What is Prolpase?
Pelvic Organ Prolapse (POP) refers to the bulging or dropping of one or more of the pelvic organs from their normal position into or out of the vagina. The pelvic organs consist of the uterus, vagina, bowel and bladder. These organs are held in place by the pelvic floor, ligaments and fascia (a network of supporting tissue). Pelvic organ prolapse occurs when these muscles, ligaments and fascia that hold these organs in their correct positions become weakened or damaged.
Up to 75% of women will develop some form of prolapse in their lifetime
What can cause POP?
The main cause of POP is pregnancy and Vaginal delivery, particularly a vaginal birth involving a long pushing stage or forceps, but other things that can also cause POP include:
Ageing and menopause
Chronic coughing
Being overweight/obese
Chronic constipation
Heavy lifting
Genetics
Symptoms can include:
A heavy dragging feeling in the vagina or lower back
Feeling of a lump in the vagina or outside the vagina
Urinary symptoms such as slow urinary stream, a feeling of incomplete bladder emptying, urinary frequency or urgent desire to pass urine, and urinary stress incontinence
Bowel symptoms, such as difficulty moving the bowel or a feeling of not emptying properly, or needing to press on the vaginal wall or rectum to empty the bowel
Discomfort during sexual intercourse
Locations and types of prolapse:
A prolapse may arise in the front wall of the vagina (anterior compartment), or back wall of the vagina (posterior compartment), the uterus or top of the vagina (apical compartment). Many women have a prolapse in more than one compartment at the same time.
Anterior Wall Prolapse: This is when the bladder drops down and pushes the front wall of the vagina downwards. Your care provider may refer to this as a cystocele.
Posterior Wall Prolapse: This is when the lower part of the large bowel (rectum) bulges into the back wall of the vagina and/or part of the small intestine bulges into the upper part of the back wall of the vagina. Your care provider may refer to this as a rectocele.
Uterine prolapse: This occurs when the uterus (womb) drops or herniates into the vagina. This is the second most common form of prolapse.
How do you stage prolapse?
Prolapse can occur in different stages which range from stage 0, where organs are in the most anatomically correct position, to stage 4 where they are external to the vagina. Most commonly prolapses will be stage 1 -2, and less often will they be stage 3 and 4.
The stages of prolapse are based on the POP-Q system of measurement:
Stage 0: there is essentially no prolapse demonstrated.
Stage 1: there is a little bit of downward movement of the pelvic organs, however they are still high in the vagina and you may be asymptomatic.
Stage 2: one or more of the pelvic organs has descended and may be just inside the entrance of the vagina. You may be able to feel this, or you may be asymptomatic. Up to 47% of women will have a stage 2 prolapse.
Stage 3: one or more of the pelvic organs has descended past the entrance of the vagina. You may feel or see a bulge at the entrance of the vagina and you may have symptoms of heaviness and urinary and bowel dysfunction.
Stage 4: one or more of the pelvic organs are >2cm outside the vagina. This stage of prolapse is rare.
While this may seem scary, a lot of prolapses can become asymptotic and having a pelvic organ prolapse does not mean it will affect your everyday life forever.
There are lots of ways we can help you!
Your treatment options may include:
Do nothing: When you have a diagnosis of prolapse there is always the option to do nothing, depending on how bothersome the symptoms are. A prolapse is only an issue if you find it bothersome or if it is affecting your daily life. Some women will be asymptomatic and sometimes a prolapse can be an incidental finding on a vaginal exam, which in these cases, nothing really needs to be done. Many women will choose not to have any treatment if they have no symptoms or discomfort. However if you do have prolpase screening for risk factors and ensuring it doesn’t progress to the point of bother is still really important!)
Lifestyle modification: if you want to do something about your prolapse then there are a number of things you can implement in daily life that may help to prevent your prolapse from getting any worse and/or to decrease and eliminate your symptoms. If you have been diagnosed with prolapse then the following may be helpful for you:
Avoid straining when opening your bowels: It’s important to manage the pressure in your abdomen and straining to open your bowels will create a large increase in intra-abdominal pressure, which is not what we want! Ensure your stools are soft and easy to pass. You can do this by ensuring you drink enough water each day and eat a diet rich in fibre (lots of fruits and veggies). Also try to use correct bowel techniques like using a foot stool and leaning forward. Note however that this sitting posture is not always appropriate positioning for your prolapse, so talk to your trusted health care provider about what is appropriate for you.
Choosing the right exercise: sometimes exercise can worsen your symptoms, but not all exercise is likely to do this. Having an individualised assessment will help you to determine what exercise is appropriate for you and how to progress back to the type of exercise you want to be doing be that running, HITT, yoga, dance, pilates, etc. We can help you not only exercise safely whilst you have symptoms but help you return to the type of exercise and activity that you love!
Keeping your weight at a healthy range: excess weight can worsen your prolapse symptoms so trying to manage your weight with diet and appropriate exercise will help to manage you symptoms.
Pelvic floor exercises (or 'kegels' if you know them by this name): Often prolapse symptoms can be assisted by working your pelvic floor whether that be working on your strength, endurance or co-ordination. Keeping your pelvic floor strong and active will help to assist in symptom management and potentially in avoiding any worsening of the prolapse. Our team of pelvic floor physios will be able to individualise a program that is right for you. It's important to ensure that you can contract and relax the pelvic floor properly but also that you are doing the right number of sets and reps, so ideally you seek individual advice for this.
Pessaries: Pessaries are vaginal devices that come in various shapes and sizes. If a pessary is appropriate it will be fitted by a health care professional who will teach you how and when to use it. Fitting a pessary can sometimes require some trial and error to discover which device and size is right for you, so there is no one size fits all approach. Pessaries work by providing mechanical support to the prolapsed organs, which can help to relive symptoms. Our team has undergone advanced training and can fit a pessary for you.
Surgery: In some cases pelvic organ prolapse may require surgery to completely eliminate symptoms or when conservative manage has not been effective. 1 in 9 women will choose to have surgery to correct their prolapse. In this case there is also a role for proper pelvic floor rehab and life style advice post-surgery in order to prevent symptoms from returning and ensuring the pelvic floor stays strong.
Some questions to consider asking your health care provider when discussing prolapse and your treatment options include:
What are the chances my prolapse will get worse?
What are the chances my prolapse will get worse if I return to running or high impact sport?
What are my non-surgical options?
What are my surgical options?
Would I be able to improve my symptoms by doing pelvic floor exercises or using a pessary?
Would you recommend I see a pelvic floor physiotherapist?
