What is prolapse?
Organs in the body are usually well supported and are held in place by fascia, muscles, and ligaments. When components of this support are compromised, it can lead to very uncomfortable ailments, such as pelvic organ prolapse, described as the descent of pelvic organs into the vaginal canal and opening.
Up to 50% of women who have given birth have been reported to have some degree of prolapse while up to 20% have experienced symptoms.(1) While it is not a life threatening condition, it can cause distressing symptoms such as bulges protruding past the vaginal opening, feeling pelvic area fullness, dull lower back pain, pain during intercourse, problems with urination, bleeding from the vagina, and constipation.
The prevalence also increases with age.(2) Given how common the condition is, women, especially those that have given birth, must be aware of pelvic organ prolapse.
Why does prolapse happen?
The cause of prolapse is dependent on several factors, including connective tissue defects, congenital defects, and surgeries, but is primarily associated with pregnancy and vaginal delivery, which has been seen to cause pelvic floor muscle, connective tissue injury, and pelvic neurpoathies that predispose women to pelvic floor prolapse.(3)
With weakened pelvic floor muscles, essentially, an increase in pressure in the abdomen leads to pelvic organ prolapse. Subsequent increases in intra-abdominal pressure result in prolapse, including pelvic surgery and conditions associated with prolonged instances of increased intra-abdominal pressure, including obesity, chronic coughing constipation, and repeated heavy lifting.
Descent of the pelvic floor places stress on the endopelvic connective tissue support system. Thus, prolapse revolves around pelvic floor muscle weakness.
What is the safest way to heal prolapse?
Many women are not aware of pelvic organ prolapse, much less the treatment steps. Surgery should only be considered in women with severe symptoms and have tried or refused conservative management.(4) Studies have recommended conservative management before surgery is considered.
Nonsurgical treatment represents the safest and most effeective method to treat prolapse. This includes observation, reducing weight, cessation of smoking, and reducing constipation. The main aspect of conservative treatment though lies in pelvic floor muscle exercises. It has been found to lessen prolapse symptoms, lower the diagnostic grading, and impedes progression of the condition.(5)
It must be noted that exercises in the studies were done properly with the aide of physiotherapists. This does not mean that an observing therapist is required to do the exercises, but rather proper training and form to achieve the desired effects.
What are the best pelvic floor exercises to heal prolapse?
Pelvic floor muscle training provides the necessary rehabilitation towards the effective and non-invasive prevention and treatment of pelvic floor dysfunction. Training revolves around Kegel exercises, which when done properly, focuses on the pelvic floor muscles and promotes increased blood flow and strength.(6)
The key to properly executing Kegel exercises is by identifying the target muscles. As if trying to prevent midstream urination, bowel movement or passing gas without the contraction of the glutes, abs, or inner thigh muscles without any upward body movement.(7) Placing a hand on the abdomen or buttocks while doing the exercises to watch out for contraction of the non-pelvic floor muscles is a good practice to develop perfect technique.
Perifit provides an app and a biofeedback device to ensure that Kegel exercises are properly executed. Perifit teaches user proper technique through the app, includes various pelvic floor muscle focused training programs, and games at different training levels to not only challenge the user but also keep her involved in her training to ensure that the benefits of training are maintained. Using Perifit to treat prolapse will give the best results possible from Kegel exercises.
What are the alternatives to kegel exercises to heal prolapse?
Other than Kegel exercises, studies have been trying to identify other methods to safely reduce the effects of symptoms of pelvic prolapse. Yoga and pilates have been seen as effective in reducing the symptoms.(8)
1 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.
2 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
3 Iglesia CB, Smithling KR. Pelvic Organ Prolapse. American family physician. 2017;96(3):179-85.
4 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.
5 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.
6 Women’s and Men’s Health Physiotherapy Team. Your recovery after childbirth. Physiotherapy, exercises and advice. 2016. Version 2.
7 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
8 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.