6. Pelvic Support Treatment
Many women do not need treatment. Some women find symptoms are relieved by exercising, making changes in their diet, keeping their weight under control, not smoking, and avoiding heavy lifting and straining. Medication or use of a device called a pessary also may be helpful. Pelvic support prob¬lems sometimes may be treated by surgery.
No form of treatment is guaranteed to solve the problem. However, the chances for getting some degree of relief are quite good.

Special Exercises
Exercises called Kegel exercises, or pelvic muscle exercises, are used to strengthen the muscles that surround the openings of the urethra, vagina, and rectum (see box). Do these exercises 3 or more times

a day. In time, you may be better able to hold urine. To learn these and other exercises that can help strengthen the pelvic muscles and organs, you may be referred to a physical therapist.
Diet

You should cut down on caffeine, which acts as a diuretic. Caffeine can be found in coffee, tea, and soft drinks. A high-fiber diet may help bowel func¬tion and prevent constipation.

Medicines
There are special medicines that help treat urinary and bowel symptoms. Sometimes a medication that softens stools is prescribed along with a special diet to help control intestinal symptoms. A medication that puts bulk in the stool may be given with a high-fiber diet. Hormonal treatment also may help strengthen vaginal tissues.

Vaginal Pessaries
A pessary may be inserted into the vagina to sup¬port the pelvic organs. When a pessary is used, it must be removed, cleaned, and reinserted on a reg¬ular basis. If it is not cleaned, it might cause a bad¬smelling discharge and ulcers in the vagina. If used correctly, a pessary can last for years.
There are many types of pessaries. Your doctor can fit you with the right one for you. You may have to try a few types to get a good fit.

Surgical Repair
Pelvic support problems may be corrected by surgery. The surgery can be done through the vagina or abdomen based on your type of support problem. Women who want to have children often decide to have them before they have surgery for pelvic support problems. This is because if a woman has uterine prolapse, her doctor may suggest that her uterus be removed as a part of the procedure. If the uterus is left in place, a later vaginal delivery may increase the chances that a cystocele or rectocele will recur. If you have severe pelvic support problems and wish to keep your uterus, discuss the options with your doctor.

Surgery may relieve some, but not all, of the symptoms caused by pelvic support problems. In a few cases, symptoms may return or persist. During the surgery, the doctor has to use the already weakened fascias, ligaments, and muscles that are within your pelvis to improve your pelvic support. Synthetic or natural materials may be used to help correct the problems.
The factors that caused you to have prolapse in the first place can cause it to occur again. After surgery, you should control your weight, avoid constipation, not smoke, and avoid activities that put pressure on these muscles. There is still a chance that more surgery may be needed later.

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