Abstract
Pelvic organ prolapse is treated to relieve symptoms and restore daily function rather than to correct anatomy in isolation. This structured narrative review compares conservative treatment, particularly pelvic floor muscle training and vaginal pessaries, with surgical correction, emphasizing patient-reported improvement, treatment persistence, complications, recurrence, and quality of life. PubMed/MEDLINE and current guidance from NICE, ACOG, and the American Urogynecologic Society were searched between August and September 2026; randomized trials, prospective comparative cohorts, systematic reviews, consensus documents, and recent multicenter registry data were prioritized. Pelvic floor muscle training improves symptoms and pelvic floor function mainly in the short term, with less certain long-term benefit in older women. Pessaries can provide rapid, reversible relief and substantial quality-of-life improvement, but fitting failure, discharge, discomfort, expulsion, erosion, and discontinuation reduce strategy-level effectiveness. Direct comparative evidence shows clinically important improvement with both pessary and surgery, while surgery produces a somewhat higher probability of marked global improvement and lower retreatment rates over medium-term follow-up. Surgery, however, introduces perioperative morbidity, recurrence, urinary or sexual trade-offs, and procedure-specific risks. The best treatment is therefore not defined by prolapse stage alone. Symptom burden, goals, comorbidity, uterine and sexual preferences, tolerance for device maintenance, recovery constraints, and willingness to accept operative risk should determine shared decision-making.