15 Oct 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:
- 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.
- 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.
- 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.
- 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.
- 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!