Prolapse – what is it and why are your pelvic floor exercises so important?
This blog post is written to be informative and hopefully answer some of the many questions surrounding prolapse of the pelvic organs and how a prolapse can be avoided or treated.
What is a prolapse?
Chances are if you are pregnant or have had children you may be familiar with this term, or maybe not?
A prolapse refers to the bulging of one or more organs ‘hanging down’ or ‘protruding out’ where it shouldn’t be. The organs which have the potential to prolapse are the bowel, uterus, vagina and, or the bladder.
With the pelvis, this is classically felt from the vagina in ladies.
Cue everyone now squeezing their pelvic floor muscles.
Why does a prolapse occur?
It’s due to weakness in the pelvic muscles, ligaments and fascia (supporting connective tissue) that work to keep the organs elevated in your pelvis.
Do I have a prolapse?
The signs and symptoms of a prolapse may include:
- A feeling of “heaviness” or ‘dragging down” sensation around the vagina or low back region.
- This may feel worse towards the end of the day.
- You may feel discomfort in standing.
- Your bladder function may alter in one of the following ways:
- Slow flow when passing water
- Incomplete emptying
- Going to the toilet to wee more often (Frequency)
- Urgent desire to void your bladder (Urgency)
- Leakage when you cough, sneeze, laugh, jump (Incontinence).
- Your bowel function may alter in one of the following ways:
- Constipation
- Incomplete emptying
- Needing to press the back of the vaginal wall to fully empty the bowel.
- A feeling of discomfort during sexual intercourse.
What causes pelvic organ prolapse?
As mentioned earlier, prolapse is caused by damage to the muscles, ligaments, fascia and nerves which can be caused by…
- Pregnancy
- Childbirth
- Ageing
- Menopause
- Excessive pressure on the pelvic floor muscles.
- Inherited risk.
Pregnancy and childbirth have huge impacts on the strength of the vagina and it’s supporting muscles, ligaments and fascia. Carrying a growing foetus for nine months causes increased pressure on the pelvic floor, as well as the journey of baby through the birth canal.
1 in 3 women who have had one or more children will experience PROLAPSE.
Prolapse can occur during pregnancy, just after childbirth or many years later. Ageing and the menopause affect the strength of the supporting tissues in the pelvis due to altering hormone levels and body changes with age.
What’s important to know is that only 11% of ladies will need surgery for it. (IUGA ref see below).
Excessive pressures on the pelvic floor muscles could be due to obesity, chronic cough, heavy lifting, straining, chronic constipation. Anything that causes a repeated rise in intra-abdominal pressure and an increased load to your pelvic floor muscles.
It’s not just ladies who have had children who are at risk of a prolapse.
Inherited risk of prolapse may come from some genetic syndromes that have weaknesses in their connective tissue such as Marfan syndrome and Ehlers Danlos syndrome.
What are the different types of prolapse?
If you have a weakness in the FRONT wall of your vagina this is known as an ANTERIOR PROLAPSE or previously termed a cystocele.
If you have weakness in the BACK wall of your vagina this is known as a POSTERIOR PROLAPSE or previously termed a rectocele/endocele.
A weakness in the TOP of your vagina wall is known as an APICAL/UTERINE PROLAPSE.
It is common for ladies to experience prolapse in more than one compartment.
An anterior prolapse is where your bladder bulges into the front wall of the vagina. This is the most common type.
A uterine prolapse occurs when the Uterus (womb) drops down into the vagina. This is the second most common prolapse.
A posterior prolapse is where the lower or upper part of your bowel (rectum) bulges into the back wall of the vagina.
How is a prolapse treated?
There are non-surgical and surgical options for the treatment of prolapse.
The majority of women (40%) have minor prolapses which have minimal or no symptoms.
How ‘bothersome’ your prolapse symptoms normally defines your treatment.
Here are your options:
- DO NOTHING – if your prolapse is not affecting your day-to-day quality of life and is not bothering you – leave it alone. You can make lifestyle adjustments to maintain this. You should avoid heavy lifting or repetitive straining/bearing down through your pelvic floor muscles as this is likely to cause your symptoms to get worse.
- Use a PESSARY – this is a ring that inserts into your vagina that allows mechanical support to the vaginal walls. There are many different shapes and sizes so it can be trial and error to get a good fit. Pessaries will help reduce symptoms if they fit correctly.
- PELVIC FLOOR EXERCISES – Evidence now confirms that regular strengthening programmes of our pelvic floor muscles will help improve or prevent prolapse symptoms from getting worse. It’s all about timing, motivation and technique as like any muscle they can take 6 – 12 weeks to strengthen.
- SURGERY – Based on your age, severity of prolapse and your general health your gynae surgeon will discuss appropriate surgical options for you. Generally there are two types of surgery: reconstruction or vaginal closure which depend on the severity of your prolapse and if you are sexually active or not.
The main messages to take away from this informative blog post are:
If you suspect you could have a prolapse, visit your GP or self refer (if you can) to your local continence service for advice and assessment. Seek a women’s health physiotherapist who specialises in continence care if you require help with tailoring your pelvic floor exercise programme to your needs.
Practise your pelvic floor exercises.
Make them routine.
Make them a priority.
If you struggle to remember to fit them in then be sure to download my free e-booklet: 10 Super quick ways to fit pelvic floor exercise into your day by clicking <<<here>>> to help you do this.
Finally, don’t ignore your body’s symptoms.
Your body is AMAZING at keeping you HEALTHY and it is telling you something you need to address.
Keep squeezing!
Useful resources:
Hagen et al (2013) Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multi centre randomised controlled trial. Lancet. Nov 28 2013. http://dx.doi.org/10.1016/S0140-6736(13)61977-7
Hi, it is a general problem faced by many women’s. your article is helpful and aware those who don’t know anything about that. in fact Pelvic organ prolapse affects 30% of all women and half of women who have borne children. One in nine women will have prolapse severe enough to warrant reconstructive surgery in the course of her lifetime.
Many thanks for your comments caroline.
There are things you can to do tighten your pelvic muscles and reduce your risk.
Very good website – bookmarked
Great post. I’m facing a couple of these issues.
Being overweight can increase the likelihood of a prolapse as can heavy lifting or manual work, long term constipation and persistent coughing.
Yes indeed they are all factors that can increase your likelihood of prolapse.
Normal aging and lack of estrogen hormone after menopause may also cause uterine prolapse, Chronic cough and obesity increase the pressure on the pelvic floor and may contribute to the prolapse.
The menopause can catch a lot of women out post childbirth and not just with a uterine prolapse, bladder and bowel prolapse can also occur due to the change in our hormones. However yes, persistent cough and obesity do contribute to prolapse and if we can stop smoking (if you do) and reduce your weight by even a small amount this with massively help your pelvic floor muscles to work more efficiently and help reduce prolapse symptoms.
Your pelvic organs are held in place by ligaments and muscles, connective tissue and fascia, which are collectively known as the pelvic floor.