“I was just showering and reached down and suddenly noticed a bulge”
“I had no idea something was wrong until my doctor examined me and told me I have a stage 2 cystocele”
“I started feeling heaviness in my pelvis, then was wiping after I went to the bathroom, and noticed something was there!”
Pelvic organ prolapse impacts a lot of people. Some studies show that between 50-89% of people experience prolapse after vaginal birth (if they’re examined and someone is looking for it!), however, people can experience prolapse when they have never been through pregnancy or childbirth. Prolapse is one of the “scary diagnoses” as I tend to call them– not because I think it’s actually scary– I don’t– but because there is so much AWFUL information about prolapse out there. And when people suddenly learn about this, they dive deep into a rabbit hole of research, and often end up scared about what the future holds for them. BUT– I’m here today to tell you that: 1) Prolapse is actually very common and 2) there is so much you can do to help this problem!
To digress slightly– Working with people dealing with prolapse is a passion of mine, and I’m super excited to be teaching a LIVE class on managing pelvic organ prolapse with my friends and colleagues, Sara Reardon & Sarah Duvall. It’s going to be happening this Sunday at 4pm EST, and registration is limited! I hope you’ll join us for this awesome class! (Note: If you’re reading this after the event, and missed it– no worries! The recording will be available– just click the link above!)
What is Pelvic Organ Prolapse?
Before we jump into the myths surrounding prolapse, let’s talk about what it actually is. Pelvic organ prolapse refers to a loss of support around the bladder, uterus or rectum, and this causes descent one or more of these organs into the walls of the vagina. The organs themselves are supported by fascia, ligaments, connective tissues and… you guessed it! Muscles! So, how can loss of support occurs? Well, it could be due to straining of these tissues like would happen during pregnancy and childbirth, particularly if people have injuries during birth like stretch injuries to the nerves of the pelvis, tears in the connective tissue and fascia, or tears in the pelvic floor muscles themselves. This can also be due to chronic straining of the tissues that might occur with age, chronic lifting (with poor mechanics) or chronic coughing problems. Other factors like hormones, body size and joint hypermobility can also be involved.
What does prolapse feel like?
Maybe you’ve been diagnosed with prolapse, maybe you just think this is a problem you have, or maybe you know that you have this problem. Regardless, let’s chat about what prolapse can feel like. These are some of the things people who have prolapse can feel:
- A bulge coming out of the vagina
- Pressure in the pelvis or perineum
- Lower back ache
- Difficulty emptying the bladder
- Difficulty emptying the bowels
- Heaviness or a dragging feeling in the pelvis
Symptoms are often better first thing in the morning, then worsen as the day goes on (thanks so much gravity!). Symptoms vary person to person based on where they have prolapse and the severity of their prolapse.
So, now that we know what it is and what it can feel like, let’s jump into prolapse myths.
Common Myths Surrounding Pelvic Organ Prolapse
Myth #1: “You’ll likely need surgery at some point.”
I hear this one all the time. A well-intending physician tells their patient that they have prolapse, then follows it with, “we can fix that whenever you’re done having children” or something along those lines. While some people do end up needing surgery– particularly with more severe prolapse or if their prolapse is significantly impacting their function, many people are able to manage well conservatively with specific exercises or pessaries.
Myth #2: Prolapse is probably the cause of your pelvic pain, pain during sex, or genital pain.
So, you’ll see that I listed low back pain in the symptoms, but I didn’t list other types of pelvic pain. While I get that prolapse can look like it would be painful, it typically is not a painful condition. It’s an annoying condition, and can lead to behaviors that may cause pain (like constantly trying to grip your pelvic floor muscles to prevent things from falling down!). Prolapse can cause a back ache that worsens as the day goes on, and this is due to the ligaments around the organs stretching as the descent occurs. Additionally, the pressure/bulge can be uncomfortable, and people may feel like something is being pushed on during sex. That being said, we very often find that people have prolapse and something else going on when they are dealing with significant pain.
Myth #3: Because prolapse is structural, physical therapists likely won’t be able to help.
So first, support of the organs requires coordination of forces– ligaments and fascia are involved for sure, but muscles are also involved. All that aside, prolapse is a problem related to pressure management– so it matters what is happening at the pelvis, but also, what is happening outside of the pelvis that is impacting the pressure system.
Pressures within the intrathoracic and intraabdominal cavities can impact what is happening in the pelvis. Several muscles are involved in this pressure system, including the glottal folds at the top, the intercostal muscles, the respiratory diaphragm, the transverse abdominis muscle, the multifidus, and the pelvic floor muscles. These muscles work together in a coordinated way to help manage pressure and spread the load (so it is not funneled down to the pelvic floor).
Physical therapists help people with pelvic organ prolapse by helping them manage their pressure system as optimally as they can. This means looking at posture, spinal mobility, movement patterns, hip function, breathing habits, and so much more! It also means optimizing the function of the pelvic floor muscles. With this approach, we see good improvements. A Cochrane review of 13 studies in 2016 found that most people saw good improvements in their prolapse symptoms and their severity of prolapse on exam. A multicenter trial published in 2014 found that individualized pelvic floor training led to good improvement in symptoms and severity of prolapse.
Myth #4: Pessaries are for “old people”
Not true. Pessaries are amazing medical devices that help to support the walls of the vagina and can be very useful for reducing symptoms of prolapse. There are lots of different types of pessaries, and generally, people who wear them really find them to be helpful! In fact, this study found that 96% of the people who were appropriately fit with a pessary were satisfied and thought it helped with the severity of their symptoms.
Myth #5: If you have prolapse, you should never do certain exercises and movements so your problem doesn’t get worse.
I’ve said this before, and I’ll say it again– there are no bad exercises– BUT there may be times when certain exercises may not be optimal for you. Ultimately, the best thing to do is to work with a professional who can watch you move, watch you exercise, and see how you modulate pressure during these movements. Then, they will be able to make recommendations specifically for you– help you modify where you need to modify, observe your form during movement, and then strategize with you to make a plan to get back to whatever movements you would like to get back to!
If you’re experiencing prolapse, or you think this might be you– there is hope available! I’m very excited to be working with Sara Reardon and our special guest, Sarah Duvall to jump further into this topic in our upcoming class this Sunday 10/25 at 4pmEST on Managing Pelvic Organ Prolapse. Come join us LIVE and get all of your questions answered! If you can’t make the live, no worries!! A recording will be available.
What prolapse questions do you have? Let me know in the comments!