Is Pelvic Organ Prolapse Reversible?

Is Pelvic Organ Prolapse Reversible

Pelvic organ prolapse (POP) is when the bladder or the uterus starts to descend in the vagina due to the muscles and connective tissue in the area not providing enough support. It is not typically painful per se, but can create a feeling of heaviness and pressure in the vagina that gets worse the longer a person is on her feet.

Pelvic support changes throughout the day! The degree of descent can depend on pregnancy, the contents of the bowel and bladder, hormones, recent physical activity, stage in the menstrual cycle—the list goes on.

So… there are several factors that could influence the support of the pelvic floor:

  1. Change in the strength of the levator ani muscles of the pelvic floor: strengthening means they can better resist the downward movement of the pelvic organs with pressure changes due to breathing and movement. If the levator ani muscles are worked regularly, they show improvement in strength, endurance, coordination and function— and the nervous system is better able to recruit the muscles.
  2. Connective tissue changes: pelvic ligaments in those with prolapse are longer than those without prolapse. The bladder, urethra, vagina and uterus are attached to the pelvic walls through connective tissue called the endopelvic fascia, and that can be vulnerable due to childbirth and repetitive straining. It is not likely that the connective tissue will adapt much to pelvic floor muscle strengthening, but the prevention of further stretching of the ligaments is positive.
  3. Hormonal influences are huge: estrogen receptors in the bladder, uterus, vagina and pelvic floor can make collagen to increase the thickness of the vaginal wall.  With decreased estrogen with menopause, the vaginal walls can become thinner, more acidic and have decreased blood flow. An estrogen supplement can lead to reproduction of collagen to support the tissues to withstand downward forces.
  4. Pressure changes: the pelvic floor responds to what is happening above it, and adjusts the pressure; be sure to contract the pelvic floor before coughing, sneezing, laughing etc to better manage the pressure system.
  5. Time of day- people report that POP seems to worsen as the day goes on, likely due to the amount of time spent upright, which will increase the demand of the pelvic floor due to gravity

Research shows that 19% of participants in pelvic floor strengthening program experienced a decrease in grade of POP, but 74% reported a reduction of bothersome symptoms. Instead of thinking about “reversal” of prolapse, it is maybe better to think about regaining function and restoring strength through the pelvis. There can be improvement due to remodeling of tissue and increasing estrogen levels, and it is very important to control what you can! There is hope to improve a prolapse through strengthening the area, managing the pressure system, controlling weight and looking at supplemental estrogen.  Symptoms can be significantly improved—work with the pelvic floor physiotherapists at Elevation Physiotherapy & Wellness to help you get better, faster!

Safe Return to Exercise After Baby

Safe Return To Exercise After Baby

Exercise is good, right?  But how soon is too soon after giving birth?

If you had an uncomplicated vaginal birth, you can start gentle exercise (walking, stairs, breathing exercises, some abdominal exercises) almost immediately after giving birth, but clear it with a medical professional first. 

Research on women who begin exercise after giving birth shows that there can be a disconnect between the pelvis and the rest of the body when trying to get back to exercise after baby. The muscles and connective tissue through the abdomen is put on stretch for several months, and are longer and softer for a period of time after giving birth, and this can lead to pain in the joints of the pelvis and pubic bone.

It would not be at all typical to experience severe pain, dizziness, weakness, vision changes, chest tightness, bleeding or leg pain—be sure to check in with your physician if experiencing any of these.  Otherwise, start back at up to 30 minutes of walking each day—if you can’t do 30 minutes all in one shot, then try two 15 minute walks, or even six 5 minute walks spaced through the day.  Just keep moving.

Also, get your pelvic floor moving—it would be best to be checked by a pelvic floor physiotherapist who can make sure that you are engaging properly and give you a specific exercise program to start, and teach you how to breathe on exertion.  The National Academy of Sports Medicine in the U.S. recommends breath work and easy abdominal exercises with moving your legs to start.

If you’ve had a Cesarean- section, you may have to wait a bit longer to get back to the exercise game.  Walking is good, and do get back to pelvic floor strengthening, but hold off at least 8 weeks for more vigorous exercises.

If you are wanting to get back to running post-partum, try the jump test first: have a full bladder, and jump up and down 20 times in a row, followed by coughing four times in a row—if you didn’t leak urine or feel any heaviness in your pelvis or vagina, you’re likely ready for that run!