Pelvic Organ Prolapse CAN be Helped!

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when a pelvic organ—such as your bladder or uterus—drops (prolapses) from its normal place in your lower belly and pushes against the walls of your vagina. This can happen when the muscles that hold your pelvic organs in place become weak or stretched.

Many women will have some kind of pelvic organ prolapse. It can be uncomfortable or painful, but is not typically a serious health problem.  It doesn’t always get worse, and it has been shown that with work it can get better!

More than one pelvic organ can prolapse at the same time. Organs that can be involved when you have pelvic prolapse include the bladder, rectum, uterus, urethra or small intestine.

A bladder prolapse (cystocele) is most common, and occurs when the tissues that hold the bladder in place are stretched or weakened. This causes the bladder to move from its normal position and press against the front wall of the vagina, forming a bulge.

A uterine prolapse occurs when a woman’s pelvic muscles and ligaments become weak, allowing the uterus to drop from its normal position and the cervix to bulge into the vagina.

A rectocele occurs when the tissues and muscles holding the end of the large intestine (rectum) are stretched or weakened, allowing the rectum to move from its regular position and press against the back wall of the vagina.

There is much that can be done to improve your prolapse!

You will need to work with a physiotherapist who works in pelvic health to make a program of exercises and other healthy habits that is specific to you and your situation and lifestyle.

Some things you can do to help:

  • Pelvic floor strengthening exercises (called Kegel exercises) can help to build support at the bottom of your core
  • Reach and stay at a healthy weight
  • Avoid lifting things that are too heavy for you, as it can put stress on your pelvic muscles
  • Caution with higher impact exercise and activity, and possibly switch to lower impact exercise
  • Avoid straining with bowel movements, and increase fibre intake
  • Try “the Knack”, which is a technique of engaging your pelvic floor muscles just before you cough, sneeze or lift in order to better manage the pressure increase

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!