Prolapse

Pelvic organ prolapse is common in women and vagina owners – but, unfortunately, not talked about a lot. If you’re suffering from prolapse, you may feel scared or discouraged. Can I still be active? Or, will this make my prolapse worse? The good news is that, with appropriate treatment, individuals with prolapse can continue to live healthy, active lives. Let’s unravel this condition.

What Is Pelvic Organ Prolapse?

Pelvic Organ Prolapse (often referred to as simply prolapse) occurs when one or more of the pelvic organs, which includes the uterus, bladder, rectum and small intestine, descends into the vaginal canal. There are several different types of prolapse, but these 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

Pelvic organ prolapse is very common, occurring in up to 50% of women in varying degrees of severity.

Common symptoms of prolapse include:

• Feeling like there’s something bulging or protruding in the vaginal area

• Sensation of pressure or heaviness

• Urinary and/or fecal incontinence, or leakage

• Incomplete emptying of the bowel and/or bladder

What Is The Role Of The Pelvic Floor In Prolapse?

The pelvic floor is the foundation of support for the pelvic organs – it essentially “holds them up.” The pelvic floor consists of two important components: 1) the muscular pelvic floor system and 2) the surrounding connective tissue, including a network of fascia and ligaments. 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 (pressure in the abdomen).

 But, if the integrity and strength of the pelvic floor and/or connective tissue are weakened, this can reduce the support to the pelvic organs. This, in turn, can increase the pressure in the abdomen and add more downward strain, result in a lowering of the organs into the vaginal canal (i.e., prolapse).  

Who Is At Risk of Prolapse?

There are a number of factors that can impact the strength and integrity of the pelvic floor and connective tissue and lead to prolapse, including:

Age
As women age, muscular and connective tissue weaken – so, the risk of developing prolapse increases with age. In fact, 31% of all women with POP are between the ages of 50-59, while nearly 50% are over the age of 80.

Higher BMI
Increased body weight puts increased pressure on the pelvic floor tissues, making it more challenging for these structures to support our pelvic organs.

Genetics
There is a strong genetic component to prolapse, meaning that it tends to run in families. In fact, women with a family history of prolapse are 2.5X more likely to develop it as well. This could be because the strength of collagen, the main component of connective tissue, differs based on our genetics.

Obstetrical and Gynecological History
The risk of developing prolapse increases with the number of deliveries that a woman experiences. In addition, the risk is higher for vaginal deliveries compared to Caesarean sections. If instruments such as forceps and suction are used during vaginal deliveries, this further increases one’s risk of developing prolapse. Furthermore, those who undergo gynecological surgeries, including hysterectomies, may also be at an increased risk due to possible injury to the various pelvic floor tissues.

Menopause
Estrogen has an important role in maintaining the strength and integrity of the pelvic floor tissues, including the supportive connective tissue. During menopause, our bodies make less estrogen. So, women who are in menopause are also at an increased risk of developing prolapse.

Lifestyle Factors
Lifestyle factors, including straining toileting habits, chronic coughing and occupations that require heavy lifting, may put a higher than average amount of pressure on the pelvic floor tissue. Over time, this may increase a woman’s risk of developing prolapse.

If you suspect you have a prolapse or have any questions about pelvic organ prolapse, be sure to follow up with you doctor, gynaecologist or pelvic floor physiotherapist

How Can Pelvic Health Physiotherapy Help?

If you are suffering from prolapse, know that you have treatment options that may be very effective and improve your quality of life. One such option is Pelvic Health Physiotherapy (also called Pelvic Floor Physiotherapy), which is considered an effective and conservative (non-surgical) prolapse treatment. Pelvic floor physiotherapists utilize a combination of active exercise-based treatments to help optimize the strength and coordination of the pelvic floor muscular system. This can include:

• Strengthening the pelvic floor and inner most abdominal muscles

• Working on breathing and posture

• Symptom management

• Restorative resting positions

• Avoiding aggravating activities (see below)

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. Usually, a number of sessions are required. Your Pelvic Health Physiotherapist will customize a plan to your unique needs and goals. 

How Do We Approach Treatment for Prolapse?

At Proactive Pelvic Health Centre, we are passionate about pelvic health and are here to guide you, support you, and empower you along your path towards optimal pelvic health. Through expertise, compassion and professionalism, we will help you release any shame or embarrassment you may feel, and (re)gain control and confidence over your body.

Our approach to treating prolapse is holistic and rooted in scientific evidence. Before pelvic floor treatment begins, your Pelvic Health Physiotherapist will take your full medical history and thoroughly discuss your current problems and symptoms. With informed consent, your Pelvic Health Physiotherapist will perform a complete physical assessment of the joints and tissues affecting this area. Based on the assessment, a personalized treatment plan will be developed to help you attain your physical goals.

What Other Treatments Are Available?

In addition to Pelvic Health Physiotherapy, lifestyle and behaviour changes can help prevent and manage the symptoms of prolapse. This includes avoiding activities which add to the pressure put on your pelvic floor, which can be anything from lifting a car seat and squatting heavy weight, to passing a hard bowel movement. A good alternative is to exhale as you exert (or ‘blow before you go‘) when performing a movement to relieve pressure.

Alternative treatments, such as the use of a removable supportive device called a pessary, or surgery may also be treatment options for some women.