
Prolapse
Pelvic organ prolapse occurs when the muscles and tissues supporting the pelvic organs (such as the bladder, uterus, or rectum) weaken or stretch, causing one or more of these organs to descend or press into the vaginal area. This condition can happen due to factors such as childbirth, aging, menopause, or chronic pressure on the pelvic floor from activities like heavy lifting or prolonged coughing.
Physical Sensations:
- Heaviness or Pressure: A feeling of fullness or heaviness in the pelvic area.
- Bulging or Protrusion: A noticeable bulge or tissue protruding from the vagina.
- Dragging Sensation: A pulling or dragging feeling in the lower abdomen, pelvis, or back.
Urinary Symptoms
- Frequent Urination: The urge to urinate more often.
- Difficulty Emptying the Bladder: Feeling like your bladder doesn’t fully empty.
- Urinary Incontinence: Leaking urine, especially when coughing, sneezing, or lifting.
- Urinary Retention: Difficulty starting or maintaining a stream of urine.
Bowel Symptoms
- Constipation: Straining or difficulty with bowel movements.
- Incomplete Evacuation: Feeling like you didn’t completely empty your bowels.
- Rectal Bulge: A sensation of needing to push something back in during bowel movements.
Sexual Symptoms
- Pain During Intercourse: Discomfort or pain during sexual activity.
- Reduced Sensation: A loss of sensation or pressure during intimacy.
General Symptoms
- Discomfort While Standing or Walking: Symptoms may worsen when standing for long periods.
- Relief When Lying Down: Symptoms often improve with rest or lying down.
Pelvic organ prolapse is caused by the weakening or damage of the muscles, ligaments, and connective tissues that support the pelvic organs. Several factors can contribute to this condition, including:
Childbirth and Pregnancy
- Vaginal deliveries, especially those involving large babies, prolonged labor, or the use of forceps/vacuum assistance, can strain or damage pelvic floor muscles and tissues.
- Multiple pregnancies increase the risk due to repeated stress on the pelvic floor.
Aging and Menopause
- As women age, pelvic muscles naturally lose strength and elasticity.
- Decreased estrogen levels after menopause can weaken the tissues that support the pelvic organs.
Chronic Pressure or Strain
- Constipation: Straining during bowel movements can weaken the pelvic floor over time.
- Chronic Cough: Conditions like asthma or smoking-related cough place repeated pressure on the pelvic area.
- Heavy Lifting: Jobs or activities involving frequent heavy lifting can strain pelvic support structures.
Surgery or Trauma
- Hysterectomy or other pelvic surgeries can compromise the support structures for the pelvic organs.
Obesity
- Excess weight increases pressure on the pelvic floor, contributing to muscle and tissue weakening.
Genetics
- A family history of connective tissue disorders or weak pelvic support structures can increase the likelihood of prolapse.
Other Factors
- High-impact Activities: Repeated high-intensity exercise, like running or jumping, can strain the pelvic floor.
- Neurological Conditions: Conditions like spinal cord injuries or multiple sclerosis may interfere with pelvic floor function.
Pelvic organ prolapse can involve different pelvic organs depending on which structures have weakened. Here are the common types of prolapse:
- Cystocele (Bladder Prolapse): The bladder drops into the front wall of the vagina.
- Rectocele (Rectal Prolapse): The rectum bulges into the back wall of the vagina.
- Uterine Prolapse: The uterus descends into the vaginal canal.
- Vaginal Vault Prolapse (After Hysterectomy): The top of the vagina (vaginal vault) loses support and drops, often following a hysterectomy.
- Enterocele (Small Bowel Prolapse): The small intestine presses against the top part of the vaginal wall.
- Urethrocele: The urethra, the tube that carries urine out of the body, bulges into the vagina.
- Combined Prolapse: More than one organ (e.g., bladder, uterus, rectum) prolapses simultaneously.
Pelvic organ prolapse is not usually life-threatening, but it can significantly affect your quality of life if left untreated. Here’s a breakdown of potential risks and concerns:
When Prolapse is Not Dangerous
- Mild to Moderate Prolapse: In many cases, prolapse causes discomfort, inconvenience, or embarrassment but isn’t medically dangerous. Symptoms like pressure, bulging, or urinary/bowel issues can often be managed with pelvic floor physical therapy or lifestyle changes.
Potential Risks of Untreated Prolapse
- Worsening Symptoms: Over time, prolapse can progress, leading to increased discomfort, urinary or bowel incontinence, and greater difficulty with daily activities.
- Tissue Irritation or Ulceration: If the prolapsed organ protrudes outside the vaginal opening, it may cause irritation, dryness, or sores on the exposed tissue, which can increase the risk of infection.
- Bladder or Bowel Complications: Severe prolapse can obstruct the bladder or rectum, causing urinary retention or chronic constipation. These issues may lead to urinary tract infections (UTIs) or other complications.
- Impact on Sexual Function: Prolapse can cause pain, discomfort, or decreased sensation during sexual activity.
- Rare Complications: In severe cases, such as total uterine prolapse, where the uterus falls outside the vaginal opening, there is a higher risk of infection or damage to surrounding organs.
These options are ideal for mild to moderate prolapse or for individuals who prefer to avoid surgery.
Pelvic Floor Physical Therapy
Lotus Physical Therapist and Pelvic Health will guide you through exercises to strengthen and coordinate your pelvic floor muscles. Benefits of Pelvic Floor Physical Therapy:
- Reduces symptoms like heaviness and incontinence.
- Improves pelvic floor strength and support.
- Non-invasive and highly effective for many.
Pessary Use
Pessary use is where a silicone device is inserted into the vagina to support the prolapsed organ. This approach has the following benefits:
- Provides immediate symptom relief.
- A non-surgical solution that works for various prolapse types.
- Can be removed or adjusted as needed.
Hormone Therapy
Hormone Therapy is where estrogen creams or tablets may be prescribed for postmenopausal women to improve tissue strength and elasticity.
Surgery is often considered for severe prolapse or when non-surgical options are ineffective.
Vaginal or Abdominal Repair (Colporrhaphy) involves surgical repair of the vaginal walls to restore organ position. This can be through the following approach:
- Anterior repair (bladder prolapse).
- Posterior repair (rectal prolapse).
Uterine or Vaginal Vault Suspension involves lifting and securing the uterus or vaginal vault using ligaments, sutures, or mesh for support.
Hysterectomy involves removal of the uterus if it is prolapsed. This is often combined with procedures to support other organs.
Sacrocolpopexy is a minimally invasive procedure that uses mesh to provide long-term support for the vaginal vault or uterus.
Non-Invasive Approach
- No Surgery or Incisions: Treatment involves exercises, manual therapy, and education, eliminating surgical risks.
- No Recovery Downtime: You can continue daily activities without the lengthy recovery period associated with surgery.
Cost-Effective
- Lower Expense: Physical therapy is typically more affordable than surgery, especially when factoring in hospital stays, anesthesia, and follow-ups.
- Insurance Coverage: Many health insurance plans cover physical therapy.
Symptom Management and Prevention
- Strengthens Pelvic Floor Muscles: Therapy targets the root cause of prolapse by restoring muscle strength and support.
- Prevents Progression: Regular exercises can prevent the prolapse from worsening.
- Improves Related Symptoms: Helps address incontinence, constipation, and pelvic pain.
Tailored to Your Needs
- Personalized Care: Therapy plans are customized to your specific symptoms, lifestyle, and goals.
- Empowers Self-Management: Learn exercises and strategies you can use throughout your life to maintain pelvic health.
Safe for All Stages of Prolapse
- Particularly beneficial for mild to moderate cases or for those not ready or medically cleared for surgery.
- Can also be used post-surgery to improve outcomes and prevent recurrence.
Pelvic organ prolapse (POP) and pregnancy are closely linked due to the increased strain pregnancy places on the pelvic floor. While prolapse during or after pregnancy can be concerning, understanding the condition and treatment options can help ensure a healthier pregnancy and postpartum recovery.
- Hormonal Changes: Hormones like relaxin and progesterone soften ligaments and connective tissue, reducing pelvic support.
- Increased Pressure – The growing uterus and baby increase intra-abdominal pressure, straining the pelvic floor muscles and tissues.
- Vaginal Delivery – Vaginal childbirth, especially with prolonged labor, forceps use, or delivery of a large baby, can weaken or damage the pelvic floor.
- Repetitive Pregnancies – Multiple pregnancies can compound strain, increasing the risk of prolapse.
If you have pelvic organ prolapse, straining increases intra-abdominal pressure, which can stress the pelvic organs. It’s important to avoid activities and habits that could worsen your symptoms. Here’s what to avoid:
- Straining and Bearing Down
- High-Impact Exercises
- Improper Lifting Techniques
- Prolonged Standing or Sitting
- Carrying Excess Weight
- Coughing Without Support
- Neglecting Core and Pelvic Floor Strength
Contact us if you would like guidance on exercises or tips for managing prolapse symptoms.
Yes, pelvic organ prolapse (POP) can affect sexual experiences for some individuals, though the impact varies depending on the severity of the prolapse, personal comfort, and emotional or psychological factors.
Physical Symptoms
- Pain or Discomfort
- Vaginal Dryness or Irritation
- Reduced Sensation or Feeling of Fullness
- Visible Bulge or Awareness of Prolapse
Emotional and Psychological Impact
- Body Image Concerns
- Fear of Worsening Prolapse
- Decreased Libido
At Lotus, we can help strengthen pelvic muscles and suggest comfortable positions.
Pelvic organ prolapse (POP) can potentially affect fertility, but it largely depends on the severity of the prolapse and the specific organs involved. Here’s how prolapse might impact fertility and reproductive health:
Prolapse and Uterine Position
- Uterine Prolapse: When the uterus descends into or outside the vaginal canal, it may alter its position, making it challenging for sperm to reach the egg for fertilization.
- Cervical Exposure: In severe cases, the cervix may be outside the vaginal opening, complicating conception.
Effect on Reproductive Organs
- Impact on Fallopian Tubes and Ovaries: Severe prolapse may distort the normal anatomy, potentially affecting the ability of the fallopian tubes to pick up eggs released from the ovaries.
- Endometrial Lining: Chronic prolapse may cause irritation or changes to the endometrial environment, affecting implantation.