.
a) Adequate antenatal and intranatal care
• To avoid injury to the supporting structures during the time of vaginal
delivery either spontaneous or instrumental.
b) Adequate postnatal care
• To encourage early ambulance.
• To encourage pelvic floor exercises by squeezing the pelvic floor
muscles in the puerperium.
c) General measures
• To avoid strenuous activities, chronic cough, constipation and heavy
weight lifting.
• To avoid future pregnancy too soon and too many by contraceptive
practice.

2. CONSERVATIVE
Indications of conservative management are:
• Asymptomatic women.
• Old women not willing for surgery.
• Mild degree prolapse.
• POP in early pregnancy.
Meanwhile, following measures may be taken:
• Improvement of general measures.
• Estrogen replacement therapy may improve minor degree prolapse in
postmenopausal women.
• Pelvic floor exercises in an attempt to strengthen the muscles (Kegel
exercises).
• Pessary treatment.
 Pessary Treatment
It should be emphasized that the pessary cannot cure prolapse but relieves
the symptoms by stretching the hiatus urogenitalis, thus preventing vaginal
and uterine descent.
Indications of use are:
• Early pregnancy - The pessary should be placed inside up to 18 weeks when
the uterus becomes sufficiently enlarged to sit on the brim of the pelvis.
• Puerperium - to facilitate involution.
• Patients absolutely unfit for surgery especially with short life expectancy.
• Patient’s unwillingness for operation.
• While waiting for operation.
• Additional benefits: Improvement of urinary symptoms (voiding problems,
urgency).