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Pelvic Organ Prolapse. What is it? Can it be resolved?


Besides being a pretty scary thing to think about, pelvic prolapse is a treatable condition that is not as rare as you might think.


In this blog post, I'm going to share information about prolapse, causes, symptoms, and how you can live normally without constantly worrying about your prolapse.


Pelvic prolapse is a diagnosis involving the pelvic organs and the pelvic floor muscles. It occurs when one or more of the pelvic organs are descending down into the vaginal canal. Women may be aware that their mother or grandmother had some sort of experience with prolapse and that leads them to worry that they are also destined to deal with a prolapse condition.


Be careful googling pelvic prolapse! There is some scary information about “slings” and “meshes”. Getting this diagnosis can be an unpleasant experience for a lot of women as they may feel shame and start to form thoughts about how there is now something "wrong" with their body. Please, don’t be ashamed. There is nothing “wrong” with you or your body. There is a tremendous body of knowledge devoted to responding to prolapse in ways that can make you feel strong and allow you to live an active and worry-free life.


The good news is that pelvic floor physical therapy can be an excellent way to resolve or manage your pelvic prolapse symptoms. Many women return to living a very normal life without having to worry about prolapse.



Types & Grades of Prolapse


There are 3 types of pelvic organ prolapse when we are considering the vaginal canal. We assign the diagnosis of pelvic organ prolapse when either the bladder(cystocele), uterus, or rectum (rectocele) is descending down into the vaginal wall.


There are different “grades” of severity which identify how close to the vaginal opening the prolapse is descending. We use grades 1-4. A grade 1 is a slight desention and a grade 4 is where the prolapse is protruding outside of the vaginal canal (see image below). The most common grades are 1-2. All women with any degree of prolapse would benefit from pelvic floor physical therapy, but grades 3 and 4 are often referred for surgery and are not as common.






Causes of Prolapse


Prolapse can occur for different reasons, but often comes back to having increased pressure down through the pelvis. Having a long or intense pushing phase during birth, chronic constipation and straining during evacuation, or a lot of heavy lifting with breath-holding can be common causes leading to a prolapse. This excessive pressure causes the ligaments that support the organs in the pelvis to lengthen, and the organs will relax down with gravity into the vaginal canal.


The pelvic floor muscles are responsible for supporting the organs in the pelvis from below. Decreased strength and function of these muscles can worsen symptoms of a prolapse. That’s not to say that everyone with a prolapse has pelvic floor muscles that are too “relaxed,” I often find women with prolapse have pelvic floors with a lot of tightness. So tight, that these muscles are not doing their job correctly. Our pelvic floors are working for us all day long without us thinking about it. But if they are stuck in spasm, they can’t contract and relax on their own as effectively.




Symptoms


Prolapse is actually a common, even normal, condition. Many women are walking around with some degree of prolapse (~50%) especially if they have had babies. However, most women do not have symptoms and may never even know they have a prolapse. In my opinion, prolapse is only a problem if you are experiencing bothersome symptoms. However, it is always a good idea to be screened for one and get treatment when appropriate. Symptoms include a sensation of heaviness in the pelvic region, a bulge at the opening of the vagina, difficulty emptying your bowel or bladder, and urinary leakage.


Symptoms can occur with any grade of prolapse. Our bodies are funny like that, you could have a grade 1 prolapse and feel like there is a lot of heaviness and pressure after you run or have been on your feet all day. This is just your nervous system telling you that it was not ready for the activity you are asking of your body.



Resolving prolapse


The good news is that pelvic floor physical therapy can be an excellent way to resolve or manage your pelvic prolapse symptoms to where you are living a very normal life without having to worry about your prolapse.


There is no one right way to treat for prolapse. This is because prolapse can occur for different reasons for different women. This is why it's important to have an individualized assessment and examination of a pelvic therapist.


I worked with one woman who gave birth to her second child 2 years prior to seeing me. She was having a sensation of pressure in her pressure that worsened with exercise or just being on her feet, picking up her son. She expressed worry that she had done permanent damage to her body. On our exam, we found that she had significant scar tissue adhesions from her vaginal birth as well as pelvic floor spasm and significant pelvic floor weakness. We started out with working on the perineal scar tissue, getting it more mobile and soft. This also helped the pelvic floor muscles relax as well and we found that they were able to get stronger and better support her organs. I progressed her through a home exercise program that included stretching and mobility and gradual strength training. Eventually, we added high impact jumping, which was a type of exercise she enjoyed prior to having babies. When we started, she was experiencing the prolapse symptoms daily and was scared to pick up her toddler. As we addressed the scar tissue, tightness, and overall strength, she was not experiencing symptoms and was able to exercise without thinking about her prolapse.





Here are some important topics and tips I discuss with my clients to prevent prolapse from becoming a problem or to prevent it from worsening:


  • Constipation, getting the bowels regular and evacuating without straining

  • Breath techniques with exercise and lifting to reduce pressure into pelvis

  • Listening to your body and rest when you are feeling symptoms

  • Hip, core, and pelvic floor strengthening

  • Don’t push out your pee

  • Pelvic floor relaxation and meditation techniques

  • Exercise is great but ease into it and gradually build up intensity/resistance

  • Pessary education, not every woman needs one of these but some would benefit one, even just for exercise


Prolapse is a condition many women experience. It can feel disheartening to receive this diagnosis. Many may feel like surgery is their only option. However, it is a very treatable problem. Pelvic floor physical therapy can help you reverse your symptoms and get you moving without the fear that you are worsening your prolapse.



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