# Severe Pelvic Organ Prolapse Managed Without Surgery: Pessary Discontinued After Pelvic Floor Muscle Training With M‐Mode Ultrasound

## TL;DR

A 63-year-old woman with severe uterine prolapse successfully discontinued a vaginal pessary after 4 months of pelvic floor muscle training guided by ultrasound.

## Contribution

Pelvic floor muscle training with M-mode ultrasound can reduce reliance on pessaries in severe pelvic organ prolapse.

## Key findings

- Pelvic floor muscle training with M-mode ultrasound improved pelvic floor function in a patient with stage III prolapse.
- The patient's prolapse improved to stage II without recurrence after 2 years of nonsurgical management.
- Physical therapist-guided PFMT may allow pessary removal in patients with severe uterine prolapse.

## Abstract

We report the case of a patient with severe uterine prolapse who underwent successful vaginal pessary removal after pelvic floor muscle training.

A 63‐year‐old woman presented with urinary dysfunction and residual urine. She was diagnosed with stage III pelvic organ prolapse by an obstetrician‐gynecologist, and a vaginal pessary was inserted. The patient underwent pelvic floor muscle training for 4 months while the vaginal pessary remained in situ. M‐mode ultrasonography revealed improved pelvic floor function, necessitating vaginal pessary removal. The patient's uterine prolapse improved to pelvic organ prolapse‐quantification stage II without recurrence of pelvic organ prolapse, urinary dysfunction, or residual urine after 2 years.

In patients with severe uterine prolapse who use a vaginal pessary, appropriate pelvic floor muscle training guided by a physical therapist may eliminate the need for continued pessary use.

Pelvic floor muscle training (PFMT) guided by a physical therapist using M‐mode ultrasonography enhances pelvic floor muscle function, reduces the duration of bladder base elevation (BBE), and increases BBE speed in patients with severe uterine prolapse during vaginal pessary insertion. For patients seeking pessary removal and preferring nonsurgical intervention, continued appropriate PFMT may facilitate ring pessary removal.