The word Prolapse can induce a lot of fear and worry and worry in women. In reality prolapse is an extremely common condition that affects up to 50% of women1.
Prolapse is a condition where the pelvic organs sit lower in the pelvis than they used to. Your bladder, uterus and bowel are suspended inside the pelvis by an amazing array of connective tissue and is supported underneath by the deep pelvic floor muscles. I often describe this support system like a suspension bridge – the pelvic floor muscles are the road base, and the ligaments / fascia are like the suspension cables. Prolapse can happen when either the muscles or ligaments of the pelvic floor become weaker, more flexible or damaged.
You can have prolapse of the bladder backwards into the vaginal wall (anterior wall prolapse), the bowel forwards into the vaginal wall (posterior wall prolapse) or the uterus (or vaginal vault in hysterectomy) dropping down into the vagina (apical prolapse). It is important to remember that prolapse damage to the support structures of the pelvic organs, not damage to the organs themselves.
Things that that can increase your chance of prolapse are;
- Pregnancy and childbirth (particularly with Vaginal deliveries)
- Chronic constipation
- Chronic respiratory conditions causing excessive coughing / sneezing
- Connective tissue disorders (eg Marfans or Elhers-Danlos )
- Potentially heavy lifting
The main symptom of prolapse is a heaviness or dragging feeling within the pelvis or vagina which can feel worse by the end of the day. Other symptoms include;
- Being able to see or palpate (feel with your hand) a bulge in the vagina
- Urinary symptoms – like a slow flow, or inability to empty fully, urgency or incontinence
- Bowel symptoms – like the inability to fully empty
- Discomfort with intercourse (often deep within the pelvis).
So what are the treatments for prolapse if you have one? They fall into 3 categories;
- Watch and wait – as prolapse can wax and wane over your lifetime
- Conservative treatment with physiotherapy, pessaries and lifestyle modifications
Your pelvic health physio and your GP are great places to start if you think you may have prolapse. Your pelvic health physio should be able to classify your prolapse into type and stage and start you on a treatment plan to improve things. Common treatment strategies include
- Pelvic floor muscle strengthening – This is a really simple thing to do which can make a huge difference to your symptoms and as an added bonus costs nothing. Research shows that if the prolapse is not past the entrance of your vagina, pelvic floor strength can change your symptoms2.
- Bowel management – working on good bowel health to limit constipation and straining
- Weight management through exercise prescription
- Adjustments to lifting technique and exercises to better support your prolapse
- The fitting of a pessary to further support your pelvic ligaments and organs (more on pessaries in another post!).
So, if you are having symptoms of prolapse, know that you are definitely not alone, and that pelvic floor physiotherapy is a great place to start.
- Thakar R & Stanton, S 2002, ‘Management of genital prolapse’ British Medical Journal. Vol. 324, no. 7348, pp. 1258-1262.
- ACSQHC (Australian Commission on Safety and Quality in Health Care) 2018, ‘Treatment options for pelvic organ prolapse’, Australian Commission on Safety and Quality in Health Care, viewed 29 October 2018, https://www.safetyandquality.gov.au/wp-content/uploads/2018/12/Treatment-Options-POP-Consumer-Info.pdf.