Pelvic Organ Prolapse - What You Need to Know.

Pelvic Organ Prolapse - What You Need to Know

Did you know that approximately 50% of women will develop some form of Pelvic Organ Prolapse in their lifetime? But what is Pelvic Organ Prolapse? How can it affect you? And what can you do about it? June is Pelvic Organ Prolapse Awareness Month, so this month’s blog at Fit For Life Physiotherapy is devoted to answering these questions.

What is Pelvic Organ Prolapse?

The International Urogynecological Association (IUGA) and the International Continence Society (ICS) define pelvic organ prolapse, or POP, as “the descent of one of more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix) or the apex of the vagina (vaginal vault or cuff scar after hysterectomy).” 

It can be hard to imagine what POP looks like. The pictures below show a side view of a female pelvis. In the first picture (Stage 0), it shows the positions of the bladder (left/front), uterus (middle), and rectum (right/back) when no prolapse is present. The pictures after that show the bladder pressing into the anterior vaginal wall, and in stages 3 and 4 the anterior vaginal wall (along with the bladder) exiting the vaginal opening. This is called cystocele.

Pelvic Organ Prolapse - Cystocele.

Uterine prolapse is depicted in the following pictures. The first picture (Stage 0) shows the pelvic organs with no POP, while the following pictures depict increasing grades of uterine prolapse.

Pelvic Organ Prolapse - Uterine Prolapse

Rectocele is shown in the following two pictures. The first picture depicts laxity in the posterior vaginal wall with the rectum pressing against it. The second picture demonstrates a way to splint the posterior vaginal wall while placing a finger or instrument inside the vagina and applying pressure back (posteriorly).

Pelvic Organ Prolapse - Rectocele

Symptoms of Pelvic Organ Prolapse

The symptoms of POP are variable–and do not always correlate well with the level of descent of the pelvic organ(s). Many people report a sensation of a bulge or fullness in the vagina, a feeling like a tampon is falling out, or pelvic pressure. Some people report difficulty emptying their bladder or bowel, urine or fecal incontinence, sexual dysfunction, difficulty achieving orgasm, and/or lack of vaginal sensation. For some people, the symptoms interfere with their participation in household tasks, work, recreational or fitness activities, and sports. They may report unhappiness, depression, and anxiety. There is often a feeling of frustration, annoyance and irritation, and a sense that they were not listened to by their healthcare providers or given options for treatment of their symptoms.

Treatment of Pelvic Organ Prolapse:

The 2019 NICE Clinical Practice Guidelines for managing Pelvic Organ Prolapse in Women recommend a multi-pronged approach:

  1. Pelvic floor muscle training:  there is excellent evidence for reducing POP symptoms by following a supervised program of pelvic floor muscle training with a Pelvic Health Physiotherapist. It is important to note that there is more to Pelvic Floor Muscle Training than just squeezing your pelvic floor. See a Pelvic Health Physiotherapist for more information.

  2. Avoiding/Treating Constipation: Management of constipation is often a team approach. Physical activity–i.e. putting the movement back in “bowel movement”--is an important first step. Optimizing hydration and nutrition–including fiber intake–are also essential. Pelvic health physiotherapy can provide education about voiding position (see picture below) and treatment of the pelvic floor muscles. If a rectocele is contributing to difficulties with bowel movements, a Pelvic Health Physiotherapist can teach you methods of splinting, along with pelvic floor muscle training.

Voiding positions to help ease constipation from pelvic organ prolapse.

3. Pessary:
a device that is inserted vaginally to help support your pelvic organs. There are several options available–some off the shelf and some custom fit to you. Speak to your healthcare team to see if this is a good option for you.

4. Medical Management: There is evidence supporting the use of local, topical, low dose vaginal estrogen. Talk to your doctor or prescriber to see if it’s right for you.

5. Surgery: For higher grades of POP that are significantly distressing to the individual, surgery may be an option. We know that outcomes after surgery are better if a person sees a Pelvic Health Physiotherapist before and after surgery for Pelvic Floor Muscle Training and management of constipation. Talk to your doctor and ask if a referral to a Urogynecologist is right for you.

At Fit For Life Physiotherapy, we have Pelvic Health Physiotherapists that are trained to help you with your POP symptoms. We have a Kinesiologist who can help take your Pelvic Floor Muscle Training to the next level by integrating it into your chosen fitness or exercise program. We also have a Registered Dietician who is an excellent resource for assisting with the management of constipation and ensuring you are fueling your body well to support the strength and function of your pelvic floor muscles and beyond. We are committed to helping you move well, live well, and be well with Pelvic Organ Prolapse. Please reach out if you have any questions.

Orthopaedic and Pelvic Health Physiotherapist Wendy Hancock can help you address Pelvic Organ Prolapse.

Wendy Hancock is an Orthopaedic and Pelvic Health Physiotherapist. She incorporates manual therapy, individualized exercise, acupuncture, education and other modalities to help her clients achieve success! 

Ready to feel your best? 
Click here to book an appointment with Wendy.