Pelvic Organ Prolapse

The pelvic organs, which includes the bladder, uterus and bowels are held in its anatomical position by the pelvic ligaments and the pelvic floor muscles. Pelvic organ prolapse occurs when the support structures are weakened, which then causes the sensation of pelvic dragging or heaviness, or it can feel like a vaginal lump or bulge. 

Occasionally, this can be felt at the vaginal opening, or outside the vagina, and this can contribute to pain, anxiety due to the prolapse and can cause great bother for the woman.

 

What causes pelvic organ prolapse?

The main risk factors for pelvic organ prolapse includes:

– Vaginal birth, including usage of vacuum or forceps, birth of large baby (>4kgs), long pushing stage during birth

– Chronic constipation

– Recurrent Heavy lifting

– Genetic predisposition, including Ehler Danlos syndrome, or hypermobility

– Chronic coughing

– Previous prolapse surgery

– Previous hysterectomy

– Having more than one vaginal birth

– High BMI

– Perimenopause or postmenopause

What are the signs and symptoms of pelvic organ prolapse?

Some women with a mild pelvic organ prolapse might not have any symptoms or discomfort at all, and may only feel the symptoms when they have overexerted themselves eg: hiking with a heavy backpack, or carrying their baby for a long duration of time.

 

Signs and symptoms of pelvic organ prolapse includes:

– Sensation of pelvic dragging or heaviness

– Feeling of vaginal lump/bulge (especially when using the toilet or when showering)

– Incomplete emptying of bowels

– Incomplete emptying of bladder

– Low back pain that eases with laying down or after sleeping

– Pain during intercourse

 

How do we diagnose pelvic organ prolapse?

Clients who often suspect the diagnosis of pelvic organ prolapse are often very worried that the prolapse would worsen, and that they might have exacerbated the prolapse with their daily activities.

Physiotherapist Aileen listens to your history, your symptoms and your concerns, asks you about your symptoms, and would proceed to complete a comprehensive assessment to address you’re the prolapse and the contributing lifestyle factors to your pelvic organ prolapse. Based on the assessment, she would normally complete an internal vaginal examination laying down to further diagnose the type of prolapse that you might have.  The type of prolapse refers to the organ (uterus, bladder or bowels) that is affected, and there are also different stages (stage 1-4) for a prolapse.

Physiotherapist Aileen is extremely thorough and comprehensive, and would normally complete a standing vaginal examination (as permitted by you) as it is a functional position, and because gravity would contribute to further lowering of the prolapse.

 

How do we help with pelvic organ prolapse?

Based on research, pelvic floor exercises are shown to help to lift up and support your pelvic organ prolapse, thus preventing it from worsening. In these research papers, it is highly important that your pelvic floor program is individuslised, tailored to you and progressed as soon as possible to improve your pelvic floor strength. Thus, physiotherapist Aileen would provide you with a clear and concise pelvic floor exercise plan.

We would also discuss activities (including exercise) to avoid to reduce your prolapse symptoms and to prevent your prolapse from worsening, which may include discussing ways of managing your constipation.

If required to, physiotherapist Aileen can fit a vaginal pessary to further reduce your symptoms, and will work with your gynaecologist and your general practitioner to aid with managing your pelvic organ prolapse.

 

What exercise is safe to do for pelvic organ prolapse?

Clients with pelvic organ prolapse often find it rather tricky to exercise as it can often worsen their symptoms, hence worsen their prolapse.

Firstly, doing your pelvic floor exercises everyday, as prescribed is extremely important to improve your pelvic organ prolapse.

Furthermore, we highly advice and encourage clients to add in clinical exercise (pilates) as a form of exercise. Clinical exercise (pilates) is extremely pelvic floor friendly and is targeted to your pelvic floor muscle strength, your overall body and core strength. 

Clients with prolapse often need to getstronger in their core, glutes and their large muscle groups to reduce weight, tone their muscles and improve their pelvic floor strength.

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