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Treatment of female genital prolapse

Female genital prolapse

Surgical treatment is not funded for asymptomatic or mildly symptomatic pelvic organ prolapse.

Prior approval from the Clinical Commissioning Group (CCG) will be required before any treatment proceeds in secondary care.

Definition of Prolapse:

Grade 2 moderate

Grade 3 & 4 severe

  • Grade 0 – Normal position
  • Grade 1 – Descent into vagina not reaching introitus
  • Grade 2 – Descent just outside the introitus MODERATE
  • Grade 3 – Descent outside the introitus – beyond 2 cms SEVERE
  • Grade 4 – Procidentia SEVERE
Mild / moderate symptoms

Offer appropriate conservative management:

  • Weight loss if BMI >30
  • Constipation treatment to minimise straining
  • Management of any cough
  • Pelvic floor muscle training click for leaflet
  • Gynaecological Physiotherapy (specialist physiotherapist Charlotte Leung Women’s Health Clinic on the NHS eReferral Service)
Severe symptoms

Referral for secondary care assessment is indicated for any of the following:

  • Failure of primary care or community management in moderate or severe prolapse with a history of ring or other pessary failure
  • Prolapse combined with faecal incontinence or urinary incontinence that has failed to respond to conservative management or combined with urethral sphincter incompetence
  • Isolated rectal prolapse as the use of pessary is ineffective

Urinary Symptoms

Symptoms without prolapse should be referred to Urology or Continence Clinic click link

Continence Physiotherapy
  • Incontinence of bladder and/or bowel
  • Prolapse
  • Weak pelvic floor muscles
  • Overactive bladder
  • Loss of sexual sensation

Procedures include vaginal examination, bowel examination, bladder scans, urinalysis, neuromuscular stimulation and biofeedback. The clinical lead is Ms Charlotte Leung, Specialist Physiotherapist for Women’s Health, Charlotte.Leung@uhcw.nhs.net Please refer to “Women’s Health” via Choose and Book.

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