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Pelvic Organ prolapse – a diagnosis unfamiliar to many and unfortunately one not spoken about nearly enough. Symptoms of prolapse are commonly experienced by women in Australia, especially those who have experienced pregnancy and childbirth. In many instances the occurrence of prolapse may have been preventable and the level of severity better managed. There are plenty of strategies woman can use to avoid a prolapse in the first place – a better understanding of this condition the best place to start.
The word ‘Prolapse’ means to slip or fall out of place. Pelvic organ Prolapse is classified and diagnosed when one or more of the pelvic organs (the bladder, uterus, bowel or small intestine) descends from its original position in the pelvic cavity and falls through to the vagina. This movement occurs following significant stress of the pelvic floor muscles, ligaments and/or the connective tissue which would ordinarily be strong and sturdy enough to hold all of these important organs in place.
Let’s talk more specifically about two types of prolapse; Bladder and Uterine.
An anterior wall prolapse or a Bladder prolapse is when a portion of the bladder, which would usually sit in front of the vagina close to the pubic bone, has descended down into the vaginal canal. In the instance of a uterine prolapse, the uterus, which would usually sit centred between the bladder and the bowel, closest to the tailbone, has descended straight down into the vaginal canal.
There are differing degrees of Pelvic organ prolapse which is best measured and diagnosed by a Women’s Health Physiotherapist. Most Women’s Health Physios will classify the level of prolapse based on a particular scale. A slight prolapse (Grade 1) means the organ remains within and very close to its original position in the body. A complete descent of the organ classifies as a Grade 5, with the organ clearly visible outside the body, beyond the vagina. Symptoms very much vary depending on the level of prolapse and from person to person.
A Bladder prolapse also known as a cystocele, is very common in women during pregnancy, post traumatic birth or even following acute or chronic respiratory issues. All of these experiences have one thing in common; pressure. Pressure placed down onto the pelvic floor and therefore onto the bladder, can cause forces in which the pelvic floor muscles and ligaments can no longer withstand. If these forces are strong enough, they will overcome the pelvic floor and it will no longer hold the pelvic organs effectively, hence causing one or more organs to bulge into the vaginal canal.
Common symptoms of a bladder prolapse are urine leakage or incontinence with force. Such forces can result from a cough, sneeze, a good laugh, heavy lifting or impact exercises such as jumping and running exercises. Women may also report trouble emptying their bladder completely and may feel the need to strain to empty the bladder or report a double void where there are two attempts in the one sitting to empty as well as lower back pain.
Uterine prolapse can cause very similar symptoms. Many women report a ‘heavy’ sensation and may even be able to feel the uterus quite close to the vaginal entrance.
It’s very common for these two types of Pelvic organ prolapses to present with secondary symptoms of constipation or trouble emptying the bowels. Constipation leads to excessive straining and pressure on the pelvic floor - in a pelvic cavity with already vulnerable pelvic organs this can be very problematic. It’s no wonder Women’s health Physio’s are a little obsessed with good toileting habits – these must be adopted in order to succeed in the alleviation of prolapse symptoms.
As outlined, prolapse can result from anything that puts excessive pressure onto the pelvic floor, including:
Although all of this can sound daunting, there are many treatment options available to help settle symptoms and ensure the woman can live a full and happy life without boundaries.
SRC pregnancy and recovery garments are wonderful as they help reduce symptoms during pregnancy and post birth, and allow woman to be mobile with less pain and discomfort during this already restricted and vulnerable time. The Restore products are also a great external wear for woman who are experiencing uterine and/or bladder prolapse as they too help to reduce the downwards pressure from gravity and can give women one less concern when out and about.
An appointment with a Women’s health Physio can help guide you through the correct treatment plan for you. Management and treatment of prolapse can start from basic lifestyle changes, such as regular pelvic floor exercises done correctly, weight management, regular low impact physical exercise and a healthy diet with lots of fibre and good toileting habits. In moderate to severe cases, a pessary can be fitted to help support the pelvic organs and lift the bulge back into a comfortable position and if all else fails, a discussion with a Gynaecologist can be arranged to discuss specialist surgery.
This blog was written by Women's Health Physiotherapist Alyssa Mesiti from The Studio Physio and Pilates in Rozelle NSW