Among other things, your pelvis contains organs such as your bladder, uterus, and rectum. These organs are kept in place by a dynamic system involving connective tissue, which holds your organs up, and pelvic floor muscles, which provide a bed of support from below. When your connective tissue has been stretched (such as in childbirth, chronic coughing, or long-term constipation), and when your pelvic floor muscles have been weakened, it results in sagging of your pelvic organs into the vagina. This is known as pelvic organ prolapse.
Prolapse is not a disease, it is more of a functional problem. It is also not a painful condition. Actually, most women are asymptomatic. The important thing to remember with prolapse is that, in most cases, prolapse occurs gradually over time. It could even occur 20-30 years post-partum. It may begin with slight falling of one organ into the vaginal space, where you will likely not feel any symptoms at all. Over time, it will continue lower down further into the vagina until one day, you feel a bulge at the vaginal opening. Unfortunately, prolapse doesn’t go away if you ignore it.
The most common types of prolapse are:
- Cystocele: Bladder prolapse – laxity in the front wall of the vagina causes the bladder to drop down into the vaginal space
- Rectocele: Prolapse of the rectum – laxity in the back wall of the vagina causes the rectum to drop down into the vagina
- Uterine Prolapse: Prolapse of uterus
- Vaginal Vault Prolapse: Prolapse of the upper portion of the vagina. This usually occurs post-hysterectomy.
Some signs of prolapse include:
- The feeling as though your insides are coming out
- The feeling of pressure or heaviness in your pelvis
- The presence of a bulge at the vaginal opening
- Pain and discomfort during sexual intercourse
- Difficulty emptying bowels
Since prolapse is caused by a failing support system of connective tissue and pelvic floor muscles, those with prolapse often experience incontinence as well.
What Causes Prolapse?
The main cause is childbirth. As the baby makes its way down through the vagina, and is then pushed out, it can stretch the connective tissue and pelvic floor muscles creating a weakened support system for your pelvic organs. Multiple vaginal births, prolonged pushing, use of forceps or vacuum, and episiotomy also affect the supporting tissues.
Additional risk factors include constipation/chronic bowel straining, chronic coughing (such as smoker’s cough or asthma), repetitive heavy lifting.
What can be done to prevent prolapse?
Preventing prolapse is a lot better than fixing it. Since prolapse is the result of weakened connective tissue and pelvic floor muscles, the best thing to do is to strengthen your pelvic floor muscles (kegel exercises) and keep them strong throughout your life, no matter what your age.
How can Pelvic Floor Physiotherapy help with preventing prolapse and treating it once it’s happened?
Physiotherapists are specially trained in dysfunctions of the musculoskeletal system. Physiotherapists with advanced training in pelvic floor conditions are able to help rehabilitate the pelvic floor muscles to their optimal state. Research has shown that at least 50% of women do not contract their pelvic floor muscles correctly with just written or verbal instructions alone.
The pelvic floor physiotherapist will assess the current state of your muscles through an internal exam, and will then teach you how to strengthen them appropriately. They will also provide you with advice on specific lifestyle changes, activity and diet modifications, and bowel and bladder habits that can help to minimize/prevent the prolapse from getting worse. Current research now states that pelvic floor muscle retraining is effective at reducing prolapse symptoms and should be considered first-line of treatment for women with prolapse.
If the degree of prolapse is large, surgery may be necessary. The surgery for prolapse involves repairing the torn or stretched connective tissue, but may also involve a hysterectomy if the uterus has lowered down. Since surgery only addresses half of the equation, by correcting the connective tissue only, you may be at risk for a recurring prolapse. To help prevent prolapse from coming back again, you should work with your Pelvic Floor Physiotherapist to build your pelvic floor strength and learn the appropriate lifestyle/activity modifications that will protect the newly operated tissue.