Pelvic Organ Prolapse - Confused about... What it is?? How it occurs??

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

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