Which conservative management strategies are recommended for patients with mild to moderate pelvic organ prolapse?

Recommended conservative management strategies for mild to moderate pelvic organ prolapse include:

• Pelvic floor muscle training (PFMT): A supervised programme of pelvic floor muscle training for at least 16 weeks is recommended as a first-line treatment for women with symptomatic stage 1 or 2 pelvic organ prolapse. If beneficial, women should be advised to continue the exercises thereafter.
• Lifestyle modifications: Advice should be given on losing weight if BMI is over 30 kg/m2, minimising heavy lifting, and preventing or treating constipation.
• Vaginal pessaries: Consider use of vaginal pessaries alone or combined with supervised PFMT for symptomatic prolapse. Women should be informed about the need for possible multiple fittings, potential complications, and regular pessary removal (at least every 6 months) to prevent serious complications.
• Topical vaginal oestrogen: Consider vaginal oestrogen for women with prolapse who have genitourinary symptoms associated with menopause, including use of oestrogen-releasing rings for those with cognitive or physical impairments that make pessaries or creams difficult to use.

These options should be discussed with the woman, taking into account her preferences, prolapse site, lifestyle, comorbidities, age, desire for childbearing, and previous surgeries.