Pelvic organ prolapse is common – it affects around 50% of women, although only about 12% will have symptoms. Some people get a prolapse soon after childbirth, others may not notice any issues for many years, even decades, but vaginal birth is a big risk factor.
What is a prolapse?
A prolapse occurs when the pelvic organs (bladder, bowel or uterus) are no longer supported by the pelvic floor muscles, ligaments and connective tissue. This means they are no longer sitting in the right place. Symptoms vary depending on which organ has lost support.
People often tell us they get quite a shock when they find this – sometimes they don’t know what it is, and see their GP, who can provide reassurance and refer them for pelvic health physiotherapy. So don’t worry – there is help available.
What causes a prolapse?
There are many factors that may contribute to the formation of a prolapse.
These include:
– Vaginal delivery – especially the first one
– The number of babies you’ve had – the more you have, the greater the risk
– How old you are – as we get older, muscles weaken and there is less support
– Weight gain – obesity can contribute to prolapse
– Menopause – changes in hormones have an impact
– Constipation – prolonged straining on the toilet over a long period of time can cause prolapse
What are the symptoms?
If the bladder or bowel slips down and presses against the vaginal walls, you may feel a bulging sensation. You might feel this when showering, or with your finger inside the vagina, or you may see a bulge when you have a look with a mirror.
Other symptoms include and sense of dragging or heaviness or feelings of “something being in the way” inside the vagina. There can also be difficulty emptying the bladder or bowel.
For some, there may be low back or lower abdominal pain or discomfort.
Treatment options
Pelvic health physiotherapy
This may include
– Pelvic floor rehab – to help reduce the prolapse and improve symptoms – or stop it developing further so that it starts to cause symptoms!
– Advice on bladder and bowel emptying
– Education on lifestyle modifications, including
- Heavy lifting
- Management of constipation
- General exercise rehabilitation – abdominal and core exercises, and appropriate exercise progression to get you back to what you enjoy in a safe way, without making the prolapse worse
Pessaries
A pessary is a silicone device that is fitted into the vagina, to help support the pelvic organs and reduce symptoms of prolapse – and excitingly, recent studies have shown that for some people, wearing a pessary for a period of time can even reduce it enough that the pessary is no longer required!
In our clinic, Stephanie and Liz have undergone extra training in pessary management and are happy to assess anyone for suitability. There are many different types and sizes of pessary, so fitting may require a trial of different ones to find the one that works the best for the individual.
Having a pessary can help with reduction of symptoms. It can also help to stop the prolapse from worsening, and may avoid the need for surgery.
Surgery
Some people do end up having surgery for their prolapse. Even if you’re having surgery it’s a good idea to see a pelvic health physio to help you get the best outcomes, and prevent the prolapse from recurring. Research shows that 30% of people who have a prolapse repair end up with another prolapse sometime in the future. Don’t let that be you – come and see us and find out some simple lifestyle modifications to help prevent this.
Further information:
Liz talking to a patient with prolapse – click here
A story of a personal account of a prolapse journey – click here
Self help measures to reduce the risk of pelvic floor problems developing -click here