Ins and Outs of Pelvic Organ Prolapse
June 13, 2018 at 10:00 AM
Pelvic organs are the organs that live inside your pelvic cavity. In women, these include the bladder, uterus and rectum. Prolapse is when these organs drop out of their normal position inside the pelvic cavity. Prolapse is a major health concern affecting New Zealand women. Did you know that as many as 75% of women will experience some degree of prolapse in their lifetime. Similarly to incontinence, embarrassment prevents many of these women from seeking help.
How do you know if you have a prolapse?
Many women actually have some degree of prolapse, but if it is only mild you may not know. If the prolapse worsens symptoms experienced include:
- A heavy, dragging feeling in the vagina. Some women describe a sensation that their “insides are falling out”.
- A lump inside the vagina or a lump or bugle outside the vagina. This is often noticed when in the shower or bath.
- Incontinence of the bladder or bowel
- Difficulty emptying the bladder or bowel, commonly with a weak stream of urine.
- Pain or discomfort during intercourse.
You may notice that these symptoms are worse at the end of the day or following exercise.
How does prolapse occur?
The pelvic organs are supported by the pelvic floor. The pelvic floor is a sling of muscles and fascia which sits at the base of the pelvis as shown below. The pelvic floor helps to attach the pelvic organs to the bones around the pelvis and it holds the organs up inside the pelvic cavity from below. The pelvic floor may become stretched or torn or may weaken with age. When this happens the pelvic organs lose their main form of support and will eventually begin to drop down into the vagina.
Childbirth is the most common contributor to prolapse. During the pregnancy, the pelvic floor is weakened from the weight of the baby in the uterus. Then during the birth, the muscles and fascia are further stretched and sometimes torn as the baby exits the vagina.
Other risk factors for prolapse include:
- Repetitive heavy lifting or high impact exercise
- Chronic coughing
- Chronic constipation
- Being overweight
- A family history of prolapse
Types of prolapse
Cystocele- Bulging of the bladder through the front wall of the vagina.
Rectocele- Bulging of the rectum through the back wall of the vagina.
Uterine- Bulging of the uterus into the vagina.
Prolapse may occur with just one type or a combination of the different types of prolapse. The prolapse is also graded according to the severity. This is based on how far towards the vaginal opening the prolapse extends.
How you can prevent prolapse
The best way to prevent a prolapse is to keep your pelvic floor muscles strong. This is important no matter what your age but especially following pregnancy. Physiotherapist Michelle can check that your pelvic floor is working correctly and help you with a specific strengthening program. Make sure to also avoid heavy lifting post birth when your pelvic floor is still recovering and you should also check with your physio when you can return to higher intensity exercise such as running.
Other things you can do include keeping active and within a healthy weight range. A healthy diet will also help to avoid any constipation.
What if you already have a prolapse?
Although pelvic floor prolapse cannot be fully reversed it can be treated depending on the severity. Treatment can prevent worsening of the prolapse and often provides relief of symptoms such as pain or discomfort, incontinence and constipation.
Treatment with a womens health physio will include a pelvic floor strengthening program prescribed specifically for you. It will also commonly involve simple lifestyle modifications including changes to diet, fluid intake, exercise and weight management and bladder and bowel habits. Sometimes we may also recommend getting a pessary (a device which sits inside the vagina) fitted to provide extra internal support to your organs.
Surgery is sometimes needed for more severe prolapses to repair the damaged muscles and fascia.
If you think you might be suffering from prolapse or that you might be at risk of developing a prolapse, remember that even though it is a very common problem it is not a problem you should have to live with. The first step is to seek professional help with a womens health physiotherapist or doctor.
For further information some useful links:
- National Continence Helpline 18003366
Michelle has completed specialised training in the area of Women’s Health physiotherapy including the treatment of incontinence and pelvic floor dysfunction. She is passionate about empowering women to take control and keep fit and healthy throughout pregnancy and beyond and finds this area extremely rewarding.