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!

Pelvic Organ Prolapse—What Can Be Done?

It is really common for women to have some descent in their bladder, uterus or bowel, and it is not just women who have had babies—this condition can be an issue for women who have never had kids as well.  Research supports physiotherapy as a first-line treatment for pelvic organ prolapse (POP). A 2016 Cochrane review of the physiotherapy studies for POP found that pelvic floor muscle training significantly decreased symptoms and improved the stage of prolapse when compared to control groups (Dumoulin et al., 2016).

Many women diagnosed with POP had no idea it was even possible for prolapse of the pelvic structures to occur, had no idea where to seek treatment (or that treatment even existed!), and were scared to discuss their concerns with their friends or healthcare providers. Additionally, many people’s concerns are written off as a “normal” part of aging by their practitioners; this leads to people living with potentially modifiable symptoms because they simply don’t know where to go or who to see.

Sometimes the advice given to a woman to help a prolapse is not very practical. For example, a young mother being told not to lift anything heavier than 5 or 10 pounds and to stop all exercise beyond swimming and those performed in lying down positions. While this might be important in the early stages of healing, the exercises and movements would have to progress to the point that this woman could comfortable lift and carry her baby, and get back to the activities that she finds meaningful and fulfilling. No two pelvic floors are the same and everyone experiencing POP has different goals and abilities.

Research has supported that different people manage intra-abdominal pressure during activity differently, and each woman needs to understand how their own body will respond to the exercises and activities that they are interested in returning to. Some women who are looking to resolve or manage their symptoms tend to do well with the help of physiotherapy and lifestyle modification/education. A physiotherapist who works in this area will have advanced training to help pelvic floor issues, and will likely do an internal assessment to gauge the strength, endurance and control of the pelvic floor, and address the pelvic floor engagement with proper breathing to manage pressure changes. 

If you’re noticing pressure or heaviness in the vaginal area, or you can feel a bulge in your vagina in the shower, get checked by your doctor or a pelvic health physiotherapist—there is much that you can do to help this problem!