I have been talking about ... 'June is Pelvic Organ Prolapse Awareness Month'! And as the month has progressed I’ve realised from talking to lots of women, that although you may have heard the word ‘prolapse’ or even been given the diagnosis of ‘prolapse’ ...you may still be wondering what I am talking about!
​So let’s get down to the details:

What is Pelvic Organ Prolapse?
How do I know I have a Prolapse?
And What Causes Pelvic Organ Prolapse?
Are there ways Prolapse can be avoided and treated?

What Is Pelvic Organ Prolapse?
"Prolapse" refers to a descending or drooping of organs. Pelvic Organ Prolapse (POP) refers to the prolapse or drooping of any of the pelvic floor organs, including:  the bladder, the urethra, uterus, vagina, small bowel, or rectum. These organs are said to prolapse if they descend into or outside of the vaginal canal or anus.
Different Types of Pelvic Organ Prolapse
Prolapse is sometimes given these specific names to describe which organ is descending:

• Anterior Wall Prolapse (Cystocele): The bladder falls backward into the front (anterior) vaginal wall – most common
• Urethrocele: A prolapse of the urethra (the tube that carries urine) into the vaginal wall
• Uterine prolapse: prolapse of the uterus
• Vaginal vault prolapse: prolapse of the vagina
• Enterocele: Small bowel prolapsed
• Posterior Wall Prolapse (Rectocele): the rectum falls forward into the back (or posterior) vaginal wall.

 
How do I know I have a Prolapse?
Symptoms depend somewhat on which organ is in descent. If the bladder prolapses, urine leakage may occur but in some cases you may have no leakage. If it's the rectum, constipation and uncomfortable intercourse often occur. A backache as well as uncomfortable intercourse often accompanies small intestine prolapse. Uterine prolapse is also accompanied by backache and pain or discomfort with intercourse.
Some people will feel nothing at all and can live with prolapse without even knowing it is present!
Common symptoms include:

• A feeling of  “something falling out” of the vagina or rectal area
• A “bulge”, or feeling of “fullness/heaviness” in the pelvic area
• Feeling like you are “sitting on a golf ball”
• Extra tissue in the vaginal opening
• Unable to insert or keep a tampon in place
• Needing to use a finger to splint near or in the vagina when emptying bowels
• Inability to contain urine or a constant need to urinate
• Low back or Sacral pain
• Pain with sex
• Gas incontinence or air escaping from the vagina
• Constipation
• Staining of faeces on underwear
• Spotting or bleeding from the vagina
• Inability to orgasm or reduced intensity/frequency of orgasm

What Causes Pelvic Organ Prolapse?
Prolapse occurs when pressure in the abdomen is greater than the strength of the pelvic floor and deep core muscles that help keep organs in their place.
Common causes and risk factors include:

• Pregnancy, labour, and childbirth (the most common causes)
• Diastasis Recti Abdominus(separation in abdominal muscles & weak core)
• Being overweight or obese
• Respiratory problems with a chronic, long-term cough
• Frequent or Chronic constipation
• Poor posture
• Pelvic organ tumours and cancers
• Hysterectomy, and Abdominal surgeries
• Changes due to menopause such as low oestrogen levels and weakened tissues
• Repeated manual work and heavy lifting
• High impact sports or repetitive straining over time
• Connective tissue disorders
• Genetics may also play a role in prolapse

 
 
How is Pelvic Organ Prolapse Treated?
Treatment methods for pelvic organ prolapse depend on the severity of symptoms. These may include different therapies like:
Physiotherapy:

• Posture and body mechanics training
• Exercises to strengthen the pelvic floor muscles    
• Diastasis recti recovery
• Regaining core control – pressure management
• Lifestyle changes and modifications
• Correcting pelvic floor dysfunction (bladder, bowel & sexual function)

Other Interventions include:

• Mechanical treatments such as pessary insertion in the vagina for added support
• Surgical treatment to either repair or remove the affected organ

 
Tips to Prevent Pelvic Organ Prolapse
Many risk factors that contribute to pelvic organ prolapse cannot be controlled including:
● Genetics and family history
● Aging
● A strenuous vaginal delivery
● Hysterectomy
However, the risk of experiencing the symptoms and problems associated with pelvic organ prolapse can be reduced through:
● Daily Kegel exercises for the maintenance of good pelvic muscle strength(making sure you are doing them correctly!!)
● Maintaining a healthy weight
● Avoiding constipation
● Avoiding/or not smoking – reducing risk of chronic cough & respiratory problems
● Treatment of chronic cough and constipation that apply strain on the pelvic floor
● Strengthening the core muscles and pelvic floor muscles.
Pelvic organ prolapse is a common problem among women. The types and symptoms vary, but effective treatments are available.
Though the word prolapse can be scary, the research supports pelvic health physiotherapy as an important treatment option for POP. In addition to strengthening your pelvic floor muscles, physiotherapy helps to coordinate your pelvic floor with the rest of your body, especially with functional movement patterns (correct lifting techniques) and lifestyle modifications.
You are more than your pelvic floor and pelvic floor physiotherapy is more than just kegels!
Remember it’s NEVERTOO LATE to seek help
You are not alone and if something doesn’t feel right or normal you should talk to someone about it. There might be many ways to improve it!

Bernadette Nolan is a Specialist Pelvic Health Physiotherapist based at Clinic rooms of Carlyle Medical Centre, in Napier
For further Information on Bernadette check out her websiste: www.hawkesbaypelvicphysio.co.nz

Being a new mum brings with it many challenges: recovering from a birth, sleep deprivation, constant feeding, changing, lifting... are just a few! Why not throw a bit of wrist pain into the mix?  I like to call it Baby Wrist and it’s something I experienced myself and I see & hear a lot of during my working day with mums, so I thought I would help to explain what exactly causes it and how it can be managed.
 
What is ‘baby wrist’?
‘Baby wrist’ is essentially an overuse injury that is triggered by the often repetitive tasks of having a new baby, like feeding, lifting, carrying and rocking. New mums are prone to overuse conditions like these because of the softening effect certain pregnancy hormones (like relaxin) can have on the ligaments and tendons. It can range from a niggle when you hold your baby to more severe pain that prevents you from gripping ... (a bit of nuisance to say the least when caring for a new baby)
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The most common cause of ‘baby wrist’ is DeQuervain’s Tenosynovitis, which involves inflammation of two tendons in the thumb. It normally produces pain on the thumb side of the wrist during lifting/carrying and gripping.
 

Another possible cause is Carpel Tunnel Syndrome. This involves compression of the structures in the carpel tunnel of the wrist, which can cause tingling, numbness and pain in the wrist & hand. It is quite common during pregnancy, because the extra fluid we retain can compress the tunnel. After pregnancy, the cause is usually more related to overuse; specifically spending too much time with the wrist in flexion (i.e bent – think how many times you are doing that!!!).
 
What you may feel

• Pins and needles
• Numbness.
• Pain, may be worse at night.
• Weakness in the hand(s).
• Burning sensations in the fingers.
• Sharp darting pains from the wrist.
• Radiating pain into the arm and shoulder

 
What can you do to help?
Often making just a few changes to your wrist position in feeding, carrying & lifting postures can make a huge difference. Try:

• Using your forearm to support your baby’s head while feeding or their bottom while carrying, rather than your wrist
• Using a pillow to support your baby while you feed, so that your hand and wrist are not working too hard
• Minimising gripping activities where possible (like chopping lot of veggies, carrying heavy shopping bags)
• Try to aim for a straight wrist when carrying and feeding. Avoid holding your wrist in a bent position and allowing your thumb to move away from your hand – think about those long walks by the beach pushing prams!!

 
What can I do to help?
I can help by determining what the exact cause of your wrist pain is. Sometimes the wrist or thumb needs hands on treatment and support to help alleviate the pain - especially if the tissues are very inflammed and the pain is not alleviating with the above strategies.
I can then help by:

• applying protective strapping/taping (this can work wonders!!)
• massaging the muscles of the forearm & wrist
• giving you some simple exercises and strategies to manage it at home
• prescribing a wrist brace/splint if we think it is necessary.

 
Bernadette is a pelvic health & women’s physiotherapist, a mother & female advocate. She specialises in treating ALL conditions affecting women, especially new mums and mums-to-be. She runs Hawkes Bay Pelvic Health & Women’s Physiotherapy, empowering & helping women through all stages of life – www.hawkesbaypelvicphysio.co.nz. She can also be found on facebook @hawkesbaypelvichealthphysio
Give Bernadette a call today 021 02554238 to see how she can help you enjoy your motherhood journey & beyond.
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