Pelvic Organ Prolapse

 
 
 

Pelvic Organ prolapse

By Jacinta Meharry

1 in 2 women that have had a vaginal delivery experience prolapse at some point in their lives.

(Continence Foundation of Australia, 2021)

So, what is prolapse and how do I know if I have one?

Let’s start by explaining the pelvic anatomy. 

Pelvic Anatomy

The bladder, bowel and uterus make up your pelvic organs which are suspended high in the pelvis by several strong ligaments. Underneath these lay your pelvic floor, a group of hammock shaped muscles providing support to the pelvic organs and facilitating closure of each passage (urethra, vagina and anus).  

 

A pelvic organ prolapse or ‘POP’ is where one of more of these pelvic organs sits lower in the pelvis creating a bulging sensation at the vagina. This usually occurs due to lengthening of the pelvic ligaments and/or weakness of the pelvic floor muscles.

Common Symptoms

  • Bulging or dragging sensation in the vagina &/or back passage 

  • Low back & abdominal discomfort 

  • Changes in bladder and bowel habits e.g. difficulty emptying bladder/bowel easily  

  • Symptoms are typically worse in positions where gravity may take effect (e.g. standing) and better in positions across gravity (e.g. lying)  

    POP can sometimes have no symptoms and may only be discovered during a pelvic exam 

 
 

Types of Pelvic Organ Prolapse

Anterior (front) vaginal wall prolapse: urethra and/or bladder descends

Posterior (back) vaginal wall prolapse: rectum and/or small bowel descends

Uterine prolapse: cervix/uterus descends

Vaginal vault prolapse: for women who have had a hysterectomy the top of the vaginal or the vaginal ‘cuff’ descends

 

Diagnosis

Following a detailed medical history, POP can be diagnosed via an internal pelvic examination with a pelvic floor physio, GP or gynaecologist.  

It is worth noting that all women have a degree of normal anatomical movement. Because of these normal variations, the International Urogynaecology Association (IUGA) and International Continence Society (ICS) state a women must be experiencing symptoms of POP in order to be diagnosed with POP.  

 If you think you might be experiencing POP, we recommend an appointment with one of our experienced pelvic floor physiotherapists to complete a full assessment and provide you with a plan in line with your individual treatment preferences and goals. Alternatively we recommend seeing a Women’s Health GP or Gynaecologist.  

Risk Factors to Pelvic Organ Prolapse Include:

Vaginal delivery

Multiple pregnancies and vaginal deliveries

Difficult delivery

Chronic constipation and straining

Repetitive heavy lifting

Pelvic floor dysfunction

Abdominal separation and/or poor core strength

Hysterectomy

Menopause

Exercise rehabilitation

If you are experiencing Pelvic Organ Prolapse (POP) symptoms it is important that your exercise regime is complimenting your pelvic rehab and not making your POP symptoms worse.

At TPS we can guide you on how to optimise your exercise regime to improve your POP symptoms. Our 1:1 and 4:1 small group sessions are a great way to progressively and safely strengthen your body. These sessions are run by our experienced physiotherapists in a safe tranquil environment. Our programs are individualised and tailored to your goals.

More information about our exercise rehabilitation services can be found here.

Treatment Options

There is the high level of evidence for the effectiveness of pelvic physiotherapy in the management of prolapse. Research shows that pelvic floor rehabilitation can both improve symptoms and may reduce the severity of your prolapse. In other words, pelvic floor rehabilitation may help to lift your organs so that they sit higher in the pelvis, reducing the degree of bulge seen in the vagina.

At The Pelvic Studio it is important to know that we manage your pelvic floor dysfunction holistically. Your rehabilitation will not only involve pelvic floor exercises, but we also assess and optimise: your posture, the way you move/lift, the strength of your muscles above & below your pelvic floor (such as your core and glute strength, hip and ankle stability), and your bladder & bowel habits.

The following can also be effective management strategies for POP:

  • Activity modification: minimising things that increase intraabdominal pressure e.g. heavy lifting, constipation, excess weight 

  • Exercise modification: as a general rule begin with low impact exercises such as cycling, swimming, Pilates and avoid high impact exercise such as running/HIT

  •  Hormone replacement: your GP may prescribe hormone replacement therapy to optimise pelvic floor and vaginal wall support  

  • Vaginal Pessary

  • Surgery: in more severe cases surgery may be indicated 

 

In some cases a vaginal pessary may be used as an adjunct to your management.

A pessary is a small silicone device that is inserted vaginally acting like a support bra for your pelvic organs and vaginal walls. These can be fitted by a pelvic floor physio, gynaecologist or GP who is specifically trained in this area.

What else can I do to help?

Brace your pelvic floor muscles when you cough, sneeze, laugh or lift.

Minimise lifting/pushing/pulling until you are strong enough

Avoid prolonged standing

Rest in lying down (this allows your pelvic floor muscles to rest) a few times a day

Low impact exercise

Use vaginal lubricant if sexual intercourse is uncomfortable

Optimise and maintain healthy bowel habits

To discuss the management of your pelvic organ prolapse, or any other pelvic health concerns, book with one of our expert physiotherapists here

If you have any questions, feel free to email the clinic at info@thepelvicstudio.com

 

References: 

Donna Sarna Physiotherapy and Rehabilitation. 2022. Pelvic Organ Prolapse. [online] Available at: <https://dsphysio.com/womens-health/pelvic-organ-prolapse/> [Accessed 1 June 2022].

Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010 Jan;21(1):5-26. doi: 10.1007/s00192-009-0976-9. Epub 2009 Nov 25. PMID: 19937315 

Jean Hailes (2022) Prolapse. Retrieved 29th May 20220 from https://www.jeanhailes.org.au/health-a-z/bladder-bowel/prolapse-bladder-weakness 

Pelvic HealthJaclyn ThurleyThe Pelvic StudioPelvic Health, Pelvic Physio, Postnatal, Post baby exercise, Return to running after having a baby, post baby running, post baby exercise, post baby rehab, post baby recovery