The Who, What, Why and How of Pelvic Organ Prolapse
Pelvic organ prolapse is a common diagnosis in women, but unfortunately it’s not something that the average person likely knows much about. A quick google search reveals a lot of (sometimes conflicting) information, and some scary looking pictures…which makes it easy to understand how a woman with a new diagnosis of prolapse could be left feeling pretty confused and discouraged. She may even feel scared to exercise or participate in activities she enjoys, for fear of making the prolapse worse. The good news is that with appropriate treatment, symptoms can be addressed, and women with prolapse can continue to live a healthy active life! The purpose of this post is to provide an overview on prolapse and hopefully dispel some of the fears that can be associated with this common but often unfamiliar condition.
What even is a prolapse?!
First, lets define what pelvic organ prolapse is and explain the different types. Prolapse is a condition that involves dysfunction of the pelvic floor muscles and surrounding connective tissue (fascia) that results in one or more pelvic organs lowering into or pressing onto the walls of the vagina. There are different types, but here are the most common:
-Cystocele: lowering or shift of the bladder, causing pressure onto the front wall of the vagina
-Rectocele: rectum causing pressure onto the back wall of the vagina
-Uterine: uterus lowering into the vaginal canal
-Hysterocele: vaginal wall dropping after a hysterectomy
-Enterocele: small intestine lowering into the upper portion of the vagina
Why does it happen?
The lowering that occurs in prolapse is due to stretched connective tissue and weakness of the pelvic floor muscles, who’s job it is to hold up the pelvic organs. When they are working properly, the pelvic floor muscles form a basket or hammock shape that supports the organs against gravity and intra-abdominal pressure. Weakness can develop for a number of different reasons, but common ones include pregnancy, vaginal delivery, constipation, being overweight, chronic coughing, and the hormone changes that occur with menopause. Studies show that prolapse affects up to 65% of women at some point in their lives.
What are the symptoms?
Symptoms of prolapse can include the sensation of pressure or heaviness, discomfort, urinary retention, altered bowel function, and sometimes urinary incontinence or leakage. Sometimes it will even feel like there’s ‘something’ bulging or protruding into the vaginal canal.
How does pressure fit into all this?
Prolapse is a condition that is highly influenced by the pressure system in the body, specifically the pressure in the abdomen (called intra-abdominal pressure). If the pelvic floor muscles are weakened and having a hard time supporting the pelvic organs, increases in intra-abdominal can add more downward strain, contributing to prolapse. An easy way to manage pressure and make sure you aren’t doing more than the pelvic floor can handle is to avoid activities which cause you to strain or hold your breath. This could be anything from lifting a car seat or squatting heavy weight, to passing a bowel movement. A good alternative is to exhale as you exert (or ‘blow before you go‘) when performing a movement to relieve pressure.
What are some treatment options?
The research shows that conservative treatment of prolapse can successfully reduce symptoms. Key components in a management program include strengthening the pelvic floor and innermost abdominal muscles, working on breathing and posture, symptom management, restorative resting positions and avoiding aggravating activities. With dedication and hard work the strength and support of the pelvic muscles can be built up to enable participation in higher intensity activities with time. For more advanced cases of prolapse, other treatment options can include surgery and the use of support devices called pessaries.
If you suspect you have a prolapse or if you have any questions about pelvic organ prolapse, be sure to follow up with you doctor, gynaecologist or pelvic floor physiotherapist.
References:
1) Hagan S, Stark D. Conservative prevention and management of pelvic organ prolapse in women (review). Cochrane Db Sys Rev. 2011;12
2) Jelovsek JE, Maher D, Barber MD. Pelvic organ prolapse. Lancet. 2007;369(9566): 24–30.
3) Miekle S, Kinkle C. Pelvic Organ Prolapse. A Fact Sheet From the Office on Women’s Health. 2016.
4) Swift S, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D, Wang W, Schaffer J. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support efects. Am J Obstet Gynecol. 2005;192(3):795