Common, but not normal. That seems to be a key theme for pelvic pain, and it also rings true for pelvic organ prolapse (POP). Prolapse means ‘to fall,’ and this condition can range from mild to severe. We’re all individuals, so pelvic organ prolapse can look different for every one of us. That’s why, at InvigoPhysio, we believe in customized care that matches your body’s unique needs. If you’re living with pelvic organ prolapse and looking for relief and recovery from your pain, read on to learn what you can do about your pelvic prolapse.
What is pelvic organ prolapse?
Prolapse, by definition, means ‘to fall’, and in the case of pelvic prolapse, it refers to a dropping or ‘descending’ of the pelvic organs. The pelvic organs include the bladder, uterus and bowel. These organs are supported by a ‘hammock’ of pelvic muscles and ligaments that stretch from the tailbone to the pubic bone. When these muscles and ligaments weaken, they can no longer provide adequate support for the pelvic organs and prolapse can occur.
What are the types of prolapse?
There are four main types of pelvic organ prolapse:
Cystocele
This is the most common type of prolapse. Cystocele happens when the bladder bulges into the front or anterior wall of the vagina. As a result, you may experience difficulty passing urine, urinary incontinence, or general discomfort.
Uterine prolapse
This happens when the uterus descends into the vaginal space and can protrude outside of the vagina. A dropped uterus can lead to other prolapses as this structure’s weight can put extra pressure on the nearby organs, causing them to sink.
Rectocele
A rectocele is when the bowel bulges into the back or posterior wall of the vagina. This can cause a sense of pressure in the rectum or the feeling that the bowel hasn’t emptied after completing a bowel movement.
Enterocele
An enterocele happens when the small intestine protrudes into the upper part of the vagina.
What causes pelvic organ prolapse?
Prolapse happens when the muscles and ligaments that support the pelvic organs weaken or loosen. This can be due to:
- Pregnancy and childbirth
- Sudden weight gain (more weight than what your body is used to)
- Chronic cough or constipation (straining to void)
- Hysterectomy (surgical removal of the uterus)
What can further increase the risk of having a pelvic organ prolapse?
Many factors can further increase your risk of pelvic organ prolapse, including:
- A family history of pelvic organ prolapse
- Number of vaginal deliveries
- Menopause
- Smoking (which weakens all tissues)
- Weight (more pressure on the tissues can encourage the descent)
Generally, it is difficult to predict who would get prolapse and who wouldn’t.
What are the prolapse symptoms?
Not everyone who has a pelvic organ prolapse will experience symptoms and get bothered by it. If you have a pelvic organ prolapse, you’ll often see a bulge at the opening of your vagina. While not dangerous, this bulge can feel really uncomfortable. Sometimes, people will notice the bulge more towards the end of the day, especially if their day is full of lifting, coughing, or stressful exercise. The bulge may cause difficulty when you pee or feel like you have to go pee all the time or have urinary leakage.
Another common symptom is a sensation of heaviness or pressure or a sensation of something ‘coming down’ or ‘dragging’ in your vagina area. This can worsen throughout the day or with exertion such as walking, running, carrying and lifting heavy things.
A prolapsed bladder can sometimes obstruct the flow of urine, while a rectal prolapse can cause difficulty with emptying. Occasionally, some women need to insert their fingers vaginally and push against the back of the vaginal wall to support the bowel movement. This is usually referred to as splinting.
Sometimes the bulge of vaginal tissue can get in the way and interfere with sexual intercourse. If the vaginal tissue is fragile, especially during breastfeeding or menopause, spotting or bleeding can happen.
Your symptoms will also depend on the severity of your prolapse and on which organ may be dropping.
Is pelvic organ prolapse serious?
While prolapse is not a life-threatening condition, its symptoms can significantly affect the quality of life and cause distress.
Pelvic organ prolapse is often seen as embarrassing, and many women hesitate to seek medical help. There is no need to feel ashamed or embarrassed about it. It is important to remember that pelvic organ prolapse is very common and affects women of all ages.
What happens if the prolapse is left untreated?
Sometimes, people living with a mild prolapse can recover on their own within a few months or years. However, there is a bigger chance that if left untreated, the prolapse will gradually get worse over time. Plus, all that time you are hoping the prolapse goes away on its own means you are living with all the uncomfortable, sometimes painful, symptoms of prolapse.
How is pelvic organ prolapse diagnosed?
It is often diagnosed during a pelvic internal examination, either by a family physician, a gynecologist, or a pelvic floor physiotherapist. The length of the vaginal canal, the width of the vaginal opening, and the perineal body are taken into consideration when grading the pelvic organ prolapse.
Clinically, pelvic organ prolapse is graded on a scale from I to IV, with stage I being the least severe and stage IV being the most severe. The severity of prolapse is determined by how far the pelvic organs have descended.
For example, grade I uterine prolapse means the uterus has dropped down into the lower part of the vagina. However, it’s still able to be moved back into place. Grade IV uterine prolapse, on the other hand, means the uterus has prolapsed so far that it’s protruding out of the vaginal opening.
During the pelvic exam, your pelvic floor strength and tension should also be assessed, especially if you have difficulty with bladder control or pelvic pressure.
How do you fix a pelvic prolapse?
While prevention is the best medicine for pelvic prolapse, treatment is possible, and some stages of pelvic organ prolapse can be reversed.
While some risk factors for pelvic organ prolapse are out of your control (genetics, aging, or a difficult delivery), there are things you can do to reduce your risk, such as:
Avoiding constipation
Straining to complete a bowel movement will aggravate prolapse. A diet rich in fibre (25 g per day) will help prevent constipation in most people. Sometimes the use of a laxative is necessary. Osmotic laxatives are usually recommended as they draw water into the stool, soften it and make it easier to pass. Toilet positioning is also crucial as elevating your feet on a stool can assist in relaxing and lengthening your pelvic floor muscles, thus, reducing straining.
Maintaining a healthy weight
Carrying extra weight can put additional pressure on the pelvic organs and strain your pelvic floor muscles, which increases the risk of the pelvic organ coming down.
Not smoking (or quitting smoking)
Smoking has been shown to decrease blood flow to muscles, weakening pelvic floor muscles and reducing support for pelvic organs.
Use good lifting technique
Practice good body mechanics when lifting heavy objects (legs are shoulder-width apart, squatting down to pick up the object rather than bending at the waist). This will help take the pressure off the pelvic region.
Pelvic physiotherapy
Many times, pelvic organ prolapse can be treated without surgery through pelvic physiotherapy.
Pelvic physiotherapy is an effective and conservative treatment for pelvic organ prolapse. Your pelvic floor physiotherapist will conduct a thorough assessment to determine the root cause of your prolapse and the pelvic floor muscles that are not functioning optimally. Then, a pelvic physiotherapy treatment plan will be created specifically for you. The treatment plan may include:
- Pelvic floor muscle training (consisting of Kegel exercise but not always) to improve pelvic floor muscle function and coordination
- Core strengthening exercises to help reduce overall pressure in the area
- Connective tissue massage to release tightness in the pelvic floor muscles and surrounding muscles that might contribute to pelvic floor dysfunction
Vaginal delivery is also a risk factor for POP. Visiting a pelvic floor physiotherapist throughout pregnancy and preparing your pelvic floor for vaginal delivery can be beneficial in reducing the risk of pelvic organ prolapse.
Pessary
Sometimes a severe pelvic organ prolapse might require the use of a pessary. A pessary is a small medical device inserted into the vagina and supports pelvic organs. Pessaries have various shapes and sizes, such as rings, discs, and Gellhorn. Finding a pessary that would feel comfortable when they are in and easy for you to remove and clean on your own is essential. You can get fitted for a pessary by a doctor, a nurse practitioner or a pelvic physiotherapist specializing in pessary fitting.
Pessaries can stay in for a month or longer between cleaning. You will have to remove the pessary when having sex.
Reconstructive surgery
If pelvic organ prolapse is severe and pelvic physiotherapy and the use of a pessary do not improve POP symptoms, surgery might be recommended. The surgery will depend on the type and degree of prolapse, the symptoms, associated pelvic floor disorders, history of previous prolapse surgery, and other factors. Prolapse surgery is an extensive surgery with a high recurrence rate as the weakness of the tissue is the main problem, and surgery can’t repair that.
It should be noted that prolapse surgery changes vaginal anatomy, and a small percentage of patients develop painful intercourse afterward due to muscle spasms. This can be treated with pelvic physiotherapy.
Can pelvic physiotherapy treat pelvic organ prolapse?
Yes, pelvic floor physiotherapy can help heal your prolapse. Pelvic floor physiotherapy is often recommended as the first line of defence against pelvic organ prolapse. Many women find significant improvement in their symptoms after working with a pelvic floor physiotherapist to address core and pelvic floor muscle weakness.
Physiotherapy treatment for prolapse focuses on addressing the strength of your pelvic floor, core, and surrounding muscles. Knowing what safe exercises to do and avoiding worsening the prolapse can be extremely helpful. Your pelvic physiotherapist will also work with you to address other bladder and bowel issues, such as how to pass your bowel movements without straining. Seems simple, but it works!
After your first physical exam with your pelvic floor physiotherapist, you’ll discuss the findings and explore custom treatment options that fit your lifestyle and needs. At InvigoPhysio, your appointment is a safe space to ask questions and really understand the cause of your problem and what your treatment could look like.
Can I exercise with a prolapse?
The good news is, yes, you can. Depending on your symptoms, there are physical activities that you might have to modify so that the pressure on the pelvic organs isn’t increased tremendously upon exertion. If you wish to engage in a high-impact activity such as running with a moderate prolapse, having a pessary during these activities might be beneficial. You will need to discuss this with your care provider.
Pelvic organ prolapse can be a debilitating condition, but there are treatments available that can help. If you are suffering from pelvic organ prolapse, book an appointment with us today to see how we can help you.
Have questions? Reach out to us directly at trang@invigophysio.com
