Pelvic organ prolapse is more common than women think, 1 in 2 women who have had a vaginal birth will have a prolapse however other known causes are due to pregnancy itself, chronic straining (asthma or constipation) genetics, pelvic surgery or obesity. The most commonly reported symptom is the feeling of something coming down or pressure at the vagina entrance (Think of the feeling when a tampon’s not properly in, hands up we have all done that!). It can be very terrifying for a woman to feel the symptoms for the first time, the thought of your insides down around your ankles (this physically cannot happen… Phew) but do not fear there are many things you can do to improve or resolve prolapse symptoms that don’t involve surgery.
What is a prolapse?
The pelvic organs (bladder, uterus and bowel) are supported by the pelvic floor muscles, fascia (connective tissue) and ligaments. Fasica and ligaments are like elastic bands that wrap around the pelvic organs and attach to the bony pelvis to keep them in place, supported by the pelvic floor muscles below. However the fasica can stretch with certain activities (e.g. pregnancy, vaginal births, chronic straining) which increases the movement of the fascia/vaginal walls, this alone (or add in poor support from the pelvic floor muscles, stretching the facsia further) can lead to the descent of the bladder (anterior wall prolapse), uterus (uterine prolapse) or bowel (posterior wall prolapse) giving bothersome symptoms.
How do I know if I have one?
The symptoms often depend on the type of prolapse, but these are the more commonly reported symptoms:
- Lump / bulge or dragging sensation in the vagina
- Leaking urine with coughing, sneezing or high impact exercise
- Urge urinary incontinence
- Constipation or difficultly emptying your bowels
- Low back or lower abdominal pain
- Difficulty passing urine, slow flow, hesitancy or increased urinary frequency
- Pain with intercourse
Not everyone has symptoms so the easiest way to know is to get assessed by a Women’s Health Physiotherapist or G.P. Pregnancy and vaginal births are the biggest risk factors to developing a prolapse therefore I highly recommend a vaginal assessment if you’re getting back into exercise postnatally (who isn’t hopefully). Woman are often not aware they need to allow time for healing, muscle strengthening or to gradual build back up to previous exercise postnatally until it’s too late, and symptoms arise.
How can I improve my symptoms?
Treatment will vary depending on individual factors therefore seeing a women’s health physiotherapist or gynaecologist is important to have a comphrensive assessment, Dr google isn’t the most reliable!
A pelvic floor muscle strengthening program has been shown reduce prolapse and symptoms. Like any other muscle in the body it can take 3-6 months to feel the effects, research recommends a supervised progressive program by a physiotherapist to achieve this. Doing a squeeze here and there simply isn’t enough, these muscles need to hit fatigue to grow.
Weight loss, appropriate exercise and avoiding constipation are other modifications that can make a huge difference to your symptoms and quality of life. A women’s health physiotherapist can help you with all of the above.
A pessary is an intravaginal silicone device to support the pelvic organs (the support bra for the vagina). It can be hugely successful in reducing or resolving prolapse symptoms, some women wear it daily others use only when exercising. Adding a pessary to a pelvic floor strengthening program has been shown to add further benefits. Yay! I highly suggest this option is discussed with your women’s health physiotherapist or G.P prior surgery.