One of the functions of the pelvic floor muscles is to support the organs of the pelvis. When the muscles and fascia that provide this support become weak; organs can descend into the vagina causing numerous symptoms. This is called “pelvic organ prolapse” or “POP.” As women, we have a major role in the procreation process – We have babies! (duh). Well, childbirth, hormones, various predispositions, pelvic obliquity, genetics, surgery, anatomy, scar tissue, trauma, pelvic girdle shape, the list goes on – can all play a part in this condition.
So what happens exactly?
The pelvic organs include the cervix, vagina, uterus, bladder, urethra, intestines, and rectum.
Prolapse can occur if there is weakening of the vaginal walls which can result in bulging of one or more of the pelvic organs into the vagina.
Lets go over the different types of prolapse into the vagina:
1. Uterine Prolapse: The uterus descends into the vagina.
2. Cystocele: The bladder descends into the vagina.
3. Rectocele: The rectum descends into the vagina.
4. Urethrocele: The urethra descends into the vagina.
5. Enterocele: The small intestines descend into the vagina.
(Rectal prolapse is another type of POP, but occurs with rectal wall weakness when part of the rectum descends into or out of the anus.)
What are some common symptoms associated with Pelvic Organ Prolapse (POP)?
· A pressure or heaviness in the vagina. Sometimes can get worse at the end of the day
· Needing to “splint” or push stool out the rectum by placing finger(s) into or around the vagina during bowel movements
· Difficulty starting the flow of urine or a weak stream
· Incomplete emptying or the sensation that you did not empty the bladder completely
· Urinary frequency
· Low back pain
· Urinary and/or bowel fecal incontinence
Pelvic organ prolapse is a very common condition. Lets dive a little deeper…
What are the causes of Pelvic Organ Prolapse?
- Pregnancy puts pressure down on the pelvic floor and can leave the pelvic floor stretched and decrease its ability to perform correctly
- Vaginal deliveries can cause injury and tearing to the pelvic floor muscles leading to weakness and inability to fully contract your muscles correctly
- Although pregnancy and childbirth can contribute to the development of POP, there are women who deliver numerous times and never develop POP, and others who have never been pregnant and can develop these conditions.
- Research has shown that POP is a hereditary condition and sometimes runs in families. Our genes influence the strength of our bones, muscles, and connective tissue. Some women are born with a higher predisposition.
- Some procedures that are done to treat POP are associated with future development of prolapse due to the change in the myofascial attachments and anatomical stability of the pelvis.
4. Pelvic floor injury
- Surgery, pelvic radiation, pelvic fractures, lower back fractures, vaginal delivery.
- Smoking increases your risk of developing POP.
- Obesity. Obese women have a 40-75% increase risk in developing POP.
6. Other Health conditions
- Chronic constipation and chronic straining
- Chronic coughing
- Nerve or muscle diseases that can lead to general pelvic floor weakness
- Heavy lifting and intense repetitive activity such as Cross Fit (more on this later)
Can I prevent Pelvic Organ Prolapse?
Because there are different causes of POP, and it is probably caused by a combination of things – there is no single way to prevent POP from occurring. Currently, there is no way to change any genetic risk factors; however, there are lifestyle choices that you can make in order to decrease the risk.
- Prevent chronic straining during exercising and during bowel movements. (AKA Get a Squatty Potty!!)
- Maintain a healthy weight
- Maintain strength of the hip girdle and pelvic floor
- This advice comes with a caveat: Pelvic floor contractions/squeezing/kegels are not for everyone. Some people have restricted pelvic floors or pelvic pain that can be made worse with kegel exercises. Ask your gynecologist or contact a Pelvic Floor PT to see if kegels are right for you.
What are the treatment options for Pelvic Organ Prolapse?
1. Conservative Treatment:
- Pelvic Floor Physical Therapy
- A pelvic floor PT can assess the strength of your pelvic floor muscles and abdominal muscles. Lifestyle changes and education are very important in order to avoid activities that may make the prolapse worse. PT can also help you with learning how to properly lift, and give an individualized pelvic girdle stabilization exercise regimen in order to further support the pelvic organs. Options on conservative treatment and surgery can be discussed, as well as, recommendations on urogynecologists to seek care.
- A plastic device that is placed inside the vagina to help support the organs and vaginal wall. Gynecologists and urogynecologist fit patients for this device. It is a good option for conservative treatment.
2. Surgical intervention:
- Remember that the severity of the prolapse, age, activity levels, and sexual activity are all considerations for which type of surgical approach may be used.
- It is often suggested that conservative treatment take place first and if symptoms still persists then a surgical consult may be in order.
- Pelvic floor PT can help you to learn ways to keep your hip girdle stabilized and to keep pressure off the pelvic floor after surgical intervention.