It’s estimated that up to 50% of women will experience some form of prolapse in their lifetime. For something so common, it’s not widely talked about and often misunderstood. Women’s Health Physiotherapist, Clare Turnbull, is on hand to explain what prolapse is and how it can be managed.
Pelvic organ prolapse (POP) is when one or more of the pelvic organs descends into the vaginal cavity.
Our pelvic organs are the bladder, bowel and uterus. They are primarily supported by fascia and connective tissue, which act as the elastic supports that hold the organs within the pelvic cavity. Pelvic floor muscles, which are located in between the tailbone and pubic bone, are important, but they are more of a backup system. Over time or due to trauma, the connective tissues may stretch, which allows more movement of the pelvic organs and can lead to prolapse symptoms developing.
The most common symptom of pelvic organ prolapse is vaginal bulge, but other symptoms include heaviness or dragging, pain during intercourse and low back ache.
People experiencing prolapse may also have difficulty emptying their bladder and feel like they need to lean forwards to empty it fully, or have difficulty emptying their bowel, which could include straining, using a finger or hand to help empty the rectum, or feeling like you haven’t completely emptied your bowel.
However, sometimes the symptoms can be really mild or completely undetectable. There are varying stages of prolapse to define severity, but having a more advanced grade prolapse does not always correlate with having noticeable symptoms.
Prolapse can affect women of all ages at any time in their life, but is most common in postnatal women, particularly if they have had a vaginal delivery, more than one baby, a baby with a large birthweight, or an assisted delivery involving instruments such as forceps or a ventouse. Even women who have a caesarean section can experience prolapse after giving birth, due to increased weight on the pelvic area from carrying a baby throughout the course of pregnancy.
It’s more likely to present in women with a history of smoking, chronic coughing, constipation or repetitive straining, or those who have a history of extremely heavy lifting over long periods of time. People with hypermobility issues can also be more prone to prolapse due to the increased movement of their connective tissues, as can those with a family history of prolapse.
There is evidence to suggest that perimenopausal or post-menopausal women may be more likely to develop prolapse symptoms due to the hormonal changes taking place within the body during this time, with less oestrogen being produced making the connective tissues that support the pelvic organs more sensitive to movement.
Everybody is different and prolapse will affect people differently, but there are lots of treatment options available, depending on how the anatomical grading of the prolapse and how much the symptoms are bothering them.
A Specialist Women’s Health Physiotherapist can conduct a pelvic floor assessment and diagnose prolapse based on symptoms. They can assess movement of the pelvic organs, strength and endurance of your pelvic floor muscles and provide exercises to help reduce prolapse symptoms.
A physiotherapist can also give lifestyle advice on modifications you can make to help manage prolapse-related symptoms. This includes improved bowel management, guidance around exercise including best positions to exercise in, weight reduction and pacing aggravating activities, and stopping smoking and weight loss if relevant.
Because pregnancy and childbirth can increase the risk of prolapse developing, I would highly recommend expectant mothers to visit a Women’s Health Physiotherapist before giving birth. Pelvic floor physiotherapists can safely perform pelvic floor assessments after your main morphology scan (usually from around 20 weeks). The advice and guidance that a specialist can provide during your pregnancy can have a huge impact on your experience of labour and as a new mum, and can help to inform your birth choices to reduce the risk of prolapse and pelvic floor dysfunction.
Importantly, a specialist physiotherapist can predict risk factors for pelvic floor dysfunction that might affect you in the future. That’s why it’s also a good idea to see a Women’s Health Physiotherapist after you have given birth, as they can conduct a postnatal pelvic floor assessment to see how your body is recovering and whether there are any indicators that suggest you may be at risk of prolapse developing.
Lots of women may experience vaginal heaviness or dragging in the weeks after they have delivered a baby, but these symptoms can also be caused by tightness or overactivity of the pelvic floor muscles, and don’t always indicate pelvic organ prolapse. If you are experiencing any symptoms, make sure you get checked out by a trained professional who can provide reassurance and treatment if needed.
Pessaries can also be used proactively to help reduce the risk of developing a prolapse (where appropriate) or for situations where additional support is needed to support the vaginal walls. A pessary is a silicone device that is inserted vaginally to help relieve prolapse symptoms and prevent the prolapse from worsening, by taking the load off of the connective tissues. It can provide additional support when exercising, and can make a really big difference in improving your quality of life. Other treatment options include surgery and topical oestrogen cream.
Six Physio has launched a pessary fitting service which is currently available at our clinics in Fitzrovia, Kensington and Lindfield. If you think you might benefit from a pessary, our Women’s Health team can talk to you about the different types that are available and which may be most suitable. They can also provide pessary management advice including how to remove and reinsert the pessary if needed. You can find out more about this specialist service here.
