Pelvic Organ Prolapse
What is it?
Pelvic organ prolapse (POP) is bulging/dropping of the pelvic organs into the vagina. POP can also refer to changes in the rectum and perineum. The most common form of prolapse is an anterior vaginal wall prolapse, previously called a cystocele or urethrocele. This is a protrusion of the bladder into the vaginal space. Prolapses can also occur with the rectum, the uterus, the vaginal vault (post-hysterectomy), or the small intestines.
How common is it?
Some form of prolapse affects approximately 50% of women. Men can develop rectal prolapse but it is less common than in women.
What causes it?
Factors include aging, pregnancy and delivery (especially vaginal birth, prolonged second stage of labor, and instrumental delivery), previous pelvic surgery, smoking, chronic pulmonary disease or cough, constipation, obesity, heavy manual labor, repetitive heavy lifting or straining.
What are the symptoms?
Possible symptoms include lower abdominal, pelvic, or low back pain; feeling of pelvic pressure or heaviness; incomplete bladder or bowel emptying; incontinence; urinary urgency or frequency; slowed urine stream; splinting to void; awareness of a bulge; discomfort or pain during sex.
How is it assessed?
A physical therapist screens for prolapse by inserting 1-2 fingers vaginally, asking the client to bear down, and then visualizing or palpating a bulge and its location. A more specific assessment can be conducted by a gynecologist or urogynecologist to assign the stage of prolapse. Generally, stage 0 is no prolapse, stage 1 is descent of organs into vagina, stage 2 is descent to vaginal opening, stage 3 is descent beyond vaginal opening, and stage 4 is all of the pelvic organ beyond the vaginal opening.
How is it treated?
There are 3 main options for POP treatment: pelvic floor physical therapy, pessaries, and surgery. Sometimes only one of these treatments is pursued, sometimes multiple options are pursued. Pelvic floor physical therapy is highly effective in resolving the symptoms of POP, reducing grades 1-2 of POP, and may be recommended as “pre-hab” for those pursuing surgery. Pessaries are silicone supports that are inserted vaginally to support the prolapsed organs. They are usually specially fitted in a urogynecologist’s office.
How do I manage it?
When you have POP it’s important to:
Avoid pushing when you pee and poop. Diaphragm breathing and a squatty potty can make using the bathroom easier and reduce strain.
If you have a cystocele/anterior vaginal wall prolapse: lean forward or gently press above your pubic bone to ensure you have fully emptied. If this is not adequate for you to fully empty your bladder, you might try “double voiding”: After you have peed, stand up and move around a bit to reposition your bladder (turn around in a circle, or walk the length of the bathroom). Then, sit back down again and allow your bladder to empty a second time.
If you have a rectocele/posterior vaginal wall prolapse: When pooping, try “autosplinting.” Insert a finger or a device like the CMT Release tool vaginally and exert gentle pressure posteriorly to reposition the rectocele, permitting the BM to pass through the rectoanal canal without strain
If you have perineal laxity, try pressing up on your perineum when you have a bowel movement to assist emptying
Have regular, soft bowel movements. Adequate fiber and water intake are important. Poop should be like a soft sausage shape in consistency.
Don’t stop moving, but do rest when you have bothersome symptoms. The key is to rest if you feel pelvic pressure, find comfortable positions to alleviate symptoms so you regain control, and learn to strengthen your pelvic floor to improve your activity endurance over time.
Learn how to do “The Knack” to support your pelvic organs when performing activities that increase intra-abdominal pressure. By building up pelvic floor strength and coordination, you can use your muscles to effectively support your organs when you cough, laugh, sneeze, lift, push, pull, bend, and stand.
Pelvic Care Physical Therapy
3770 W. Robinson St. - Ste. 112 - Norman, OK - 73072
www.pelviccare.org - 405.240.9575 – info@pelviccare.org
