Pelvic Organ Prolapse

By
By Lakeview Physio
Gayle Hulme
,
BScPT, Acupuncture, Certified Gunn IMS, Pelvic Health Physiotherapist
on
Pelvic Health
March 3, 2016

So, you’re 35, 45, or 55 – and not anywhere near a nursing home? I caution you that if you don’t deal with fixing the prolapse now, you may find that the prolapse is causing major issues with your life-style, sexual, urinary and bowel function, as well as self-image. It’s never too late to make it right!

Help… I think my vagina is falling!

It is likely that most of us females have never given much thought about the integrity of our vaginas.  However, as a pelvic health physiotherapist, this is one of the main concerns that women have when they come into my office.

What I am talking about is pelvic organ prolapse (POP).  This can be seen in a variety of forms:

  • Anterior vaginal wall prolapse (also known as “bladder prolapse” or “cystocele”)
  • Posterior vaginal wall prolapse (also known as “rectocele”)
  • Uterine prolapse
  • Small intestine prolapse (also known as “enterocele”)
  • Vaginal vault prolapse (sometimes seen after the uterus has been surgically removed)

Symptoms of POP are wide-ranging:

  • Seeing tissues coming out of vagina
  • Problems having intercourse or inserting tampons
  • Feeling heaviness or pressure in vagina or rectum that may worsen with coughing, lifting, standing or as the day progresses
  • Low back pain or lower abdomen/pelvic pain/pressure
  • Urinary incontinence
  • Problems having a bowel movement

Some women may have no symptoms at all.

Anterior Vaginal Wall Prolapse

What causes POP?

Most people would consider vaginal childbirth as the only risk factor for pelvic organ prolapse.  However, I have seen many patients who have had a cesarean section, or who have never been pregnant, exhibit signs and symptoms of pelvic organ prolapse.  Other such risk factors include:

  • Chronic constipation
  • Persistent, long-standing cough
  • Certain types of connective tissue disorders
  • Genetics – did your mom or other female family member have a prolapse?
  • Repetitive high impact activities that increase intra-abdominal pressure
  • Obesity

What treatments are there?

Depending on the severity of the prolapse there are a number of treatment options.  Yes, surgery is one option but that is typically for significant prolapses.  The good news is there are a number of different surgical methods that are not always complex or invasive.  Pessaries, which are medical devices fit to support the vaginal tissues are also good options for a lot of women.

There is of course Pelvic Health Physiotherapy!

The pelvic health physiotherapist will assess your external and internal parts.  That is, expect the physical exam to include your postural alignment, mobility of your spine, and control of your muscles as well as an internal vaginal and rectal exam.  Internal examination is the gold standard to evaluate the severity of prolapse along with the health of the tissues and muscles on the inside of your pelvis.  Don’t worry, this may sound a little uncomfortable but as health professionals, we are well-trained in doing these exams.  And they need to happen: there is no way to determine what type of prolapse you have if we don’t look.

Treatments during physiotherapy can include:

  • Teaching proper body alignment and mechanics
  • Manual movement of spinal and pelvic joints
  • Retraining pelvic floor muscle control (note that I did not say strength!  Often we look at balancing over-used, tight pelvic floor muscles on their ability to contract AND relax)
  • Looking at exercises that reduce intra-abdominal pressure, which includes Low Pressure Fitness/Hypopressive training
  • Therapeutic taping such as gynecological K-tape techniques
  • Acupuncture and Intramuscular Stimulation (IMS)

Learn more about pelvic health physiotherapy.

What if I have a prolapse but I don’t want to do anything about it right now?

In my early years as a physiotherapist, I gained valuable experience working in both hospital and long-term care settings.  I learned that urinary incontinence due to pelvic organ prolapse was a major reason for female patients to be admitted.  Sometimes it was because their leakage was the cause for a slip and fall and they were admitted for a broken bone.   Other times they were admitted because of recurrent bladder infections which can contribute to mental confusion as well as pelvic pain.  Or, their prolapse was causing skin break down between their thighs and perineum and they needed wound care.  What a shame to have such a cascade of events for a very preventable – and treatable – problem.

So, you’re 35, 45, or 55 – and not anywhere near a nursing home?  I caution you that if you don’t deal with fixing the prolapse now, you may find that the prolapse is causing major issues with your life-style, sexual, urinary and bowel function, as well as self-image.  It’s never too late to make it right!

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