Pelvic Organ Prolapse Affects up to 50% of Older Women
It often starts with a sudden, awful feeling. “I feel like something just fell out of me!” This is what I felt after the birth of my daughter for several years. Pelvic organ prolapse (POP) is an unmistakable and uncomfortable feeling of pressure in the pelvic area and can affect anyone of the pelvic organs (bladder, uterus, vagina, rectum or intestines). POP is characterized by a bulging or dropping of these organs into or outside of the vaginal or rectal walls. Usually, these organs are held in place by the muscles and tissues that comprise the pelvic floor; however, when things go wrong, it can result in prolapse. The truth is that 49% of older women have popped, so this is a big issue doctors are not properly addressing. The other reality is that many women get surgeries they don’t always need because they are not aware of natural therapies that work.
Types of Pelvic Organ Prolapse
It’s possible for one single organ to prolapse, or to have multiple organs prolapse simultaneously. A cystocele is the most common type of prolapse when the bladder protrudes downward into the vagina. A rectocele is when the rectum protrudes forward into the back wall of the vagina. A uterine prolapse is when the uterus drops down into the vagina. An enterocele is when the intestines drop down into the vagina. The condition is most commonly found in women; however, men can also be affected by rectocele.
Risk Factors For Pelvic Organ Prolapse
There are numerous ways you can develop a prolapse. One is during labor, particularly amongst women who are pushing for a long time. POP can occur if one returns to vigorous exercise, particularly high impact, too soon after childbirth before the pelvic floor muscles have had time to heal. The same is true after any other surgery that involves the abdominal and pelvic area. Women with hysterectomies are at a higher risk of POP. The pelvic floor muscles support and lift the pelvic organs, said organs are more likely to descend or drop if they do not have adequate muscular support from these muscles. All women with POP need to be on a consistent pelvic floor training program.
A history of significant high impact exercise can also lead to POP in young and older women. Dancers, gymnasts, runners, and people that engage in CrossFit can do damage to the pelvic floor support if they are consistently and repetitively landing heavily. Fortunately, by proactively taking care of your pelvic floor muscles, you can practice these activities without injury.
POP can also be a product of poor body mechanics. People who do a lot of heavy lifting in their daily lives, either with childcare or during their workday, without engaging their pelvic floor muscles for support can prolapse. Similarly, a long history of constipation and bearing down to pass a bowel movement can result in excessive pressure and POP. While a hysterectomy does not directly cause prolapse, the uterus is a significant support structure in the pelvic cavity, and its removal can result in a cystocele over time.
Pelvic Organ Prolapse Affects Daily Life and Hinders Activity
The impact of POP on daily lifestyle is great. The feeling of pressure in the pelvic area is very uncomfortable, with women often complaining that it feels like something is about to fall out of them. Sex can be uncomfortable at best, and painful or intolerable at its worst. Urinary or fecal incontinence (depending on what type of prolapse you have) can occur with exercise, sex, or even simple daily activities like lifting your child, coughing, sneezing, or laughing. Because the pelvic floor muscles function as stabilizers in the pelvic girdle, prolapse can result in low back and sacroiliac joint pain because of the lack of stability in this region. Symptoms may start out as mild and become more severe over time if left untreated.
Kegels, Core and Lifestyle Medicine is The First Line of Defense for POP
Fortunately, there are conservative ways to treat pelvic organ prolapse. The most non-invasive intervention is physical therapy. A Women’s Health or Pelvic Floor Physical Therapist specializes in this condition and can evaluate the degree of severity of prolapse and design a treatment protocol. It is crucial to not blindly begin doing Kegels because there is so much more to prolapse than just strengthening one muscle group. Mainly if the prolapse occurred because of childbirth, you could often expect there to be trauma to the tissues, which can result in hypertonicity (muscles that are too tight), scar tissue, or a diastasis rectus abdominus (separation of the abdominal muscles). Your abdominal muscles help to support your pelvic girdle, so if you lack stability in this region, it leads to increased pressure on the pelvic organs. A physical therapist will take you through the appropriate progression of pelvic floor strengthening, often beginning lying down or in the resting position (with your knees bent and 1-2 pillows placed under your hips), and then eventually progressing to strengthening in seated and standing.
Techniques called overflow incorporate other muscle groups that maximize firing of the pelvic floor muscles simultaneously. Other methods include bladder massage, manual therapy to release tension and scar tissue in the pelvic floor area, and instruction in how to relax the pelvic floor muscles (called a reverse kegel), which is equally if not more important than learning to do a proper kegel. Without relaxing the pelvic floor muscles following a contraction, you risk building up tension and lactic acid in the muscles that can result in pain, spasm, and weakness. Each of these dysfunctions must be addressed in addition to Kegels to recover from a prolapse. I cover all of this and many more of these pelvic organ prolapse healing exercises in my V Core Lift program.
1 Type of POP Non-Invasive Treatment – The Pessary
Non-invasive treatment can also include a diaphragm or pessary ring. These are place-holding devices, typically made out of silicone, that are inserted into the vagina to help hold the prolapsed structure in place. They are fit by your gynecologist and can be removed by yourself or by your doctor as frequently as weekly or infrequently as 1-3 months, depending on the type of ring you have. You must feel comfortable after your doctor fits you with the ring; otherwise, you won’t be likely to wear it consistently, and you won’t reap the benefits of it. Another option is over-the-counter temporary inserts like the Poise Impressa, which supports the urethra to prevent leaks from occurring. It looks like a tampon can be worn for up to 12 hours, and is inserted and removed yourself.
In some extreme cases, invasive intervention, including surgery is necessary. The vast majority of women with prolapse do not need surgery, and it should only be considered as a last resort if all conservative measures and activity modification have been tried and failed first.
A grade 4 prolapse, where the organ has descended outside of the body, may require surgical reconstruction. One of the more common procedures for this is the vaginal mesh repair. Mesh surgeries have been widely publicized in the media with class-action lawsuits due to severe complications. A class-action lawsuit in Australia alleged the downplayed debilitating risks of the surgery and resulted in Johnson Johnson pulling the mesh from the Australian market. And in 2016, the FDA changed the classification of a transvaginal mesh procedure from moderate-risk to high-risk [i].
The potential complications from a mesh surgery include pain with intercourse, infection, mesh erosion, and organ perforation. The importance of analyzing the risk-reward value of electing to have surgery like this is critical, as the complications are often irreversible.
Perhaps the easiest way we can address prolapse is through prevention. Proactively toning your pelvic floor muscles and strengthening your core. For high-level athletes or women that engage in lots of high-impact exercises, make sure that not only are you cross-training with low-impact workouts, you are also taking care to address your pelvic floor muscles. Kegel exercises strengthen the pelvic floor muscles and can help prevent POP.
As a pelvic floor physical therapist, I find most women don’t know how to do Kegels correctly or don’t have enough variation in their Kegels, so their Kegels fail them. Many women also lack a core program as well that does not put pressure on the organs. I believe that the majority of women need proper guidance to do Kegels and core exercises correctly.
POP May Be Painless
Women with POP women may not experience “pain.” Some may experience back pain or sacroiliac joint pain but not pelvic pain. Just because women are not feeling symptomatic or don’t have pain does not mean that there is no damage to the pelvic floor! At the end of the day, rest assured that no matter what stage you are at with a prolapse, there is always help available to you, and most often it can be done without invasive treatment.
A good old fashion Kegel and Core program with lifestyle medicine is the medicine that most women need to heal their POP. At the end of the day, you deserve full healing and to feel whole, loved, and in control of your Queendom.
[i] (2016, January 4). FDA strengthens requirements for surgical mesh for the transvaginal repair of pelvic organ prolapse to address safety risks. Retrieved from fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm479732.htm