Pelvic organ prolapse.
What is it & what does it mean for your health?
If I had a nickel for every patient that came into clinic, fearful and frantic because of a prolapse…
But I get it. It is a scary concept that an organ might be falling out of your body. If you are in the fearful/frantic boat… hopefully this post helps ease your mind and gives you an action plan.
What is prolapse?
Pelvic organ prolapse simply means that one of your pelvic organs (bladder, uterus/cervix, rectum) is falling into the space of your vaginal canal. If you want a visual, check out this insta reel that I made. It might help you conceptualize it easier!
Because you have multiple pelvic organs, there are multiple types of pelvic organ prolapse. Sometimes the type of prolapse you have corresponds with the symptoms present (ex, someone with bladder prolapse might have urinary leakage).
-Uterine/cervical prolapse
-Bladder prolapse (cystocele)
-Rectal prolapse (rectocele)
-Vaginal prolapse (vaginal vault)
-Urethral prolapse (urethrocele)
-Small bowel prolapse into top of vagina (enterocele)
-Anal prolapse
(psst. the last three are pretty uncommon; the first three are the most common types).
Okay, so why does this happen?
There are a few reasons… most of the time it’s a combination of these that actually cause prolapse.
1. Pelvic floor insufficiency. One of the main functions of the pelvic floor is to support your pelvic organs. If your pelvic floor isn’t working perfectly, it might make a prolapse feel/be more drastic.
2. Connective tissue insufficiency. If the tissue that “holds up” your pelvic organ is not supporting it well, it could cause the organ to prolapse down. This can be a result from childbirth, aging, improper mechanics, and some systemic conditions.
3. Vaginal wall weakness. Your vaginal tissue lines the tube of your vagina and provides structural support to the surrounding anatomy! If your vaginal tissue is dry or weakened from things like: recent childbirth, aging, hormonal changes, lactation, it might contribute to prolapse.
4. Poor breathing/pressure mechanics. Sounds kind of crazy, but poor lifting techniques (say… a 35 lb child that you are lifting constantly) might contribute to or even cause prolapse. This absolutely doesn’t mean you should stop lifting your child, but it is very helpful to assess your lifting and breathing mechanics!
How do I know if I have prolapse?
This is a little tricky because actually, lots of people have pelvic organ prolapse but don’t have symptoms associated with it. In these cases, you might never know you have one… and as long as you’re happy and able to do what you want without symptoms- it’s not a big deal!
If you do have symptoms, you might be cued into prolapse with the following:
-Feelings of vaginal or perineal heaviness
-Seeing or feeling a bulge or “bubble” in vagina.
-Dull/achey/dragging discomfort in vagina or perineum
-Urinary leakage with activity (running, walking, coughing, sneezing)
-Difficulty starting urine stream or completely emptying bladder
-Gas or stool incontinence
-Discomfort during penetrative intercourse
-Dull low back, hip, or sacrum pain
In situations where prolapse is present, it’s common for any symptoms to get worse when standing for long periods of time or being on your feet for for long hours.
What can I do about it?
Pelvic floor physical therapy should absolutely be the first line of defense when it comes to prolapse. Why? Because we can do a lot to help your body, core, and pelvic floor support your pelvic organs better… it’s not just kegels that help prolapse, and in fact, sometimes kegels are the last thing you want to do (just depends on the situation). When I am assessing and treating prolapse, I look at your posture, functional movements (lifting, bending, walking, etc), the way your pelvic floor and core are supporting you, your lifestyle, and much more.
There are also other great conservative (i.e. low-intervention) methods to help with prolapse, depending on how your respond to PT interventions. There are little devices called “pessaries” that can help elevate and support your organ. There might be hormonal factors to prolapse that can be fixed with supplements. Sometimes certain injectables can be helpful in certain forms of prolapse.
Surgery should be the absolute last line of defense and only considered if conservative measures fail. Unfortunately, lots of people are referred to surgery as the first option for treatment when they might not actually need it. So if you’ve been referred to surgery for prolapse and haven’t yet been to a pelvic PT… cancel your surgery! It might sound dramatic, but I’ve treated many women who have had surgery that probably didn’t need it! Also, it’s poor medical practice to refer someone to surgery without trying conservative measures first.
Cheers, to learning about our bodies and being empowered by it!
Sam