Imagine this, you have been to your doctor because you are experiencing symptoms in your pelvis. They complete a pelvic exam (hopefully) and tell you that you have a prolapse. For some, this might be the end of the discussion, others might be directed to a Women’s Health Physiotherapist or advised to do Kegels. But what does this mean and what options do you have after diagnosis?

What is a prolapse?

A prolapse is the descent of one or more of the pelvic organs (bladder, uterus, rectum, or vault) into the walls of the vagina. This is typically due to damage of the supportive structures of these organs, ligaments, or muscles of the pelvis. There are different types of prolapse depending on which organ has slipped out of place.

The symptoms of prolapse vary from person to person and they also don’t indicate the severity of the prolapse. These symptoms can also be cyclic! You might find with your monthly hormone fluctuations that you only notice your prolapse at certain times, or it worsens around a certain stage of your cycle. Some people may also have a prolapse and not show any symptoms at all.

Symptoms you might experience include:

  • Pressure or heaviness in the vagina
  • Bulge in or at the vagina
  • Painful vaginal penetration with intercourse or tampon
  • Decreased bladder/ bowel control
  • UTI’s
  • Weak urine stream
  • Constipation
  • Lower back pain

Why me?!

It is thought that prolapse affects 50% of the female population (with about 1 in 3 women experiencing a stage 2 or 3 prolapse).

Risk factors that might increase your risk of prolapse include:

  • pregnancy
  • childbirth (especially if forceps are used)
  • aging and menopause
  • obesity
  • chronic cough
  • chronic constipation
  • connective tissue disorders
  • heavy lifting
  • following a hysterectomy and other pelvic surgeries

Anything that causes increased pressure in your pelvic cavity can put a woman at risk of prolapse whether or not she has had any children.

Now what can I do?

There are a variety of treatment options that can help with managing prolapse.

Lifestyle modifications: weight loss (it has been shown that a 10% decrease in weight can improve prolapse symptoms), ceasing smoking, constipation management, decrease heavy lifting/ improve heavy lifting ergonomics, managing chronic coughing and participating in low impact exercise. All of these factors help reduce a chronic increase in intra-abdominal pressure and basically aim to take a load off of the prolapse.

Pelvic floor muscle training: Normally our pelvic organs are supported by both the pelvic muscles and fascia. If our fascia becomes stretched there is nothing we can do to “de-stretch” it. But we can increase the strength of our pelvic floor to support our organs. It is important to have a thorough assessment of your pelvic floor completed (internal vaginal assessments are the gold standard) by a trained Women’s Health Physiotherapist. This assessment allows us to check your ability to contract and relax the superficial and deep pelvic floor muscles, the endurance of the muscles and also the coordination. There are many different options for treatment depending on your symptoms and your assessment findings. We might suggest use of electrical stimulation to help increase the muscle activation or even vaginal weights.

Vaginal Pessary: If required to get back to certain activities or to help support your organs (alongside muscle training) your Women’e Health Physiotherapist might suggest a pessary. There are various types of pessaries depending on the type of prolapse you have. It is best to discuss these options with your physio as some are easily inserted and removed by the patient and some require more intensive care.

Topical Oestrogen: As we age (especially after menopause) our risk of prolapse increases. This is because of a decrease in our body’s natural ability to produce oestrogen. Therefore, if deemed appropriate your doctor may prescribe you some topical oestrogen to help with your prolapse management.

Surgery: Some patients do require surgery to manage their symptoms. Typically, it is recommended to exhaust the conservative management options prior to surgery, but this decision will ultimately be made between you and your health care team.

A diagnosis of prolapse is not the end! There are many options that you and your medical team can try to improve your quality of life again. If you relate to any of the above information or want to know more about your own pelvic health, please contact the team at Female Physio Co. for an appointment with a Women’s Health Physiotherapist.

Kaitlyn Steinhardt
BExSc, MPhty (Women’s Health Physiotherapist)

Disclaimer: This is general advice only, ensure you always seek individualised advice from your obstetric care provider first.

References

Pelvic Organ Prolapse | Continence Foundation of Australia. Continence Foundation of Australia. (2022). Retrieved 24 August 2022, from https://www.continence.org.au/who-it-affects/women/prolapse#signsandsymptomswilldependonthetypeandlevelofprolapse

Treatment options for Pelvic Organ Prolapse. Australian Commission on Safety and Quality in Health Care (2018) Retrieved 24 August 2022 from https://www.safetyandquality.gov.au/publications-and-resources/resource-library/treatment-options-pelvic-organ-prolapse-pop