16 July 2016 July 2016 17 Expert guide: Obstetrics & Gynaecology 2016 pelvic floor muscles so they become firm and supportive, but not overactive. Many women will have a major improvement in or recovery from symptoms of prolapse by learning effective pelvic floor exercises, thus avoiding or delaying the need for surgery. It is important to learn to do the exercises in the right way, and to check from time to time that you are still doing them correctly. Hence it is recommended that wom-en see a specialist pelvic floor physiotherapist to take them through these exercises. Women who require surgery usually have a much better result if they work with an experienced physi-otherapist before and after their procedure. In addition to exercises women may find medi-cation such as oestrogen replacement or basic health and lifestyle changes such as dietary change or treating constipation and managing to lose weight may bring relief to their symp-toms. A vaginal pessary to support the prolapse is a good short or long-term solution. Short-term pessary use is appropriate for women to make them more comfortable if a planned surgery needs to be delayed. Some women with slight prolapse are only symptomatic at certain times, such as when they are playing golf or tennis, or sneezing) and may require a sling procedure performed at the same time to correct urinary incontinence, however in some circumstances this is best done as a two stage procedure which will be discussed with your doctor. Surgery for prolapse has three key issues which are:1. failure of treatment of recurrence of symptoms 2. the chance of developing new trouble-some symptoms such as worsening in-continence, pain due to scarring or pain with sex and change in bowel habit 3. complications of surgery including in-fection, bleeding, rarely injury to the sur-rounding organs Therefore surgery to improve prolapse symp-toms needs to considered ideally when all other options have failed and when the patient’s qual-ity of life is severely affected enough to merit accepting the above key issues.Many women are embarrassed about seeking treatment for pelvic organ prolapse. Prolapse often causes women to feel embarrassed and needlessly self-conscious despite it being so common. The possible reason is that women rarely feel comfortable talking to their friends and find a pessary useful on an as-needed basis. There are multiple types of pessaries, and find-ing the right pessary in the right size is the key to success. Some women have had a negative pessary experience and feel as a result that they are not a good candidate, when in fact the pes-sary was the wrong type or did not fit properly.These conservative treatment options are usu-ally offered to most patients before considering surgery. However if these fail and the symp-toms are compromising the quality of life sig-nificantly then surgery to repair the prolapse is an option.Pelvic reconstructive surgery can be per-formed through the vagina or abdominally (via a traditional incision or through laparoscopy/ ‘key-hole surgery’). During the procedure, the surgeon will reposition the prolapsed organ(s) and secure the surrounding tissues and liga-ments. The vaginal defect(s) which cause the bulge in vagina will also be repaired. Usually a repair of the perineum to support the open-ing of the vagina may be performed. Prior to undergoing surgery, patients should undergo a thorough evaluation to ensure a proper diagno-sis. For example, some women may have stress urinary incontinence (leaking with coughing and family about such intimate matters. The good news is that women do not have to suf-fer in silence and live with the condition. Seek help early and women can be empowered to do something about pelvic organ prolapse, and they will have choices to suit their individual needs.Please visit http://www.iuga.org/?patientinfo for more valuable patient information leaflets on prolapse and its treatment options.Preetkiron Bhal has been a Consultant Gyn-aecologist in Cardiff since 2003 with an interest in urinary incontinence, pelvic organ prolapse, general gynaecology and infertility. Mr Bhal is an expert in advanced vaginal and laparoscopic surgery. He offers a comprehensive service for managing urogynaecological problems includ-ing vaginal mesh related problems. Mr Bhal leads a multidisciplinary team in Cardiff striv-ing to deliver the best available care for patients with bladder and pelvic floor conditions in South Wales. Mr. Bhal has continued with his passion for research and evidence based medicine and has presented work at numerous meetings both nationally and internationally. uk Pelvic reconstructive surgery can be performed through the vagina or abdominally (via a traditional incision or through laparoscopy/ ‘key-hole surgery’)