What is prolapse?
Our pelvic organs are supported in our pelvic bowl by fascia, connective tissue, muscles, and ligaments. When those structures lose some of their support, due to many factors (birth and pregnancy can be one), the organs may sit a bit lower in the pelvic bowl and push on the walls of the vagina. This can feel uncomfortable, bulky, and can lead to other issues like constipation and leaking urine.
What does a prolapse feel like inside?
Pelvic organ prolapse can be stressful and scary, especially when it’s new and not something that you are used to! Prolapse can be mild or severe, and in the severe cases, there may be a bulge that comes past the opening to the vagina. Prolapse symptoms are feelings of fullness, pressure, or like something is hanging in the vagina.
How common is pelvic organ prolapse?
Prolapse is very common, but shouldn’t be considered normal. Some studies say that up to 50% of birthing persons have reported some degree of prolapse, and maybe up to 20% have reported symptoms. This can be more common with ageing, also. Since this can affect so many birthing persons, it’s important we are aware and know what to do about it.
What are the causes of pelvic organ prolapse?
The cause of prolapse is dependent on several factors, including:
- connective tissue defects,
- congenital defects (genetics and anatomy differences),
- surgeries (like a hysterectomy),
- chronic constipation or respiratory issues (history of pushing or straining or forceful coughing),
- pregnancy and vaginal delivery: prolapse is mainly associated with these factors, which have been seen to cause pelvic floor muscle, connective tissue injury, and pelvic neuropathies that predispose women to pelvic floor prolapse.
This may be the most common cause of pop, due to the strain and load on the pelvic floor muscles and structures that support the organs.
Why does prolapse happen?
When there is an increase in abdominal pressure, like with pushing for birth or lifting or coughing, that downward pressure exerts a force on the organs and the pelvic floor muscles. If the muscles are weakened or strained from birth, they have a difficult time supporting the organs, gravity, our body weight, and those increased pressures. This can lead to the organs not being as supported as the once were, and therefore sit lower in the vaginal canal.
When the pelvic floor muscles descend, the connective tissue support system, which usually acts as a sling, lengthens out and the organs aren’t held up as effectively. Pelvic floor muscle weakness has a direct effect on the support of the organs, and plays a huge role in helping the organs stay lifted and functional.
What is the safest way to heal a prolapse?
Many women and birthing persons don’t even know that Pelvic Organ Prolapse (POP) exists, and that there are treatment options for them. Surgery is one, and can be very effective for severe cases of POP. We always want to start with conservative and low risk treatment first, and then progress to surgery if needed.
Nonsurgical prolapse treatment represents the safest and most effective method to treat this issue. This includes:
- monitoring POP through observation
- decreasing weight
- stopping smoking
- decreasing pushing/straining for bowel movements
The most effective and main part of conservative, non surgical treatment is pelvic floor rehab exercises. Studies show this to be an effective way to lessen symptoms of prolapse, improve support of the prolapse so it is not as severe, and keeps it from getting worse.
It’s important to keep in mind, however, that in these studies a pelvic floor physiotherapist was monitoring and prescribing pelvic floor exercises and helped train the women to preform a pelvic floor exercise correctly.
Why should you do pelvic floor exercises?
Training the pelvic floor muscles helps provide the necessary strength and control needed for them to work optimally and properly, and this should be the first step in treating and preventing pelvic floor dysfunction. Part of that training involves pelvic floor muscle exercises, called Kegels. Kegels are specific strengthening exercises for the pelvic floor muscles, and when they are done properly can help decrease prolapse and improve support.
How do I train my pelvic floor with prolapse?
It's actually quite difficult to identify and find your pelvic floor muscles! Think about squeezing your vaginal or anal muscles as if you were going to hold in gas, or stop your urine stream (but don’t practice this while actually urinating on the toilet!). Think about lifting your pelvic muscles up and toward your head, without holding your breath, clenching your buttocks, or squeezing your thighs.
Perifit: strengthen your pelvic floor with games and take the guesswork out of Kegels
Kegel exercises are one way to train the pelvic floor to decrease symptoms of prolapse and overall pelvic floor dysfunction. It’s hard to know, however, if you’re doing them the right way. Perifit can help! Perifit gives you instant feedback about your pelvic floor contraction, and actually makes doing your program fun! The app uses games to help you train your pelvic floor successfully, and it also provides you with statistics and real-time facts about progress and muscle activity so you don’t have to guess anymore! You can be confident that you’re doing the right exercises for yourself, and that you are maintaining your strength gains and working towards a better, healthy, pelvic floor.
Learn more about the benefits of Perifit:
- Prevent pelvic floor disorders
- Stop stress incontinence
- Treat an overactive bladder
- Enhance intimate wellbeing
- Achieve faster postnatal recovery
Milsom I, Altman D, Herbison P,Lapitan MC, Nelson R, Sillén U, et al.Epidemiology of urinary (UI) and faecal (FI) Incontinence and pelvic organ prolapse (POP). In: Abrams P, Cardozo L,Khoury S, Wein A, editors. Incontinence. Paris: Health Publications Ltd; 2009. 35–111 pp.
Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG: An International Journal of Obstetrics & Gynaecology. 2013;120(2):152-60
Iglesia CB, Smithling KR. Pelvic Organ Prolapse. American family physician. 2017;96(3):179-85.
Bordman R, Telner D, Jackson B, Little D. Step-by-step approach to managing pelvic organ prolapse: Information for physicians. Can Fam Physician. 2007;53(3):485-7.
Baeßler K, Aigmüller T, Albrich S, Anthuber C, Finas D, Fink T, et al. Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016). Geburtshilfe Frauenheilkd. 2016;76(12):1287-301.
Women’s and Men’s Health Physiotherapy Team. Your recovery after childbirth. Physiotherapy, exercises and advice. 2016. Version 2.
Kegel exercises: A how-to guide for women. (2018). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/kegel-exercises/art-20045283
Baessler K, Bell BE. Alternative Methods to Pelvic Floor Muscle Awareness and training. In: Baussler K, Shussler B, Burgio KL, Moore KH, Norton PA, Stanton S, editors. Pelvic Floor Re-education. 2nd ed. London: Springer; 2008.