What is pelvic organ prolapse and how common is it?
Pelvic organ prolapse is fairly common and if you are diagnosed you are not alone. Two thirds of parous women who have given birth have anatomical evidence of pelvic organ prolapse (POP) but the majority of these women are asymptomatic. It has been reported that in a general population 40 % of women aged between 45 and 85 years have an objective POP on examination, but only 12 % of these women are symptomatic. Women with symptomatic POP can suffer physical and emotional distress, and it can be a huge negative impact on a women’s social, physical, and psychological well-being. The lifetime risk of surgery for POP in the general female population is 11.1 % with the surgery for POP to have a high reoperation rate.
Many women will not have any symptoms and others may have significant symptoms affecting their quality of life. Age, genetics, levator tears, birth injuries, chronic straining, and pregnancies increase your risk of pelvic organ prolapse (POP). POP can happen to all women, including those who have not had any pregnancies and young women in athletics. There are a lot of myths about POP and our goal is to break these myths and give hope to those who may be diagnosed with POP that pelvic floor PT can be very successful at resolving or managing POP symptoms, surgery is not your only option. Pelvic floor PT can be part of the treatment team including your obgyn or medical provider, therapist, nutritionist, etc. Surgery does not have a great success rate and prolapse has a high rate of returning post surgery. Learning to manage your pressure, body awareness, changing bad habits, postural corrections, and strengthening can be life changing.
What is POP? POP is when the organs in abdominal cavity descend down into the pelvic cavity and vagina. There are different types of POP. A cystocele is when the bladder descends down and starts to press into the front wall of the vagina creating a bulge in the anterior wall of the vagina. A rectocele is when the rectum descends down and starts to press into the back wall of the vagina (posterior wall) creating a bulge. A uterine prolapse is when the uterus and cervix descend down into the vaginal canal and can protrude out of the vaginal opening. A enterocele is a less common type of POP where the small intestine descends down into the pelvic cavity and causes a bulge at the top part of the vagina. A vaginal vault prolapse can occur after a hysterectomy, this type of POP involves descend of the top part of the vagina (vaginal vault) into the vaginal canal. A rectal prolapse involves a part of the large intestine that slips out of the anus.
There are different grades of POP, this describes how far down the organs have descended. Gr I-IV depending on type of prolapse. Gr I is minor descent and Gr IV is full protrusion out of the vaginal opening.
Symptoms can vary per person but commonly pressure or heaviness in pelvic region, noticeable bulge in vagina, feeling of a “tampon stuck in vagina”, or difficulty/pain with intercourse are common complaints.
Use of external or internal support options can be really helpful to support POP. Early postpartum an external option can support the perineum and healing tissues, splinting during bowel movements, and starting pelvic floor PT early can help significantly.
Compression garments like Bao Bai or EVB are companies that have shorts or legging options which are two examples of external supports. It’s important to support from the perineum or from the bottom up. We don’t want a tight compression brace on the abdomen that can cause increased pressure down into the pelvic floor.
Typically after 6 weeks or when cleared by medical provider some postpartum women will opt into trying a pessary which is an internal device that goes into the vagina and supports the organs. There are different types and sizes, sometimes there is need to try 3-5 different styles or sizes to get a comfortable fit. Different types of pessaries can support different types of prolapse.
A pessary is an option for anyone with POP. Typically a urogynecologist will fit you with a pessary. Some physical therapists are trained to fit pessaries, which is new in the USA as more advanced training options are becoming available.
Off the shelf POP internal supports work well for some. Revieve or poise impressa are two options. These look similar to a tampon and insert into the vaginal canal to support the POP. These typically work best for a cystocele or uterine prolapse.
Talk to your medical team to see if any of these may be good options for you.
Pelvic floor PT can be very helpful for POP. Surgery should not be the first step in our opinion. Working with a pelvic floor PT can help teach you how to manage your pressure in your abdominal and pelvic cavities to decrease the pressure on your organs, causing less symptoms. Having your abdomen mobility assessed, pelvic floor muscle coordination/strength/relaxation, pelvic and low back alignment, posture, and breathing are all very important areas to be assessed to determine what area will be most successful for resolution or management of symptoms. Even if you end up having surgery or other medical procedures learning these components is vital to hopefully help the long term success of your surgery or procedure.
An internal pelvic floor assessment completed in multiple positons, including during functional activities can be really helpful to determine when POP symptoms are worse and when there is more bulging or pressure in pelvic region. To help determine a proper strength program for you and determine activities that need to be modified. This of course is completed only with your consent and by a pelvic floor specialist.
Managing stress and anxiety may also be a big part of treatment and having a physcolgist or mental health specialist on your team may be very beneficial.
Managing constipation, avoiding bearing down throughout the day, paying attention to what is happening in your pelvic region to modify positions that increase symptoms, and improving movement patterns can be a game changer for POP. There are no rules of things to avoid, everyone is different and we need to find the specifics for your case.
At Dynamic Flow PT we are specialists in treatment in POP and can help you get your life back and help you get back to your sports, activities, or everyday life tasks without symptoms or less symptoms! Reach out if you need help.
To getting your life back post POP diagnosis!
Best,
Dr Laura Currens, DPT
Reference
Tineke FM Vergeldt, Miriam Weemhoff, Kristen B Kluivers. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. 13 May 2015, International Urogynecology Journal. Vol 26, pages 1559-1573.https://link.springer.com/article/10.1007/s00192-015-2695-8