Pelvic Organ Prolapse: What it is, signs and symptoms and what to do about it
Prolapse or POP is a condition that sounds scary. Definitions talk about it as “descent of one or more of the pelvic organs towards the vaginal opening”. It gives the image that your bladder is going to fall out of your body.
But that isn’t the case
Think about pelvic organ prolapse as an INCREASE in the range of motion of the vaginal walls. Because of the movement of the organs in our body, it is now pushing more on those walls. That is causing more movement.
Some people are more flexible than others. But there is a wide range of normal.
This is true in prolapse as well.
A better definition of prolapse is, “an increase in movement of one or more of the vaginal walls with bothersome symptoms”
In this article, we’re going to talk about
i) signs and symptoms,
ii) risk factors,
iii) types of prolapse and
iv) treatment.
We did an entire podcast episode on prolapse as well. It gets a lot of attention in pelvic health.
Signs and Symptoms of Pelvic Organ Prolapse.
The most common complaints from those experience prolapse are listed below.
Note: The amount of symptoms you feel often does NOT relate to how much movement you have. There are a lot of factors that go into how you are feeling.
A Feeling of Pressure: Often described as a sensation of pressure or fullness in the pelvic area.
Pelvic Discomfort or Pain: You can feel discomfort or pain in the pelvic region or abdominals. This discomfort might be worse after prolonged standing, certain types of exercise.
A Vaginal Bulge or Something Coming Out: Some may feel or see a bulge at the vaginal opening. This bulge can be the vaginal wall being seen from the outside. It is similar to a hernia.
Poop Problems: This can be constipation or a sensation of feeling like you can’t get your poop out.
Urinary Symptoms: Prolapse can be a factor in leaking (urinary incontinence or feeling like you can’t emptying your bladder.
Painful Intercourse: You may experience pain during penetration.
Lower Backache: Prolapse can cause lower back pain or discomfort.
Risk Factors for Prolapse
MOST of the risk factors for POP are completely outside your control. We are going to start there. So many mamas blame themselves for their symptoms. It simply isn’t true that you somehow “did this to yourself”. Let’s list these risk factors out.
Vaginal Birth: We expect our skin to change during pregnancy and birth but not our vaginas. Having baby come through the birth canal stretches the vaginal walls. Some increase in movement after vaginal delivery is normal. Long lasting symptoms are not. This risk increases with longer pushing stages or instrumental delivery.
Age: Estrogen helps the tissues of the pelvis. As we get older, estrogen goes down. Postmenopausal hormonal changes can also contribute to tissue atrophy, making POP more likely
Obesity: Extra weight around your midsection places extra stress on the pelvic floor.
Chronic Constipation: Straining during bowel movements places more pressure on the pelvic floor. Over time it can impact symptoms of prolapse.
Chronic Coughing: Coughing puts pressure on the pelvic floor. If you have a condition where you are coughing daily, over time that can lead to prolapse.
Connective Tissue Disorders: Connective tissue disorders like Ehlers-Danlos syndrome the support around the pelvics.
Being lower in estrogen: Lactating and menopause are estrogen low states. It is why we can see more prolapse symptoms during this time.
When we are talking about types of prolapse, we consider two things: grade and location.
Grading of Pelvic Organ Prolapse
The grade refers to the amount of movement you see on a bear down.
The clinician will ask you to bear down or strain as if you were going to give birth or have a hard bowel movement. They will then see how much range of motion changes with that movement.
Grading is made relative to the vaginal opening or the hymen. Simplistically, grading is like this
Grade 0 = no prolapse (this is a unicorn – I don’t see this)
Grade 1 = little bit of movement
Grade 2 = moderate amount of movement
Grade 3 = movement to the opening of the vagina
Grade 4 = moves into the outside space past the vaginal movement
** Most people that have given birth vaginally are at least a grade 1 or grade 2! Again these are normal changes after a vaginal birth. **
Type of Pelvic Organ Prolapse
Type refers to the location of movement. We used to talk about the organ causing movement. That is a bit outdated. Now it refers to the compartment where we are seeing more movement. Some people have movement in all compartments. Some are just one wall. It depends on the person.
Anterior Prolapse: Occurs on the wall between the bladder and the vagina. Previously called a cystocele.
Apical Prolapse: Also called a uterine prolapse. This happens when the uterus descends downward and you see movement from “above”.
Posterior Prolapse: Also known as a rectocele. Occurs on the wall between the rectum and the vagina. This can result in difficulty with bowel movements.
Vaginal Vault Prolapse: This type of prolapse can occur after a hysterectomy.
So you have a prolapse, now what?!
Having a prolapse and having symptoms of prolapse can be two different things.
You can run, jump, play, lift with a prolapse.
Where we are going to be treating, is with the symptoms of prolapse.
Conservative methods (aka no surgery) are the first-line and often work best for POP.
Here are some treatment suggestions that you may consider:
1. Pelvic floor muscle training: Being too tight or too weak in your pelvic floor may lead to symptoms. Working on strengthening or relaxing may help.
2. Hips up/ Pelvic rest position: Hips under a pillow with feet up on the wall can help with short-term symptoms. Stay in that position for 3-5 minutes.
3. Clear up any constipation: Constipation causes you to strain to poop. It can make your prolapse symptoms feel worse. Try to increase water and fiber intake in your diet.
4. Stop straining: This can be with pooping or with lifting. Bracing shouldn’t be a bear down. Brace should be about abdominal tightening.
5. Take signals about exercise intensity when symptoms come on. If you have heaviness with lifting, it is okay! It’s a sign your body’s tired. Change your breath strategy or lower the weight and finish your workout. It could take 24-48 hours for symptoms to go back to baseline just like sore legs after squats.
Know that symptoms DO NOT EQUAL damage! Having an increase in symptoms does not mean your prolapse is getting WORSE. Many times, it is a sign your body is tired.
6. Pessary: A pessary is like a brace for the vagina. They come in different shapes and sizes. They help support the walls of the vagina when they need some help. You can keep a pessary in for several months or just put it in when you need it (like exercise).
7. Surgery: Surgery for POP is used when i) conservative care has not improved symptoms and ii) it is a higher grade. Surgery should be reserved for grade 3 and 4 prolapse. There are options to surgery and it can definitely help with symptoms. Consult a urologist or urogynecologist if you think this is the route for you.
We hope this gave you education and not fear about prolapse. You can do a lot with it. It is not the end of your exercise journey and if you need help, get a pelvic floor physical therapist to help you out!
Did this help?! Let us know what else you want to learn about!
Christina Prevett is a pelvic floor physiotherapist who has a passion for helping women with different life transitions, including postpartum care and menopause.
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