Pelvic pain, and related painful syndromes, which can be more difficult to describe, require thorough diagnostic protocols to determine the cause in each specific case. Therefore, it’s important that your primary care physician have a good relationship with a women’s health specialist who is following your overall health as well as your OB-GYN needs. That’s why I make a point to know the primary care physician and other related specialists treating my patients. Holistic, collaborative care is the best way to keep you living a vital and healthy lifestyle.
Managing pelvic pain with non-surgical options
When diagnosed with pelvic organ prolapse, you’ll have a number of surgical and non-surgical options to consider. To select the best option for you, we’ll consider a number of elements in your medical history, current physical condition and immediate support system. Either way, it’s is important to understand all options before deciding which treatment is best. Many women do very well with nonsurgical treatments for prolapse. Here is a quick synopsis of some of them.
First, We Advise Close Observation
A first option for pelvic organ prolapse might be observation or expectant management, which simply means periodic checkups and no active treatment at all. There is no evidence that this is likely to cause more problems than treating prolapse, until organ prolapse becomes severe enough to cause poor bladder elimination, bowel evacuation or irritation around the prolapsing tissues.
Although data show that prolapse is likely to worsen over time for most women, there is no current method to accurately predict who is likely to develop worsening prolapse, so treatment may simply not be necessary for women with lesser degrees of prolapse. The key is to diagnose it early and follow it closely.
Physical Therapy for Pelvic Pain
Another early treatment option includes pelvic floor physical therapy. In this instance, treatment is designed to reduce pelvic pain by improving the muscular support of and blood flow to the pelvis. Many women find this treatment eliminates their symptoms all together. Many times this will improve bladder and bowel symptoms as well. Working with a trained pelvic floor physical therapist is more likely to result in improvement than observation or home “Kegel” exercises alone. In the event you choose this route, I’ll follow-up closely to support your commitment to a regular schedule of therapy, and to track how effectively it relieves your pain.
What Is a Pessary?
Finally, the oldest and best known non-surgical treatment of prolapse is a device called a pessary. A pessary is a device worn inside the vagina which supports the bladder, vagina or uterine apex, and rectum. There are many types of pessaries available, the most commonly used is a “Ring with Support”, which somewhat resembles a diaphragm used for birth control, except that it is a bit stiffer and flat rather than dome-shaped, and has perforations in the support membrane to allow for circulation of vaginal fluids and let the tissue “breathe.” Another common pessary includes a dome with ballast type called a Gellhorn. The appropriate type of pessary is best determined by the physician or healthcare provider trained in the proper assessment and fitting of the pessary. Once this is done, instructions regarding self-care and/or intermittent visits with office care of the pessary will be given.
Effectiveness of Pessaries
Many women achieve satisfactory treatment of prolapse with a pessary, and choose to continue this course of therapy indefinitely to relieve pelvic pain. While it is natural to develop some increase in vaginal discharge, as long as it is not disagreeable and manageable, this is usually acceptable. Sometimes, the pessary can cause irritation or erosion of vaginal tissues due to rubbing against the vaginal tissues. Often this can be corrected by increasing the amount of lubricant, or occasionally leaving the pessary out for a short period of time. A small number of women will develop a vaginal infection and become unable or unwilling to use a pessary. Normally, however, when properly fitted a pessary should be a “silent passenger”, and a woman wearing a pessary should be totally unaware of it.
You can learn more about pessaries at WebMD.
There’s much more to learn, and at Women’s Health of Chicago, WebMD we’ll make sure you’re thoroughly educated and well prepared to manage your pessary, or any other non-surgical treatment you elect.