Yes. Many women with pelvic organ prolapse can manage their symptoms without surgery.

The most appropriate treatment depends on which pelvic organs are affected, the prolapse stage, the severity of your symptoms, your bladder and bowel function, age, hormonal status, overall health, and personal goals.

A mild prolapse that causes little discomfort may only require observation. Other women may benefit from pelvic floor physical therapy, a vaginal pessary, treatment of menopause-related tissue changes, personalized hormonal therapy, or FemiLift Vaginal Rejuvenation as part of a comprehensive pelvic health plan.

Nonsurgical treatment may reduce pelvic pressure, support vaginal comfort, improve certain urinary symptoms, and help you remain active. However, conservative therapies do not always restore an advanced prolapse to its original anatomical position.

At Dr. Mariana Bubucea Women’s Wellness & Urogynecology Center, treatment begins with a comprehensive Pelvic Floor Evaluation—not an automatic recommendation for surgery.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the muscles, ligaments, and connective tissues supporting the pelvic organs become weakened or stretched.

This may allow one or more organs to descend toward or into the vaginal canal, including:

The bladder

The uterus or cervix

The rectum

The vaginal apex after hysterectomy

The small intestine

Common contributing factors include:

Pregnancy and vaginal childbirth

Menopause and declining estrogen levels

Previous pelvic surgery

Chronic constipation and straining

Repeated heavy lifting

Chronic coughing

Obesity

Age-related weakening of pelvic support

When Can Prolapse Be Managed Without Surgery?

Nonsurgical prolapse management may be appropriate when:

The prolapse causes mild or moderate symptoms

There is no significant obstruction of bladder or bowel emptying

Symptoms do not substantially interfere with daily life

You prefer to avoid or postpone surgery

You plan to become pregnant in the future

Surgery would present increased medical risks

A pessary provides adequate symptom relief

Menopause-related vaginal or urinary symptoms are contributing to your discomfort

Some women successfully use conservative treatment for many years. Others use it as a temporary strategy while monitoring symptoms or considering future prolapse repair.

Pelvic Floor Physical Therapy

Pelvic floor physical therapy is frequently included in nonsurgical prolapse management.

A specially trained therapist may evaluate muscle strength, coordination, posture, breathing mechanics, and the way pressure is managed during exercise, lifting, coughing, and bowel movements.

Treatment may include:

Correctly performed pelvic floor exercises

Core and breathing coordination

Bladder and bowel retraining

Strategies to reduce straining

Safe lifting and exercise techniques

Treatment of tight or painful pelvic floor muscles

Management of urinary leakage

Pelvic floor therapy may improve symptoms and function, but it may not completely reverse moderate or advanced prolapse.

Vaginal Pessary Support

A pessary is a removable medical device placed inside the vagina to support prolapsed pelvic organs.

Pessaries are available in different shapes and sizes. Finding the correct fit may require trying more than one type.

A properly fitted pessary may help reduce:

Vaginal bulging

Pelvic pressure

Heaviness while standing or exercising

Certain urinary symptoms

Discomfort associated with prolapse

A pessary may be used temporarily or as a long-term treatment. Regular follow-up is important to evaluate comfort, vaginal tissue health, discharge, irritation, and proper positioning.

Pessary support is commonly offered as one of the first nonsurgical treatments for symptomatic pelvic organ prolapse.

Hormonal Therapy for Pelvic and Vaginal Health

Menopause can affect much more than menstrual cycles.

Declining estrogen and androgen levels may lead to changes in the vagina, vulva, bladder, and urethra. These changes are often described as Genitourinary Syndrome of Menopause, or GSM.

Symptoms may include:

Vaginal dryness

Burning or irritation

Pain during intimacy

Reduced vaginal elasticity

Urinary urgency

Frequent urination

Recurrent urinary tract infections

Discomfort while wearing a pessary

Increased sensitivity of vaginal tissues

Hormonal therapy does not mechanically lift a prolapsed organ. However, it may improve the health and comfort of vaginal and urinary tissues when hormonal deficiency is contributing to symptoms.

Local Vaginal Hormonal Therapy

For appropriate patients, Dr. Bubucea may recommend localized vaginal therapy such as prescription vaginal estrogen or another hormonal option.

Local treatment may help improve:

Vaginal dryness and irritation

Painful intimacy

Vaginal tissue quality

Comfort with pessary use

Some menopause-related urinary symptoms

Susceptibility to recurrent urinary infections

Low-dose vaginal estrogen is an established treatment for the vaginal and urinary symptoms of menopause, although every patient requires an individualized evaluation of benefits, risks, and medical history.

Systemic Hormonal Therapy

Some patients also experience hot flashes, sleep disruption, mood changes, loss of energy, bone loss, or other systemic symptoms of menopause.

When clinically appropriate, Dr. Bubucea may discuss a personalized systemic hormonal therapy plan based on:

Age

Time since menopause

Symptoms

Personal and family history

Cardiovascular risk

Breast and uterine history

Bone health

Laboratory and clinical findings

Individual treatment goals

Systemic hormonal therapy and local vaginal therapy are not interchangeable. One may be appropriate without the other, and treatment should be selected after a medical consultation.

FemiLift Vaginal Rejuvenation

FemiLift is an in-office, fractional CO₂ laser procedure offered at our clinic as part of a personalized vaginal and pelvic health program.

For carefully selected patients, FemiLift Vaginal Rejuvenation may be considered when symptoms include:

Vaginal dryness

Vaginal irritation

Discomfort during intimacy

Changes in vaginal tissue quality

Reduced vaginal comfort after childbirth or menopause

Certain mild urinary symptoms

A desire for a nonhormonal or complementary treatment option

The procedure is performed in the office and generally does not require surgery or a hospital stay.

What FemiLift Can and Cannot Do

FemiLift may be used to address selected vaginal and menopause-related symptoms, but it is important to understand its role.

FemiLift:

May support vaginal tissue comfort in selected patients

May be incorporated into a broader menopause or pelvic wellness plan

May be combined with pelvic floor therapy or hormonal treatment when appropriate

Does not replace a complete pelvic examination

Does not mechanically reposition an advanced bladder, uterus, rectum, or vaginal apex

Should not be presented as a substitute for prolapse repair when structural support has significantly failed

A vaginal bulge or pelvic pressure may be caused by prolapse, vaginal atrophy, pelvic floor muscle dysfunction, bladder disease, or several conditions occurring together. For this reason, FemiLift should only be recommended after the source of the symptoms has been identified.

Can FemiLift and Hormonal Therapy Be Combined?

For selected patients, yes.

A personalized treatment plan may combine:

Pelvic floor physical therapy

Pessary support

Local vaginal hormonal therapy

Systemic menopausal hormonal therapy

FemiLift Vaginal Rejuvenation

Bladder treatment

Lifestyle changes

For example, a woman may have mild prolapse combined with vaginal dryness, urinary urgency, discomfort during intimacy, and reduced tissue quality after menopause.

In this situation, the prolapse may be managed with physical therapy or pessary support, while hormonal therapy or FemiLift may be considered for the associated vaginal and urinary symptoms.

The combination depends on the examination, diagnosis, medical history, and treatment goals.

Lifestyle Changes

Lifestyle modifications cannot repair weakened anatomical support, but they may reduce repeated pressure on the pelvic floor.

Recommendations may include:

Treating chronic constipation

Increasing dietary fiber when appropriate

Avoiding repeated straining

Managing chronic coughing

Maintaining a healthy weight

Avoiding unnecessary heavy lifting

Learning proper breathing and lifting techniques

Selecting exercises that do not worsen pressure or bulging

Avoiding smoking

These changes are often most effective when combined with pelvic floor therapy, pessary support, or treatment of menopause-related tissue changes.

Observation and Monitoring

Not every prolapse requires immediate treatment.

If the prolapse is mild and does not interfere with bladder function, bowel function, intimacy, exercise, or daily activities, observation may be appropriate.

Periodic follow-up allows Dr. Bubucea to monitor:

Changes in the prolapse

New urinary symptoms

Incomplete bladder emptying

Recurrent urinary infections

Bowel movement difficulties

Vaginal irritation or bleeding

Menopause-related tissue changes

Changes in quality of life

Treatment can be adjusted if symptoms progress.

Can Nonsurgical Treatment Make Prolapse Go Away?

Nonsurgical treatment may significantly reduce symptoms, but it does not always permanently restore weakened pelvic tissues to their previous position.

Each treatment has a different purpose:

Pelvic floor therapy improves muscle strength, coordination, and pressure management.

A pessary provides mechanical support while it is in place.

Hormonal therapy may improve menopause-related vaginal and urinary tissue health.

FemiLift Vaginal Rejuvenation may address selected vaginal symptoms as part of an individualized treatment plan.

Lifestyle changes help reduce repeated pressure on the pelvic floor.

The goal of conservative management may be to:

Reduce vaginal pressure and bulging

Improve bladder and bowel function

Improve vaginal comfort

Reduce menopause-related symptoms

Support intimacy

Help the patient remain active

Delay or avoid surgery

Improve quality of life

When May Surgery Be the Better Option?

Surgery may be considered when prolapse is advanced, conservative treatment is unsuccessful, or symptoms substantially affect everyday life.

Signs that it may be time to discuss surgical treatment include:

A vaginal bulge extending outside the vaginal opening

Persistent pelvic pressure or heaviness

Difficulty emptying the bladder

The need to press on the prolapse to urinate or have a bowel movement

Recurrent urinary infections associated with retained urine

Bleeding, sores, or irritation of exposed tissue

Inability to tolerate or use a pessary

Difficulty walking, exercising, working, or traveling

Significant limitations during intimacy

Symptoms that continue despite nonsurgical treatment

The decision is not based on the prolapse stage alone. Symptoms, anatomy, medical history, treatment preferences, and quality of life must all be considered.

What Surgical Options Are Available?

When surgery is appropriate, the procedure is selected according to the organs involved, previous surgeries, anatomy, health history, and treatment goals.

Options may include:

Anterior vaginal wall repair for bladder prolapse

Posterior vaginal wall repair for rectocele

Uterine or vaginal suspension

Uterus-preserving prolapse repair

Hysterectomy with pelvic floor reconstruction

Vaginal prolapse repair

Laparoscopic prolapse repair

Robotic pelvic floor surgery

Removing the uterus alone does not correct every form of pelvic organ prolapse. A complete surgical plan must identify and repair the specific areas of weakened support.

How Is the Best Treatment Determined?

A comprehensive Pelvic Floor Evaluation may include:

Discussion of your symptoms and goals

Pregnancy and childbirth history

Menopause and hormonal history

Review of previous pelvic surgeries

Pelvic examination in different positions

POP-Q prolapse measurements

Pelvic floor muscle assessment

Evaluation of vaginal tissue health

Urinalysis or urine culture

Measurement of urine remaining after bladder emptying

Cough stress testing

Urodynamic testing when clinically appropriate

Pelvic ultrasound or other imaging when needed

This evaluation helps determine whether symptoms are related to pelvic organ prolapse, urinary incontinence, overactive bladder, menopause-related tissue changes, pelvic floor muscle dysfunction, or a combination of conditions.

Personalized Prolapse and Menopause Management

Dr. Mariana Bubucea specializes in pelvic organ prolapse, bladder prolapse, urinary incontinence, menopause management, personalized hormonal therapy, FemiLift Vaginal Rejuvenation, pelvic floor reconstruction, and robotic-assisted minimally invasive surgery.

Her approach begins by identifying the true source of each patient’s symptoms.

Not every patient needs surgery. A personalized treatment plan may include conservative prolapse management, restoration of vaginal health, hormonal support, bladder treatment, or minimally invasive surgical repair when necessary.

Schedule a Pelvic Floor and Hormonal Evaluation

You do not have to wait until prolapse or menopause-related symptoms become severe.

Schedule an evaluation if you experience:

A vaginal bulge

Pelvic pressure or heaviness

Vaginal dryness or irritation

Pain during intimacy

Urinary leakage

Urinary urgency or frequency

Difficulty emptying the bladder

Recurrent urinary tract infections

Bowel movement difficulties

Symptoms that worsen while standing, lifting, or exercising

Our clinic serves patients from Hallandale Beach, Aventura, Hollywood, Sunny Isles Beach, North Miami Beach, Fort Lauderdale, Miami, Boca Raton, and throughout South Florida.

Dr. Mariana Bubucea Women’s Wellness & Urogynecology Center

2500 E Hallandale Beach Blvd., Suite 401
Hallandale Beach, FL 33009

Phone: 954-395-2585

Schedule your Pelvic Floor Evaluation today to learn whether pelvic floor therapy, pessary support, hormonal therapy, FemiLift Vaginal Rejuvenation, or surgical prolapse repair is appropriate for you.