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Prolapse: My Organs are Dropping- What Now?

Pelvic Organ ProlapseWhat is it?

Pelvic organ prolapse is a common condition that occurs most often in women following childbirth or menopause. The muscles inside the pelvis become weakened and lack the endurance or strength to support the body’s internal organs. This can result in a descent of the bladder, uterus, rectum, or even the vagina itself into the vaginal canal. The degree to which the pelvic structures descend can vary greatly. Some women with pelvic organ prolapse may have no signs at all and be completely unaware of their condition, while other women may have a larger grade of loss of support to their pelvic organs and develop more significant symptoms.

How might you know if you have a prolapse?

Some symptoms of pelvic organ prolapse include:

  • Sensation of a bulge/protrusion- feeling like something is coming out of the vaginal canal
  • Pressure and/or heaviness in the vagina
  • Urinary leakage, frequency, or urgency
  • Weak urinary stream, hesitancy with urination, incomplete bladder emptying
  • Painful sexual intercourse
  • Feeling of incomplete bowel emptying
  • Fecal incontinence or leakage
  • Low backache
  • Vaginal bleeding or discharge

What are the risk factors for pelvic organ prolapse?

While women who have been pregnant or given birth vaginally are the most at risk, especially in cases where the mother has given birth to a large baby or experienced prolonged pushing during labor, there are many other causes of pelvic organ prolapse.  Some are work or lifestyle related, such as heavy and frequent lifting.  Others stem from other medical symptoms such as chronic coughing, chronic constipation and/or straining with bowel movements, connective tissue disorders, prior pelvic surgery, or obesity.  Pelvic organ prolapse may also occur as a result of a genetic predisposition or from increasing age.

How can physical therapy help?

A healthy pelvic floor is vital in preventing pelvic organ prolapse, inhibiting further descent of organs that have already begun to fall, decreasing symptoms of pelvic organ prolapse, and as an effective conservative measure to avoid or delay surgery. A study performed by the American College of Obstetricians and Gynecologists in 2007ⁱ found that women with prolapse were found to have defects in the pelvic floor muscles, specifically the levator ani, and were found to produce less power in closing of the vagina with muscular contractions. Pelvic floor physical therapy will directly assess the strength and endurance of pelvic floor and core muscles, look for trigger points within the muscles themselves, help restore shortened muscles of the pelvic floor to their optimal length, and improve awareness of control of pelvic floor muscles with daily activities.

Pelvic floor physical therapy treatment of pelvic organ prolapse includes:

  • strengthening the pelvic floor and core muscles
  • biofeedback to help with improved awareness in using the muscles correctly and effectively
  • education in how to protect from further descent of pelvic organs
  • education in activities to avoid or modify

Women with symptoms of prolapse or who are at risk for pelvic organ prolapse should seek a consultation with a licensed pelvic floor physical therapist to have the best results in long-term pelvic health, function, prevention and management of pelvic organ prolapse.

How Can I Get Started?

Here is one exercise to begin:

Exercise for to help prolapsed organsLie flat on the back with feet propped up and supported on a wall. Place a pillow beneath the pelvis so that the hips are slightly elevated. This will put your pelvic floor in a gravity-reduced position to improve the ease of contractions and encourage an upward movement of the pelvic organs. Next try a pelvic floor contraction by exhaling and drawing the pelvic floor in and upward.  Hold this contraction for 5 seconds and then fully release, allowing the muscles to rest for 5-10 seconds. Repeat 10-20 times.

 

 

 

 

For more information, please go to: http://www.pelvicorganprolapsesupport.org

ⁱDeLancey JOL, Morgan DM, Fenner DE, et al. Comparison of Levator Ani Muscle Defects and Function in Women With and Without Pelvic Organ Prolapse. Obstetrics & Gynecology. 2007; 109: 295-302.

Leaking affects One-third of Female Athletes

images[4]Thirty three percent (33%) of elite female athletes leak urine during training/competition. These girls/women typically do not tell anyone (coaches, parents, teammates) because they feel embarrassment and shame. They try to manage their leaking issues on their own by wearing pads, make frequent bathroom trips and even restrict fluid intake which does not address the cause of leaking. Pelvic physical therapy helps female athletes overcome leaking within 1-2 months of treatment so the athlete can focus on achieving their best performance.

Elite female athletes are typically between the ages of 15 and 39 years, train a minimum of 8 hours per week for their sport and qualify for aimages[9] high-level or national team.

Sports that involve jumping, high impact landings and running were the activities most likely to provoke urine loss.  Many of these athletes reported that leaking issues interfered with their mental focus to achieve top performance in their sport. The following are results from a number of studies regarding elite athletes and leaking:

95% of Female athletes who had an involuntary loss of urine experienced this during training and 50% experienced this during competition.

28 to 35% of high school and collegiate female athletes report incidents of leaking

88% of young trampolinists in one study had an incident or more of urine loss during their jumping activities.

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Uncontrolled loss of urine, from a few drops to more, is called Stress Urinary Incontinence(SUI).

SUI is defined as the involuntary loss of urine during activities such as exercise, coughing, laughing or sneezing. Leaking occurs because the force from the abdominal region during laughing or lifting overcomes the strength of the pelvic floor muscles which surrounds the urethra to prevent leaking. The urethra is the hose-like structure that runs from the bladder. The pelvic floor muscles lie at the bottom of the pelvis surrounding the urethra keeping the urethra closed during activities. The pelvic floor muscles relax allowing the flow of urine when voiding.  If they are weak or uncoordinated, the pelvic floor muscles need to be retrained to be more functional and keep the athlete dry during sport.

Female athletes should be educated about leaking issues so they don’t feel shame and can seek help. Some questions to ask female athlete are:

Do you accidentally leak during training or competition?

Do you wear protective pads during training or sports matches?

Do you make frequent trips to the bathroom or go “just in case”?

Do you restrict your water/fluid intake for fear of leaking?

With the expert assessment and guidance by a pelvic physical therapist, female athletes learn that accidental leakage is mainly due to pelvic floor muscle dysfunction. They will learn self help techniques and exercises to retrain their pelvic floor muscles to attain full continence during their sport.