What is a Prolapse?

Prolapse is the descent of one or more of the pelvic organs (bladder, bowel or uterus) into the vagina. It is due to a lack of support from the pelvic floor muscles & surrounding tissue.

 

 

How do you know if you have a Prolapse?

There are different severities of prolapse. At one end of spectrum women can have a mild prolapse but may not have any symptoms. A GP may detect the prolapse during a Pap smear or a Women’s Health Physiotherapist will assess for prolapse during a pelvic floor assessment.

On the other end of the spectrum, women can have a more severe prolapse so they feel vaginal heaviness or a bulge when they wipe themselves. Women have commonly described a severe prolapse as if their insides are falling out!

The best way to assess whether you have a prolapse & ascertain its severity is by booking in to see a Women’s Health Physiotherapist

 

 

What are common Prolapse symptoms?

Here is a list of prolapse symptoms – you don’t have to experience all of these symptoms to have a prolapse.

  • Vaginal heaviness or dragging sensation- you may only feel this at the end of the day after prolonged standing/walking.
  • Lump or bulge protruding from the vagina
  • Backache
  • Bladder leakage
  • Incomplete bladder or bowel emptying

One thing is for sure – prolapse can be very uncomfortable & can greatly affect a woman’s activity level & confidence.

 

 

What should you do if you find out you have a Prolapse?

Don’t freak out!!! As uncomfortable & mentally challenging as it might be for you, try to stay positive, as there is so much you can do to help yourself. Just keep calm & keep reading to find out.

 

 

Is it normal for women to have a Prolapse?

NO!! Despite what some people/doctors say, prolapse in NOT normal. It is common but this is very different to being labeled ‘normal’.

1 in 2 women will experience a prolapse after childbirth – regardless of whether they give birth vaginally or via caesarian.

It is important to note that caesarean sections do NOT protect against pelvic floor dysfunction & prolapse. There can be a delayed onset of prolapse symptoms after birth, which means that the prolapse may occur months or years after childbirth.

 

 

What increases your risk of Prolapse?

  • Childbirth
  • Instrumental delivery i.e. forceps
  • Large infant >4500g
  • Prolonged second stage of labour
  • Multiple births
  • Pregnancy- hormones & increased weight
  • Returning to high impact exercise too quickly after childbirth
  • Chronic coughing
  • Chronic vomiting
  • Chronic constipation
  • Repetitive heavy lifting
  • Physically stressful occupation
  • Obesity
  • Gynaecological surgery e.g. Hysterectomy
  • Weak connective tissue
  • Genetic link- if other women in your family have a prolapse
  • Menopause
  • Ageing

 

 

Can you prevent a Prolapse?

YES!! Read how below.

 

 

How can you prevent & treat a Prolapse?

Research has shown that conservative measures can prevent & reduce prolapse, alleviating symptoms. These include:

 

1. Pelvic floor exercises.

Regular pelvic floor exercises have been shown to both prevent prolapse by maintaining a strong support for the organs & treat prolapse by improving the position of the prolapse.

Doing pelvic floor exercises religiously during pregnancy & again straight after childbirth can help to prevent prolapse.

But it doesn’t stop here – Pelvic floor exercises are equally important after your childbearing years. As women move towards menopause hormone changes can predispose them to prolapse.

Download my FREE Pelvic Floor Guide & get started on these exercises pronto!

Prevent & treat Prolapse with this FREE Pelvic Floor Guide!

2. Prepare yourself for childbirth.

You can’t control what happens during childbirth but you can prepare your body to the best of your ability. One way is learning how to relax your pelvic floor completely, releasing all tension out your body. Mindfulness & breathing techniques are a way to achieve this.

To learn more, enrol yourself in a quality birth class that focuses on the physical & mental components of birth. I recommend She Births & Calm Birth.

 

3. Optimize your recovery after childbirth.

Make sure you dedicate the first 6 weeks after childbirth to allowing your body to heal with adequate rest. Your body has gone through 9 months of carrying a baby & then birthed a baby. In addition to this there are all sorts of hormonal changes that have gone on which continue to impact the strength of your body & pelvic floor.

The introduction of exercise needs to be slow & steady after you have had your 6-week check up with your doctor. At this time, I also recommend seeing a Women’s Health Physio to assess how your pelvic floor is recovering.

Starting with low impact exercise like walking, swimming, cycling, light weights, Pilates & Yoga is key. As long as you are symptom free (see list above) the gradual introduction of higher impact exercises after 12-weeks may be safe. However I recommend gradually increasing the intensity of exercise like trialing a walk-jog rather than throwing yourself into a boot camp or 5km run.

4. Choose appropriate exercise if you have a prolapse.

Women with prolapse symptoms should avoid high impact exercise or sport (involving running, jumping), excessive abdominal crunches & low squats. You should also avoid any heavy weights. Therefore cross fit, boot camps & most personal training sessions are out of the question. 

Instead opt for the low impact exercise options mentioned above; making sure the exercise you choose does not cause any prolapse symptoms.

 

5. Avoid constipation & straining.

Click here to read my post on treating constipation.

 

6. Avoid heavy lifting.

This includes weights at the gym, furniture, gardening AND repetitive lifting & carrying of toddlers. Before you call me crazy, hear me out! Encourage your toddler to be as independent as possible, use the pram, give cuddles on the couch, get your partner or paid help to lift them in & out of the bath/highchair/cot as much as possible. The short term pain is worth the long term gain!

 

7. Get treatment if you have a cough.

Or even better – stay healthy & keep your immune system working at maximum!

 

8. Listen to your body.

If an activity, exercise or household chore doesn’t feel right for your body, then stop & don’t do it again. Find alternatives where your body feels good.

 

9. Work on your posture.

Sitting & standing upright helps to activate your pelvic floor & deep abdominal muscles. This in turn supports your internal organs & provides stability to your pelvis & spine.

 

10. Weight loss (if you are overweight).

Increased weight, especially around the abdomen places increased pressure on your pelvic floor. Weight loss can be achieved by combining healthy eating habits with 30-60 minutes of moderate intensity exercise a day.

 

11. Lie down with your pelvis elevated.

Rest for 10-30 minutes EVERY afternoon/evening with pillows under your bum to elevate it. You can do this lying on the floor next to bubs with your feet up on the couch. This position uses gravity to assist bringing the prolapse back into position. To maximise the benefits of this postion, do a set of your pelvic floor exercises as well.

 

12. Consider a support pessary.

If you have a more severe prolapse, a pessary may be a good option for you. A pessary is a silicone device inserted into the vagina to support the prolapse & the weakened pelvic tissue.  Speak to your Women’s Health Physio or Gynaecologist regarding being fitted with a suitable pessary.

 

 

Is surgery an option for Prolapse?

I am a strong advocate for conservative management but in some instances, severe prolapses require surgery. If this is the case, pelvic floor exercises should be undertaken before & after the operation. This is in particularly important seeing as surgery has a considerable failure rate of 30-58% & a reoperation rate of nearly 30%! This is another reason why conservative management & therefore Women’s Health Physio is the place to start in treating prolapse.

 

 

I hope you feel more empowered now that you know what action you can take to both prevent & treat prolapse. I am here for you every step of the way so reach out if you have any questions.

 

 

Anna x

 

 

References:

Abrams P, Cardozo L, Khoury S, Wein A (Eds) (2013) Fifth International Consultation on Incontinence. Plymouth: Health Publications.

Braekken IH, Majida M, Engh ME, Bo K (2010) Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. American Journal of Obstetrics and Gynecology 203: 170-177.

Hagen S, Stark D (2011) Conservative prevention and management of pelvic organ prolapse in women (review). Cochrane Database of Systematic Reviews: 1-72.

Maito JM, Quam ZA, Craig E, Dannerq KA, Rogers RG (2006) Predictors of successful pessary fitting and continued use in a nurse-midwifery pessary clinic. The Journal of Midwifery & Women’s Health 51: 78-84.

Thakar R, Stanton S (2002) Management of genital prolapse. British Medical Journal. 324: 1258-1262.

Thompson JA, O’Sullivan PB (2003) Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review. International Urogynecology Journal 14: 84-88.

Whiteside JL, Weber AM, Meyn L, Walters MD (2004) Risk factors for prolapse recurrence after vaginal repair. American Journal of Obstetrics and Gynecology. 191: 1533–1538.

 

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