Jeopardy time! It is estimated that 50% of women over the age of 50 and many women under the age of 50 are living with this condition.   If you said “What is Pelvic Organ Prolapse” you answered correctly!  Although it is a common condition, it is certainly NOT normal.  If you are past the age of 20 and have had a baby, you really should get checked. The problem with Pelvic Organ Prolapse (POP) is that it is progressive if not dealt with.  And long before your gynaecologist starts suggesting a hysterectomy, you owe it to yourself to deal with a POP by learning a few simple and effective strategies.

If you’ve never heard about POP, here is the low-down.  By the way, if you’re going to do more research online, do yourself a favour and don’t Google image search this.  Just trust me on this one.

What is Pelvic Organ Prolapse (POP)?
A bulging or herniation of one or several pelvic organs into the vaginal wall.  It is caused by the pelvic organs shifting out of their optimal position.  A prolapse of the rectum, vagina, bladder, urethra, uterus or small intestine can occur. It can be a mild, moderate, or severe prolapse. In the cases of the most severe prolapse, the pelvic organ has slipped right outside of the body.

What causes POP? 
It is multi-factorial. Risk factors include:

  • prolonged stage 2 labour (pushing over 2 hours)
  • over stretching or tearing of suspensory pelvic ligaments or tearing of the endopelvic fascia
  • poor alignment, constrictive breathing patterns, movement patterns which increase intra-abdominal pressure
  • anything activity that chronically increases intra-abdominal pressure – constipation, incorrect abdominal workouts, obesity, persistent cough, high impact sports
  • hysterectomy – the uterus is the keystone of support in the pelvic cavity and it provides proper positioning for the other organs
  • weakness or low position of the supporting pelvic floor muscles coupled with a dysfunctional deep core system

Ultimately POP is a problem of pressure. The pelvic support system (ligaments, fascia, organ position, and pelvic floor support) is overwhelmed by pressures from above (intra-abdominal pressure) and it cannot cope.  This pressure imbalance will cause the pelvic organs to be shifted around and displaced. They will move downwards and eventually out of the vaginal opening.  POP is often accompanied by other pressure related problems – incontinence, diastasis recti, or other types of hernias.

Why is prolapse a problem?

  • “Although POP is not life threatening, it IS life altering” – Sherri Palm
  • POP most often begins after the process of childbirth. However, it may not show up right away.  It can take weeks, months, or years to develop and is hugely dependent on lifestyle. If nothing is done to reverse the trend, it will progress from a mild prolapse to a severe prolapse.  This is why awareness, education, prevention, and early treatment are vitally important.
  • Many women can experience complete reversal of prolapse with pelvic health physiotherapy and early treatment. But some women, especially women with severe prolapse who have had it for a long time, will have to learn to live with it and manage it in various ways, such as lifestyle modification or with use of a pessary.  There are a number of support groups that can help women with POP learn to manage their prolapse and still have a great quality of life.
  • Some women are surgical candidates.  However, the surgical failure rate is extremely high and can cause a myriad of other problems (50% fail within 5 years).
  • Even though POP is common, it is not normal. Part of the problem is lack of awareness about the condition by the public, by health professionals, and an embarrassment to discuss it.

Symptoms of POP

  • Pressure or heaviness near vaginal opening
  • A protrusion at vaginal opening
  • Aggravated by standing up and relieved by lying down
  • Incomplete voiding or evacuation
  • Pressure during intercourse or it may perhaps be painful
  • Recurrent UTIs
  • Incontinence
  • Usually, pain is not a factor.  But just because there is no pain doesn’t mean there is no dysfunction.

How to treat POP
It is a simple formula.  Cure = <span “font-size:12.0pt;font-family:=”” “century=”” gothic”,”sans-serif”;mso-fareast-font-family:”century=”” gothic”;=”” mso-bidi-font-family:”century=”” gothic””=””> Stop doing things that worsening it!  +  Start doing what will help to reverse it!

How do you prevent POP from worsening?

  • Prevention, prevention, prevention.
  • During labour there are many ways to prevent or minimize a POP.  Examples include positioning for optimal labour (get off your back), breathing vs. pushing the baby out, staying connected to your body so you have feedback about how much pressure is being exerted, practising perineal stretching a few weeks before labour, etc.
  • Avoid typical abdominal workouts, especially crunches, double leg lifts, or anything that increases pressure through the abdomen – ESPECIALLY in the first 8 weeks post-partum.
  • Do not jack-knife out of bed or when rising from lying down – instead, log roll
  • Avoid postures where your pelvis is thrust in front of your thorax, or is behind your thorax – instead, stack your thorax over your pelvis. When holding and carrying you baby, do it in a way where you are aligned optimally
  • Avoid or modify exercises, movements and activities which will increase intra-abdominal pressure.  You may need to take a break from high intensity exercises or sports for a time while you focus on rebuilding your stability system.
  • Take care when picking up baby or objects – engage your core correctly. Avoid heavy lifting.
  • If you cough or sneeze, do a strong pelvic floor contraction first.

How is POP treated by physiotherapy?

  • First you get assessed.  This will determine all the factors which may be causing or contributing to the POP.  Is it your alignment? Your breathing? Your exercise habits? Your toileting habits? A disconnected pelvic floor?  All of the above?
  • While it is important to remember the strength and support role of the pelvic floor, prolapse is not treated by simply doing a bunch of kegels.  In fact, if done incorrectly, it can make a prolapse worse.
  • Training the core (pelvic floor, breathing/diaphragm, TA and dMF) as a coordinated unit so balance of pressures occurs is very important.
  • Re-learning optimal alignment and optimal ways of moving that will not to increase IAP is also a huge part of the process.
  • The focus is on function.  Lying on your back and kegeling all day long is not a practical or useful exercise because we do life vertically.  We do start in unloaded positions (lying down) to help you best connect to your deep system, but then we progress to more functional positions – sitting, standing, squat, etc as soon as you are able.  Ultimately, the goal is to reverse the prolapse and get you back to your regular life and routine.

Healing from pelvic organ prolapse takes time so be patient with yourself.  It will require focused awareness, dedication to your program and some lifestyle changes, at least in the interim.  But with the right guidance and an optimistic outlook, you can get back to normal and enjoy your life once again.

For women looking for more information and support, please check out this excellent website: http://www.pelvicorganprolapsesupport.org/

If you are not sure if you have pelvic organ prolapse, contact The Mama’s Physio to set up a consultation. We will figure it out together and get you started on the path to healing.