​June is Pelvic Organ Prolapse Awareness Month!
 
As the month draws to an end I wanted to highlight a few thoughts on the subject…
Pelvic organ prolapse is common – with up to 50% of women who have had a vaginal delivery having some form of prolapse.
 
Of most diagnoses that I have come across in my career, one of "pelvic organ prolapse" aka POP is perhaps the most unhelpful, frightening and vastly vague diagnosis a woman can be given.
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Let me clarify …frequently, women are given the "diagnosis" of bladder prolapse or uterine prolapse without much guidance into what it means for their present and their future. Most women go home and google "organ prolapse" and are met with scary pictures of complete organ prolapses – spiralling many women into a world of uncertainty, exercise avoidance, fear (if you become paralysed by the fear of moving because of the state of your pelvic floor, it may have worse impact on your mental health, as well as your over-all physical health), and little to no advice on how to manage or prevent their symptoms from worsening.
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This diagnosis can be traumatic experience for so many women who either restrict their activities in hopes of avoiding their "organs from falling out" or opt in for ‘last resort’ surgery to rectify the situation – (often earlier interventions can avoid the need for surgery)
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If you hear pelvic organ prolapse , here is what I want you to think about AND ask your GP/ pelvic health physiotherapist or specialist:

1️⃣ GRADE - Prolapse can range FROM grade 1 where you DO NOT see ( or often not feel) anything coming out of your vagina TO grade 4 where an entire organ can protrude outside the vagina. What grade is your prolapse? Ask and make sure you understand what that means.

2️⃣ PROGRESSION - One thing that makes women jump to surgeries is the assumption that time will make their prolapse worse. THERE IS NO STRONG EVIDENCE TO SUGGEST THAT LOW GRADE PELVIC ORGAN PROLAPSE WILL PROGRESS WITH TIME. Watchful waiting and physiotherapy may be a clinically sound options and should be discussed with your practitioner, (some health professionals may fail to relay to the women that if you aren’t bothered by the prolapse, then you don’t necessarily have to rush into surgery to just correct the anatomy)

3️⃣ SYMPTOMS - Do you feel any symptoms from POP? Heaviness, fullness, bulging, pain? VERY OFTEN, women have low grade prolapse without any symptoms. If you don't have any symptoms, can you manage conservatively? Pelvic Health Physiotherapy is an EXCELLENT option for improving low grade prolapse symptoms so too are pessary devices – which can be hugely beneficial for many women – Has a PESSARY been offered as an option??

4️⃣ TYPE - What is the specific organ that is prolapsing? Bladder is the most common one, followed by rectum and uterus. Knowing this in addition to the grade can be helpful in making sense of your symptoms (Check out an older blog I did-http://www.hawkesbaypelvicphysio.co.nz/blog/pelvic-organ-prolapse-confused-about-what-it-is-how-it-occurs)

In summary - If you become aware that you have prolapse there is so much you can do to increase your chances that the prolapse won’t progress to the point that you may be bothered by it and ultimately need surgery. Early intervention can be helpful and allow you to continue to lead an active life with the types of exercise you want to do.

👉🏻 Calm your anxiety / fears. They hurt you more than you know 🤗
👉🏻Try more than one physiotherapist if the first one does not help. There is a HUGE difference between practitioner's education and their own experience/belief system
👉🏻It is almost always a good idea to attempt conservative treatment (aka physiotherapy or pessary) first before surgery
 
Having a prolapse need not be considered a devastating diagnosis.  
Our Vagina is dynamic not static and rigid -  it moves and responds to increased intra-abdominal pressure – and is also hugely influenced by the movement or rigidity of the abdominal organs and diaphragm muscle. It is also likely to change through the day depending on your activity levels (increased intra-abdominal pressure) and the degree of upright vs sitting/lying you undertake and it changes and adapts through pregnancy and birth.
Therefore, in any one woman can vary from day to day and from hour to hour within any given day depending on what they are doing. 

As a Holistic Pelvic Health Physiotherapist I care for my clients as a WHOLE. A woman is more than her prolapse and every woman is an individual and her individual needs have to be respected, her story has to be heard, and if it’s a traumatic birth – just because 20, 30 or 50 years ago women knew no better and seemed to ‘suck it up’ – doesn’t mean this denial of what the woman has gone through has to be continued. 

Contact me today for an holistic consultation: 
Phone 021 02554238
Email: bcnphysiotherapy@gmail.com

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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