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A guide to pelvic organ prolapse
Our Pelvic Health Physiotherapist Aby shares what it is, how to know if you have it and what you can do about it.
What is it?
The old medical definition is the descent of one or more of your pelvic organ into the vaginal space, the most common being bladder, rectum or uterus. If we stuck to this definition that looks at structural change alone, then most of us who have had a baby would fit this definition, and yet most of us are absolutely fine. So the up- to- date definition adds a small but incredibly important detail to the end. It is descent of a pelvic organ into the vaginal space WITH relating symptoms. We will talk later about what those symptoms could be.
We now need to look at severity, because if you’ve Googled it or your Great Aunt has given you a well-meaning warning of what might be to come, then you are likely terrified! Prolapse is graded 1-4, with 1 being very mild and 4 being severe. The severe prolapses are uncommon and a big risk factor is older age, as the prolapse often worsens over the years of hormonal changes in perimenopause.
How do I know if I have it?
The most common symptoms for all types of prolapse are:
- Vaginal heaviness
- Abnormal sensation such as stuck tampon, bulging, trapped air bubble
- Low back/tummy ache
- Discomfort or pain with sex
Then, depending on which pelvic organ is involved, you can get symptoms in that relating area.
Common bladder symptoms
- Leaking urine when you think you’ve finished your wee
- Feeling like your bladder hasn’t fully emptied after going for a wee
Common bowel symptoms
- Feeling like a poo gets stuck, you may even use a finger to support your perineum or vaginal wall to help it come out.
- Bulge sensation when you need a poo that improves after going.
- Sudden urge to go with little warning.
Why we shouldn’t be terrified of it and what we can do about it
If you were to ask the internet about this condition you would be met with a lot of misinformation. Lists of absolute rules with no expiry date. When our understanding progresses in the medical world, no one then goes on the internet and gets rid of outdated information, so be mindful about your sources.
We needn’t fear this condition if we understand it. The uniting factor between all types of pelvic organ prolapse is that the support has reduced somewhere in the system, so the organs aren’t being held in their place. This can happen in three main areas:
- Pelvic floor – weakened from pregnancy, and potentially injured in birth.
- Vaginal walls – stretched to the max in a vaginal birth, even more so with a forceps assisted birth.
- Connective tissue – ligaments provide support to our pelvic organs from above, and these are stretched in pregnancy.
To put it into a hopefully helpful analogy, I like to think of the pelvic organs as our boobs, the bra cups are our vaginal walls, the straps are the connective tissue and the pelvic floor is the under band. We all know what a poorly fitted bra can feel like, if the under band is loose, the straps have lost their elasticity and the cups have stretched, our boobs won’t feel supported, particularly if we were to try and jump or run up the stairs.
So let’s look at how we can increase support…
- The under band (Pelvic floor) - Get a nice thick but flexible under band by strengthening, your pelvic floor and surrounding muscles to create a strong network to manage all the activities you want to do. For example, if you couldn’t lift a 20kg weight off the floor in the gym confidently, don’t expect to get the buggy in and out of the boot easily. This means going beyond basic pelvic floor exercises and doing whole body resistance training.
- Bra cups (Vaginal walls) – we have devices called pessaries, which I like to think of as a vaginal sports bras for you. They essentially offer scaffolding to hold the walls where they need to be to give the organs support. There’s so many different types depending on how much support you need, which organ has descended, and if you need it all the time or maybe just to exercise. We can also use vaginal oestrogen, particularly helpful if you are still breastfeeding. When we breastfeed our oestrogen levels remain low and this can have an impact on the plumpness of the vaginal tissues. Giving them a local boost can be a game-changer for some. The other avenue you can explore if you have a more severe prolapse is a surgical procedure to correct the structure. This is done by a gynaecologist and is usually done when other management has been insufficient to manage symptoms.
- Bra straps (connective tissue) – unfortunately we can’t replace them nor can we force them to regain elasticity. We will get a natural improvement after pregnancy in that first year, but that will plateau. All we can really do is avoid over straining the straps further and having a great under strap and bra cups. And hey strapless bras are a thing!
Now how can you reduce strain?
- Get rid of constipation – no pushing out poos!
- Deal with chronic coughs and sneezes.
- Don’t do more than you currently have strength for – so if your symptoms get worse with a particular activity, modify or reduce it until you are stronger, then try again.
There is so much hope for a full life after a prolapse diagnosis with the right individualised plan in place and all the treatment options we now have available. Don’t count yourself out at the point of diagnosis; find the right support.
