What You Need To Know About Pelvic Organ Prolapse

When you give birth you are expecting a baby to come out, and then the placenta. Not many moms are expecting their bladder or uterus to come out (pelvic organ prolapse) – most don’t even know this is possible.

Pregnancy and childbirth are risk factors for a condition known as pelvic organ prolapse. Studies show that 50 per cent of women who have given birth one or more times will have some degree of prolapse but it is likely even higher given the low reporting rate and lack of awareness. In simple terms a prolapse is the progressive descent of the internal organs (the bladder, the uterus or the rectum) into and eventually out of the vagina.

It occurs in stages, with the first and second stages often being asymptomatic, so many women don’t even know they have a problem until it progresses to stage 3, when the organ is at the vaginal opening and may even bulge out periodically on exertion, or stage 4, when the organ is bulging right out of the vaginal opening.

Early stage prolapse is sometimes reversible and is very manageable. But once the prolapse progresses to stage 3 or 4, it becomes life altering and may require surgery – surgery that can in turn contribute to other challenges and potentially lead to more operations. Prevention and early detection are key when it comes to pelvic organ prolapse.

Here are some possible symptoms to look for:

  • low back pain
  • a feeling of heaviness in the lower abdomen
  • discomfort with sex
  • difficulty starting the flow of urine
  • difficulty emptying the bladder
  • inability to completely empty the rectum

As the descent of the organs continues, symptoms may progress to:

  • feeling like you are sitting on a golf ball
  • feeling like something is falling out
  • heaviness that gets worse as the day progresses
  • tampons getting pushed out
  • difficulty inserting a tampon.

The best thing a woman can do to prevent prolapse (and any pelvic floor dysfunction for that matter) is to see a pelvic floor physiotherapist, ideally prior to conception, then during pregnancy, then at six weeks postpartum and then annually. Find one close to you and make an appointment.  They assess the pelvic floor muscles for function and the internal organs to see if they are where they should be.

If a prolapse is found, a number of lifestyle management options would be presented.

Stand, sit and move with a neutral pelvis

If your posture is such that your pelvis is not aligned with your breathing diaphragm, then you will be given tips on how to stand, move and sit properly which in turn will make the pelvic floor exercises more effective. Most baby carriers encourage poor posture, so ensure your physiotherapist shows you the proper form while you are holding and carrying your baby as well.

Adjust lifting

Lifting causes an increase in intra-abdominal pressure and if your core (pelvic floor) has difficulty managing that pressure, then your organs will continue to move down and eventually out. Work with your pelvic floor physiotherapist to develop strategies for proper core activation to make lifting safer.

Explore a pessary

A pessary is a device inserted high into the vagina that supports the its walls and the organs. There are many different sizes and shapes, and it may take a few tries to find the right one, but once you do, it can allow the muscles to function better and provide relief from the discomfort of prolapse.

Having a prolapse does not mean exercise should be halted, it may need to be modified but avoiding movement may contribute to worsening of the condition and it puts you at risk of other conditions due to inactivity. 

One technique that is very powerful for prolapse is the Hypopressive Method.  the Kegel Mojo program includes several of these techniques which can potentially reverse early stage prolapse and help manage prolapse from worsening.  The technique involve a series of hypopresive postures (meaning “low pressure”) done with rhythmic breathing and apneas (pauses in breathing) that improve resting tone in the abdomen and pelvic floor and may even reverse early stage prolapse. 

As always I recommend seeing a pelvic floor physiotherapist annually and also kick starting your pelvic floor fitness with the 28 Day Kegel challenge.

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