Pelvic organ prolapse is the slipping (from the normal anatomical position) of the pelvic organs (bladder, bowel, rectum or uterus). Women may or may not experience symptoms. Either way having a good pelvic floor physiotherapist by your side if you’ve been diagnosed with prolapse is a great idea. Women’s health physios know lots about the ins and outs of prolapse and can help answer all of your questions, as well as assisting in helping you to manage symptoms, improve your pelvic floor (the support structure to the pelvic organs) and help keep you active.
A prolapse may cause a level of change to sensation sometimes being uncomfortable or even painful within the pelvic region. Symptoms are generally worse in situations when gravity might make the prolapse worse such as after long periods of standing or exercise. It may feel better when lying down or putting your feet up. Moments of straining may also cause symptoms to become more noticeable such as passing a bowel motion, lifting something heavy or having a big cough.
Symptoms vary woman to woman and can include vaginal bulging or something coming down; a feeling of pelvic pressure; a need to splint the perineum (spot between the vagina and anus) to pass a bowel motion; a low backache; and in extreme circumstances when ulceration of the prolapse has occurred bleeding or abnormal vaginal discharge.
So what can you do to manage your prolapse?
See a pelvic floor physio for assessment and treatment of your individual symptoms. They can help you with strengthening your pelvic floor using more than just ‘do your kegels’ to help you improve the support of your pelvic organs by giving you a plan and helping you to stay on track. They might set you up with a biofeedback machine to help you know you’re doing the right thing or if your pelvic floor is weak then you might need some help from a special machine that helps your muscles to start working again. If you’re having other symptoms like bladder or bowel issues your physio will be able to help you with this issue.
Don’t freak out! Lots of women with prolapse live symptom free doing all the things they love including running marathons and picking up their children a hundred times a day. You wont necessarily need surgery. Generally you should always trial at least 3-6 months of physiotherapy prior to considering surgery and even then you would need to be in the right age/stage of your life as it isn’t appropriate for some women.
Stay active! For our health it’s recommended that we reach a minimum of 30 minutes of moderate intensity exercise at least five times per week. That includes women with prolapse too. You might just need your physio to help you adjust your exercise regime until your pelvic floor improves.
(Here is a photo of myself, my sister and my mum and I all exercising together)
Consider being fitted with a vaginal ring pessary. These are soft squishy silicone devices that are basically like a ‘bra for your vagina’ and help to hold the prolapse tissue up. Some women wear them all the time and others just keep them in for exercise.Nobody knows that they’re even there and they are generally easy to insert and remove. No more complicated than a moon cup if you’ve used one of them before.
Finally, look after your bowels. Keep your fibre intake high. If you can’t get enough via your diet (which is often really hard unless you’re eating really really well) consider taking a fibre supplement like psyllium husk daily. Stay hydrated and avoid pushing and straining at stool as this can exacerbate the strain on your pelvic floor and connective tissue. Your physio might be able to assist you with managing your bowls through some basic positioning and advice.
Most women are able to manage their prolapse conservatively (without surgery) and with a skilled team of a women’s health physio, good GP and maybe a gynaecologist you should be able to live very well with your prolapse.