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Explained: Pelvic Organ Prolapse

Updated: Jul 6, 2022

How women's health physiotherapy can assist in managing and preventing it.

Pelvic organ prolapse (POP) is the descent of 1 or more of the pelvic organs into the vagina. This can be recognised by a lowering of either the front (bladder) or back (rectum) walls of the vagina, and/or the uterus lowering downwards into the vagina. Symptoms often include feelings of heaviness or dragging through the pelvis or vagina and trouble with fully emptying the bladder and bowels.

The pelvic floor is made up of muscles, ligaments and connective tissue called fascia. The ligaments and connective tissue is very important for holding up the pelvic organs (bladder, rectum, uterus) while the muscles are very important in providing support from underneath.

POP can result from a stretch or tear to the fascia and/or muscles which can occur due to the added weight of the baby during pregnancy or from the birth itself.

Another common factor that can affect POP is hormonal changes that occur during menopause. As oestrogen decreases, your connective tissues and muscles can become weaker, making you more susceptible to POP. In fact, many women first notice POP symptoms such as heaviness or a notable vaginal bulge during this time. Luckily the pelvic floor muscles can be strengthened at any time throughout your life.

Picture: London Health Science Centre.


The Boat Theory.

Boat = pelvic organs

Ropes = fascia/ ligaments suspending the organs within the pelvis

Water = Pelvic floor muscles (levator ani) supporting the pelvic organs from the bottom up

If the pelvic floor is weak there is increased strain on the fascia

If the fascia is torn/ stretched during child birth there is increased pressure on pelvic floor Both may result in prolapse.

What Can We Do?

Although the diagnosis of POP can be devastating for many women, it doesn’t need to be. POP can be well managed, especially in the first 1-2 years post birth, and working with a Women’s health physiotherapist who can help you get back to exercise and activities you like. You can try to prevent a prolapse from worsening in late pregnancy and early post birth (first 12-16 weeks) by steering clear of high impact exercises like running and skipping and maintaining a healthy diet to avoid constipation which will essentially decrease any further downward pressure on your pelvic floor and fascial complex.

Training your pelvic floor muscles to be stronger can give support to the prolapse from underneath.

Picture: Pelvic floor musculature. Medical Picture Library.

Doing a pelvic floor contraction:

o Take a deep breath in to relax your pelvic floor

o Exhale to squeeze and draw up your pelvic floor muscles. Most women best achieve this by drawing up through the anus as though stopping wind escaping

o Relax the pelvic floor as you breath in and repeat.

It’s also important to ensure the pelvic floor works functionally when we need it to so ensure you tighten and lift your pelvic floor muscles (as above) before every cough, sneeze, laugh and heavy lifting – this is also known as ‘The Knack’.

Please note: This is just a guideline. In order to achieve correct activation and exercise prescription it is best to have an assessment with a Women's health physiotherapist who can accurately assess and guide you on correct exercise prescription.

Picture: Ring pessary to support uterus. Hayden Medical.

Use of pessary:

Another management strategy is the use of an external support device called a pessary. They can be specifically fitted to you to help support the organs vaginally.

If you have had a vaginal delivery or have or are currently experiencing menopause it is recommended you have a pelvic floor assessment. Knowing how strong and functional your pelvic floor is always and if you have any degree of prolapse will assist in managing any worsening.

Come and see one of the physiotherapists today by calling 4454 2309.

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