Learn Everything About Pelvic Organ Prolapse

If you have pelvic organ prolapse, you are not ALONE!

What is Pelvic organ Prolapse?

Pelvic organ prolapse occurs when pelvic organs such as the bladder, bowel, uterus, or cervix protrude into the vaginal canal from their normal position. It can cause various signs/symptoms and bowel, bladder, or pelvic symptoms.

Women may not talk about these symptoms or they may not know that pelvic organ prolapse can be treated.

Is pelvic organ prolapse common?

Yes, pelvic organ prolapse is very common. 30-60% of women may have a certain degree of pelvic organ prolapse.

What are the symptoms of pelvic organ prolapse?

Prolapse can be asymptomatic or symptomatic. Symptoms may not be directly correlated to the extent of prolapse. Someone with a mild degree of prolapse may have more signs and symptoms and vice versa.

• Symptoms can vary from person to person.

• Symptoms can vary depending on the position (standing v/s sitting), physical activity (walking v/s lying down), or time of the day (evening v/s afternoon).

1. Heaviness in the vagina or pelvic area

2. Pressure or fullness in the vagina or perineal area

3. A bulge or something coming down or out of the vaginal canal

4. Discomfort in the vagina

5. Difficulty with bladder function such as incomplete emptying and urinary incontinence

6. Difficulty with bowel functions such as elimination of feces

7. Problems with inserting a tampon or keeping it well supported or tampon falling out

8. Low back, abdominal or vaginal pain

9. Discomfort or pain with penetration or sexual intercourse

What are the causes of pelvic organ prolapse?

Let us discuss why pelvic organ prolapse happens:

1. Lack of support from the connective tissue supporting pelvic organs (such as changes in the tissues due to hormones during pregnancy, perimenopause, and menopause)

2. Stretching of pelvic structures during vaginal childbirth

3. Use of forceps during vaginal delivery

4. Levator ani avulsion

5. Inadequate support from the pelvic floor muscles (weakness or non-optimal muscle recruitment)

6. Lack of timing and coordination of pelvic floor muscle contraction with other muscles

7. Increased pressure from above on the pelvic organs due to various factors such as chronic straining due to constipation and childbirth

8. Heavy lifting (non-optimal strategies) can cause downward pressure on the organs in the presence of inadequate support from the tissues below

What are the types of Pelvic Organ Prolapse (POP)?

• Cystocele- prolapse of the bladder

• Rectocele- prolapse of the rectum

• Urethrocele- prolapse of the urethra

• Uterine prolapse- prolapse of the uterus

• Vaginal vault prolapse- prolapse of the top of the vagina into or out of the canal (can occur in women after hysterectomy)

• Enterocele- prolapse of the small intestine

What is the treatment for pelvic organ prolapse?

Conservative management approaches such as pelvic floor physiotherapy, lifestyle modifications, and mechanical support (pessaries) can be very beneficial for pelvic organ prolapse. Surgery may be needed in some cases.

Tips to relieve the pelvic organ prolapse symptoms

1. Lying on back with legs up on a chair (add a pillow under hips to elevate hips)

2. Decrease straining associated with constipation by working on diet and trying to use a step stool under your feet to elevate knees higher than hips (Refer to toileting posture)

3. Manage Intra-abdominal pressure by breathing out during the exertional phase of activity. Breathing out can help to reduce intra-abdominal pressure (one of the strategies that may work for some people)

4. Modify the activities that increase the symptoms

5. Rest in intervals to manage the symptoms

6. An individualized pelvic physiotherapy assessment and treatment to address the causes.

The above tips may help women to manage the symptoms temporarily. Pelvic physiotherapy is a specialized division of physiotherapy that can help to address the condition and provide individualized support.

KEGELS ARE NOT ALWAYS INDICATED IN PELVIC ORGAN PROLAPSE.

SEE A PELVIC FLOOR PHYSIOTHERAPIST IF YOU CAN.

FAQs

I am answering common questions regarding pelvic organ prolapse:

Is pelvic organ prolapse dangerous?

Pelvic organ prolapse is not life-threatening. It can be asymptomatic or symptomatic. Most cases respond well to pelvic physiotherapy treatments.

How do I check if I have pelvic organ prolapse?

It is best to see a medical health care provider or pelvic floor physiotherapist for the assessment. You can screen yourself for these symptoms.

Can pelvic organ prolapse (POP) be fixed or reversed?

Yes, in most cases, POP can be treated with pelvic floor physiotherapy. Some cases may require surgery. It is suggested to try pelvic floor physiotherapy before choosing surgical options if applicable. You can discuss your options for physiotherapy, pessary, or surgery with your healthcare provider.

Can you prevent pelvic organ prolapse (POP)?

You can learn a lot of strategies to manage intra-abdominal pressure, learn optimal core activation strategies and avoid straining. These strategies can help to prevent the worsening of your symptoms. POP can be unavoidable at times during childbirth. However, the postpartum period can be a good time to check for your pelvic floor health by consulting a pelvic floor physiotherapist.

Can pelvic organ prolapse go away on its own?

Some women may have a mild degree of prolapse that can go away on its own in a few months or years. You can always learn optimal strategies to manage and prevent the worsening of prolapse with pelvic physiotherapy.

If you have any questions regarding pelvic organ prolapse, feel free to contact me.

Roopdeep Kaur,PT, FRCms, MSc. PT, BPT

Registered Physiotherapist

Ortho & Pelvic Physiotherapist