The video above shows the pelvic organs - the bladder, the uterus and the rectum. The sit within the pelvis above the pelvic floor.
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 or older sister had has issues then you are at risk too. Women with a higher BMI are also more at risk. But women without these risk factors can develop POP too. Some other risk factors include:
Anyone who has given birth
Having a history of chronic respiratory conditions or constipation
Regular heavy lifting at home, work or the gym
High Impact sport (this does not appear to increase risk of POP, but may show up those who are at risk)
Before, during or after menopause
Previous Gynae surgery
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). If a women had risk factors for her prolapse getting worse over time, I often suggest I do a yearly WOF to check how things are looking.
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 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 get 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.