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:
Lie 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.