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

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