Pelvic Organ Prolapse: Non-Surgical Treatment Options Explained

Pelvic organ prolapse (POP) affects millions of women worldwide, yet many remain unaware that effective non-surgical treatments exist. Whether you have been newly diagnosed or are simply exploring your options before committing to surgery, this guide explains the evidence-based non-surgical approaches available — and what the research says about how well they work.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the pelvic floor muscles and connective tissues weaken, allowing one or more pelvic organs — the bladder, uterus, or rectum — to descend into or through the vaginal canal. It is classified in stages from I (mild) to IV (complete prolapse through the vaginal opening).

Common symptoms include a feeling of heaviness or a lump in the vagina, lower back ache, difficulty emptying the bladder or bowel, and in some cases discomfort during sex. Many women live with prolapse for years before seeking treatment.

Do I Need Surgery?

Surgery is not always necessary — and for many women, it is not the preferred option. The two main non-surgical approaches recommended in clinical guidelines are pelvic floor muscle training (PFMT) and vaginal pessary therapy. These can be used alone or in combination, and many women manage prolapse successfully with non-surgical treatment for years or even indefinitely.

Non-Surgical Treatment Options for Pelvic Organ Prolapse

1. Vaginal Pessary

A vaginal pessary is a removable medical device made from medical-grade silicone that is inserted into the vagina to physically support the prolapsed organs. It is the most effective non-surgical intervention for moderate-to-advanced prolapse and is often the first treatment offered.

How well does it work? Clinical studies report that pessary therapy resolves prolapse symptoms in 70–90% of patients. Around 40–50% of women also experience improvement in urinary symptoms, and 30–50% report improvement in bowel symptoms.

Who is it suitable for? Pessaries are recommended for:

• Women with mild to severe prolapse (Stages I–IV)
• Women who prefer to avoid surgery or are not suitable surgical candidates
• Women who have not completed childbearing
• Older women for whom surgery carries higher risk
• Women who want immediate symptom relief while awaiting surgery

Types of pessary: The ring pessary is the most commonly fitted type and suits approximately 70% of women. For more advanced prolapse or wider vaginal anatomy, a Gellhorn, donut, or cube pessary may be used. Read our complete guide to pessary types to learn more.

At SciMed Store, we supply medical-grade silicone ring pessaries in a full range of sizes for self-managing patients and clinical settings.

2. Pelvic Floor Muscle Training (PFMT)

Pelvic floor muscle training — often called Kegel exercises — involves repeatedly contracting and relaxing the muscles of the pelvic floor to strengthen them. For mild prolapse, PFMT can reduce symptoms and may slow progression. It is usually delivered through a programme supervised by a pelvic health physiotherapist.

How well does it work? A large clinical trial (the POPPY trial) found that PFMT significantly reduced prolapse symptoms and improved quality of life compared to lifestyle advice alone. However, for moderate-to-severe prolapse, PFMT alone is generally insufficient and works best in combination with pessary therapy.

What does it involve? A typical PFMT programme runs for 3–6 months and includes daily exercises targeting the levator ani and other pelvic floor muscles. A physiotherapist can use internal assessment and biofeedback to ensure you are contracting the correct muscles.

3. Lifestyle Modifications

Several lifestyle factors contribute to prolapse progression and symptom severity. Making targeted changes will not reverse prolapse, but they can meaningfully reduce symptoms and slow worsening:

• Weight management: Excess body weight increases intra-abdominal pressure, which worsens prolapse. Even modest weight loss can reduce symptom severity.
• Managing constipation: Straining at stool is a major driver of prolapse progression. A high-fibre diet, adequate fluid intake, and the use of a footstool to achieve a squatting position on the toilet can dramatically reduce straining.
• Avoiding heavy lifting: Repeated heavy lifting raises intra-abdominal pressure. Where lifting is unavoidable, engaging the pelvic floor before and during the lift (the "knack" technique) provides protection.
• Treating chronic cough: Persistent coughing from smoking or uncontrolled asthma places repeated pressure on the pelvic floor. Treating the underlying cause reduces this load.
• Fluid management: For women with urinary symptoms alongside prolapse, limiting caffeine and evening fluid intake can reduce urgency and leakage.

4. Topical Oestrogen

In post-menopausal women, reduced oestrogen leads to thinning of the vaginal tissues (vaginal atrophy), which can worsen prolapse symptoms and make pessary use uncomfortable. Low-dose topical oestrogen can restore tissue suppleness, reduce irritation, and improve pessary comfort. It is not absorbed systemically in significant amounts at low doses and is considered safe for most women.

5. Watchful Waiting

For women with mild prolapse (Stage I–II) and minimal symptoms that do not impact quality of life, a “watchful waiting” approach may be appropriate. This means monitoring the condition with regular check-ups and beginning active treatment only if symptoms worsen. During this period, lifestyle modifications and PFMT are usually recommended to slow any progression.

Comparing Non-Surgical Options: A Quick Summary

Treatment	Best for	Symptom relief	Ongoing commitment
Vaginal pessary	Stage I–IV prolapse	70–90% improvement	Cleaning and follow-up appointments
PFMT	Mild prolapse, prevention	Moderate improvement	Daily exercises for life
Lifestyle changes	All stages (supportive)	Variable	Ongoing
Topical oestrogen	Post-menopausal women	Improves tissue comfort	Regular application

When Is Surgery Necessary?

Non-surgical treatment is highly effective for many women, but surgery may be considered when:

• Prolapse is Stage III–IV and significantly impacting quality of life
• Non-surgical approaches have been tried and found insufficient
• There is concurrent pelvic organ dysfunction (such as urinary retention) requiring structural repair
• The woman has completed childbearing and prefers a permanent solution

The decision to have surgery is personal and should be made in full consultation with a specialist urogynaecologist, taking into account your individual symptoms, stage of prolapse, health, and preferences.

Getting Started with Non-Surgical Treatment

If you have been diagnosed with pelvic organ prolapse and want to explore non-surgical options, speak to your GP or ask for a referral to a urogynaecologist or women’s health physiotherapist. A pessary fitting appointment takes around 20–30 minutes, and most women leave the same day with a pessary in place.

For replacement ring pessaries and other pelvic health supplies, visit SciMed Store.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before beginning any treatment for pelvic organ prolapse.