Although surgical management of symptomatic pelvic organ prolapse (POP) is common and often necessary, conservative treatments such as pessaries, pelvic floor muscle training, or both can usually result in symptomatic improvement. When treating patients with POP, health care practitioners should focus primarily on identification and alleviation of POP-related symptoms. It is appropriate to offer nonsurgical management to most people with POP. This article reviews the objective and subjective evaluation and nonsurgical management of POP, emphasizing a simple, practical approach to pessary fitting and management.
Strategies for the evaluation and nonsurgical management of pelvic organ prolapse based on published evidence as well as the author's anecdotal clinical experience are presented.
From the Division of Urogynecology and Pelvic Reconstructive Surgery, Atlantic Health System, Morristown and Summit, New Jersey; and the Department of Obstetrics, Gynecology & Reproductive Science, Mount Sinai School of Medicine, New York, New York.
Continuing medical education for this article is available at http://links.lww.com/AOG/A287.
Corresponding author: Patrick J. Culligan, MD, 435 South Street Suite 370, Morristown, NY 07960; e-mail: firstname.lastname@example.org.
Financial Disclosure Dr. Culligan is a consultant and researcher with Intuitive Surgical, CR BARD, and Boston Scientific, and a researcher for AMS.