Pelvic Organ Prolapse

PELVIC ORGAN PROLAPSE (POP) is a foreign concept for many, and can be pretty confusing for those who have actually heard of it. You may find yourself asking “my what is where?” or “can that really happen?”. I will break down what POP means and debunk some of the misconceptions. Let’s demystify what is actually going on in order to really get real about our bodies. This way we can start living our lives more responsibly and caring for ourselves with longevity in mind.

Your pelvic organs (bladder, uterus, and rectum) are interconnected by fascia and connective tissue. This connective tissue attaches to the inside of the pelvis to keep the pelvic organs lifted inside the “pelvic bowl”. The PELVIC FLOOR MUSCLES (PFM’s) are a sling-like group of muscles at the base of the pelvis. These muscles wrap underneath the pelvic organs to give them additional support. If the CONNECTIVE TISSUE is stretched, one or more of the pelvic organs can shift down into the vaginal canal and create an array or symptoms. The connective tissue can be disrupted by either a trauma like childbirth, or repetitive downward abdominal pressure like chronic straining associated with constipation. The tricky thing about this is that connective tissue does not regain elasticity once stretched too far. However, PFM’s and other supporting teammates can regain strength and coordination to minimize the prolapse and better support it. We can also learn techniques to manage our pressures on the pelvis from above (abdominal pressures) and below (ground reaction force) to further support these structures.

SIGNS & SYMPTOMS to be on the lookout for (may include one or more of the following):

Now let’s debunk some MISCONCEPTIONS going around about POP:

Myth #1) “I thought prolapse only happens to women who have a vaginal childbirth”.

POP can happen to women who have experienced VAGINAL or CESAREAN deliveries. The weight and pressure from baby and uterus during pregnancy, as well as mom’s body mechanics and genetic predisposition are thought to have an effect on the fascial structures. In addition, any sort of pushing during labor can stress the connective tissue even if the baby does not end up being delivered through the pelvis.

POP can also occur if a woman has never given birth! Prolapse is a concern for any woman who has routinely pushed their urine out with their abdominal pressure, or who may chronically strain to have a bowel movement due to CONSTIPATION. Learning effective strategies to avoid this type of downward pressure can help to prevent and treat POP.

We also see a higher risk of POP with ATHLETES who lift heavy weights, and/or participate in high intensity sports/fitness. Athletes may be putting their tissues at risk with breath holding and bearing down strategies, and compensatory postures that strain the pelvic system. It’s not to say we shouldn’t be doing these types of activities, rather how can we do these activities more responsibly. Breathing strategies, managing intra-abdominal pressure (IAP), optimizing posture, and developing muscle coordination will help the female athlete achieve her fitness goals without forfeiting bladder, bowel, and/or sexual health.

Myth #2) “I must just be weak and didn’t do enough Kegels for this to happen to me”.

It can be surprising to hear that someone with POP may actually have tight PFM’s. It took me a while to wrap my head around this concept as well! Many women with POP are convinced that they must not have worked hard enough at strengthening their pelvic floors to prevent this from happening. Let’s remember that it’s the connective tissue that has been disrupted that caused the POP (not the PFM’s). The PFM’s that lie underneath the pelvic organs now have a bigger role in “holding stuff up”. This can cause the PFM’s to become overactive leading to muscle tension, and fatigue. It is rather counterintuitive to focus on lengthening your PFM’s when addressing POP. Conflicting as it may be, the PFM’s need to have a good range of motion (lengthening and shortening) for an effective contraction. A TIGHT MUSCLE IS A WEAK OR INEFFECTIVE MUSCLE. The PFM’s also need some down time. Some time to “turn off” and rest from constantly trying to keep “the sky from falling”.

Myth #3) “My doctor diagnosed me and scheduled surgery. I must need this surgery to fix my problem”.

Surgery will depend on the severity of the prolapse (how far down or out of the vagina is the pelvic organ(s)), and what are your symptoms. Rehab can help teach you ways to manage your symptoms conservatively and AVOID SURGERY. The focus is on balancing the PFM’s, core training, managing intra-abdominal pressure, and minimizing challenges to the system. We can modify posture and breathing strategies to minimize the downward force applied to the pelvic organs. Rehab can also adjust how you approach certain tasks to reduce the demand. Be sure to explore your options and goals before committing to a surgery. Often, there are no additional health risks from POP and if the symptoms can be managed with rehab, then surgery is not necessary.

However, surgery may be recommended if the symptoms are not successfully managed with conservative techniques, and/or if the individual is at risk for additional complications. It is just as important for the surgical candidate’s to establish more optimal habits in order to protect the procedure. Rehab before and after the surgery can OPTIMIZE THE SUCCESS RATE OF YOUR SURGERY. I have seen far too many folks with a surgical repair that have come “undone”. This is often because no one ever taught them the contributing factors that lead to their POP in the first place. If you have had a surgical repair, or are considering having one, let’s make sure it is successful for the long term. Other considerations to investigate prior to surgery is a pessary (device inserted into the vagina to designed to create support to the structures), and other potential symptoms that could arise post surgery. For example; you may not be experiencing urinary leakage with your POP because the shifted position could actually be helping with closing off the urethra. Once you lift the bladder back into place, there is a chance for the onset of other symptoms such as leakage to develop. This is not to scare anyone, but to present you with all the possible outcomes and to be able to make an informed decision about what is right for your body.

Awareness and Prevention:

The earlier we start to consider safe ways to manage our pressure systems, the better chance we have at preventing POP all together. It’s much easier to just skip it than to have to treat it! The ultimate goal is to EMPOWER OUR YOUNG FEMALES with the knowledge to make safe choices and develop healthy habits to protect their bodies for the demands of life that lie ahead.

Being familiar with the signs and symptoms will aid in early detection of POP. The sooner POP is identified and addressed, the more successful the outcomes are for treating the symptoms and preventing further progression.

Roles rehabilitation can play in managing POP:

When looking at POP from a structural and pressure management standpoint, we can then start to develop healthy habits that support these structures to replace the ones that are working against them. The first and hardest step is to start the conversation! The more we start to open up about these taboo and embarrassing experiences, the quicker we can start to do away with them! I would like to help end the isolation and unnecessary acceptance of POP. Ask questions, seek guidance from specially trained professionals, and get back to doing the things you love!!

Achieving our best lives,

Laura Rowan, OT/L
Pelvic Rehab Specialist
Essential Pelvic Health

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