Treatment › Non-surgical options
Non-surgical options
For a lot of women, especially with mild to moderate prolapse, or when surgery is not wanted or not safe, non-surgical care is not a consolation prize. It works, the risks are low, and it never closes the door on anything else later.
Pelvic floor muscle training
The pelvic floor is muscle, and like any muscle it responds to training. Research consistently shows that guided pelvic floor muscle training improves prolapse symptoms, pelvic floor function, and quality of life. Because it is safe, it is recommended as a first choice treatment.
The word doing the work there is guided. A pelvic health physiotherapist can check that you are contracting the right muscles, since many women unknowingly strain instead, and build a program that fits your body. In Canada you can see one without a referral in most provinces, and many extended health plans cover it.
Pessaries
A pessary is a small, soft silicone device, often shaped like a ring, that sits in the vagina and holds up the prolapsed organs the way an insert supports the arch of a shoe. A healthcare provider fits it, and when the fit is right you should not feel it at all.
Pessaries are a first line, low risk option. They relieve symptoms for most women who use them, they can be worn for years or used as a bridge before surgery, and some designs can be taken out and cleaned at home. The honest caveats: finding the right size sometimes takes a couple of fittings, and you will need periodic check ups. Plenty of women in our community wear one daily and forget it is there.
Estrogen, and the bioidentical question
This one comes up constantly, so here is the honest picture. After menopause, lower estrogen weakens vaginal and pelvic tissue. Low dose vaginal estrogen, meaning a prescription cream, tablet, or ring applied locally, is well established for treating vaginal dryness and irritation. It is commonly prescribed alongside a pessary or before surgery, and laboratory research shows it improves the quality of vaginal tissue.
Whether it improves the prolapse itself is genuinely unsettled. Some studies show a benefit, others do not, and trials are still running. "Bioidentical hormones" is mostly a marketing phrase, and custom compounded versions are not better tested than regulated prescription options. If you are curious, take it to your doctor or a menopause informed provider, and be gently skeptical of anyone selling you hormones alongside big promises.
Everyday management
- Take constipation seriously. Straining is one of the biggest ongoing stresses on the pelvic floor. Fibre, fluids, and a footstool on the toilet all help.
- Lift with an exhale rather than holding your breath and bearing down.
- If you smoke, a chronic cough works against your pelvic floor every single day. One more reason to get support quitting.
- A healthy weight reduces the constant downward pressure on your pelvic organs.