The video below shows the pelvic organs - the bladder, the uterus and the rectum. They sit within the pelvis above the pelvic floor muscles.
If the fascia and/or muscles of the pelvic floor tear, stretch or weaken, the pelvic organs may lose their support and begin dropping down into the vagina. Pelvic organ prolapse is when one or more of the pelvic organs drops from their normal position into the vagina, causing a budge in the vaginal wall, or the organ to drop outside of the vagina as demonstrated in the video below.
We know activities that produce a downward pressure on the pelvic floor can increase your risk of developing a prolapse…and research now shows the one of the biggest risk factors again is genetics. If your mum, older sister, Granny or Auntie had has issues then you’re at risk too. But women without these risk factors can develop POP too. Some other risk factors include:
Number of pregnancies - even women who have had c-sections may develop prolapse
Forceps delivery
History of chronic respiratory conditions
Constipation and straining to poo
Regular heavy lifting at home, work or the gym
High Impact sport (this does not appear to increase risk of POP, but may flag show up those who are at risk)
Peri-post menopause - due to hormonal changes and changes in vaginal tissue
Previous Gynae surgery - hysterectomy, previous prolapse repairs
Sign and symptoms of pelvic organ prolapse include:
A feeling of pressure or fullness in the pelvic area
Low back ache
Pain or discomfort during intercourse
Feeling or seeing a bulge in the vagina, or feeling that something is falling out
Feeling like there is a tampon stuck in the vagina
Urinary incontinence, and difficulty emptying the bladder and bowel
Spotting or bleeding from the vagina
The evidence around POP is always updating and changing. I have always wondered if physio’s over diagnose POP and tell women who have some movement of the walls of the vagina they have a prolapse but in fact it is just normal for them. Many women have movement of the vaginal walls/organs to within 1 cm of the opening of the vagina and have no symptoms - this is normal for them and is ok! The advanced assessment techniques I use are to get a baseline of what your pelvic organs, pelvic floor and vagina look like now and to assess your risk of POP moving further down or developing symptoms (or symptoms getting worse if you have them). Every patients treatment plan is different - there is really no one size fits all in prolpase management.
Many many women have become so fearful of moving and exercising and constantly working on pelvic floor contractions in fear of developing POP or theirs getting worse. The reality is POP happens slllllooooooowwwwwllllyyyyy, like over a period of 5-10 years. You don’t suddenly wake up one day with your bladder falling down. The descent of the organs (if they even descend at all) takes time, and for most women their POP does not descend further in their lifetime. What can happen is it becomes bothersome and they start to experience symptoms. A common myth is menopause causes POP - not true. During menopause, oestrogen drastically decreases in the body, leaving the vagina feeling dryer and the skin a bit thinner. Women usually become more aware of their prolapse and that’s when they decide to seek help.
If you have a prolapse, or think you may have one, don’t panic. Book in for an assessment and lets see what is going on with your body. Every body’s body is so different and getting a plan in place is key to reducing symptoms. Having a pelvic floor that is strong and co-ordinates with breathing and the strain placed down on it can have a significant effect of a prolapse. Improving your posture and breathing pattern, ensuring good movement patterns (eg. running technique, lifting technique) with the core, pelvic floor (contraction AND relaxation) and breathing working together can help to manage and even reduce symptoms. Vaginal support pessaries are an amazing conservative treatment - read more about them here.
The option of “watch and wait” is also valid. Many women chose to manage their symtpoms - empty the bladder and bowels, use the pelvic floor to support during heavy lifting etc. Surgery is also an option - there seems to be a misconecption that physio’s are against surgery - we are defintiely not. Surgery comes with it’s own risks and sucess rates can vary widely. For some women, surgery cures them, and for others they require several surgeries; it really does depend on so many variables and the advanced assessment techniques I use, plus a good patient history help me give you individual advice on what surgical outcomes you could expect. I work with some amazing Gynecologists to help women decide if surgery is the best option for them and allow women to make an informed decision with realistic outcomes.
Just make the appointment…it’s worth it!