Taking a Closer Look at Pelvic Organ Prolapse

In Female Pelvic Pain, Pelvic Organ Prolapse, Stress Urinary Incontinence by Stephanie Prendergast6 Comments


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One of the jobs of the pelvic floor in women is to support the organs of the pelvis. But for a variety of reasons the muscle and fascia that offer that support can weaken, and when it does these organs can descend into the vagina causing a myriad of symptoms. This condition is known as “pelvic organ prolapse” or “POP” for short.

At PHRC we see many patients with this problem who don’t have a clear understanding of what is going on and what their options are for treatment. For this reason, we’ve decided to dedicate this post to taking a closer look at pelvic organ prolapse.

So what exactly is pelvic organ prolapse?

Prolapse is a weakening of the pelvic floor muscles as well as tissues of the vaginal wall, which results in a bulging of one or more of the pelvic organs into the vagina. (The pelvic organs include the vagina, cervix, uterus, bladder, urethra, intestines and rectum.)

There are five common types of prolapse into the vagina:

  1. Cystocele: the bladder descends into the vagina.
  2. Urethrocele: the urethra descends into the vagina.
  3. Rectocele: the rectum descends into the vagina.
  4. Enterocele: the small intestines descend into the vagina.
  5. Uterine prolapse: the uterus descends into the vagina.

(Rectal prolapse is another type of prolapse, but is associated with rectal wall laxity, when part of the rectum is bulging out of the anus.)

While some prolapses can be asymptomatic, common complaints of women with prolapse are: being unable to wear a tampon, urinary and/or bowel fecal incontinence, vaginal dryness or irritation, and pain with intercourse.

As the pelvic organ prolapse gets worse some women complain of:

  • A pressure heavy sensation in the vagina that worsens by the end of the day or during bowel movements
  • The feeling that they are “sitting on a ball”
  • Needing to push stool out of the rectum by placing their fingers into or around the vagina during a bowel movement
  • Difficulty starting to urinate, a weak or spraying stream of urine
  • Urinary frequency or the sensation that they are unable to empty their bladder well
  • Lower back discomfort
  • The need to lift up the bulging vagina or uterus to start urination
  • Urinary leakage with intercourse

Prolapse is a common condition. Indeed, it’s estimated that nearly 50% of all women between the ages of 50 and 79 have some form of prolapse.

Research has uncovered certain risk factors associated with prolapse. They include genetics, ethnicity (Caucasian women are more likely than African American women to develop prolapse), loss of pelvic support when the pelvic floor is injured during vaginal delivery, surgery, pelvic radiation or back and pelvic fractures, hysterectomy, constipation and chronic straining, smoking, chronic coughing and heavy lifting, joint hyper mobility and obesity. (Women who are obese have a 40% to 75% increased risk of pelvic organ prolapse.)

In addition, aging and menopause contribute to the deterioration of pelvic floor strength and the development of prolapse.

What are the treatment options for prolapse? 

Lifestyle modifications and exercises for the pelvic floor muscles are typically the first line of treatment for the condition, both of which can be very effective. Lifestyle modifications include not straining with bowel movements and not lifting heavy items, and learning to avoid increasing abdominal pressure during daily activities.

In some cases, wearing a pessary, which is a removable device that is placed into the vagina to help support the organ/organs from falling/bulging, is another nonsurgical way to manage a prolapse.

Surgery is typically done only after a patient has tried conservative management first.

Can a pelvic floor PT help with prolapse?

A pelvic floor PT can help patients with prolapse by assessing the strength of the pelvic floor muscles and abdomen, and also educating patients in specific strengthening routines that can help support the pelvic organs. Additionally, a pelvic floor PT can also ensure that patients are not performing any lifting or other activities that will make the prolapse worse.

Plus, a PT can inform patients of any musculoskeletal findings upon examination, and discuss how much the prolapse is impacting their quality of life. From there, he or she can discuss whether a patient should see a physician for a surgical consult. (For more information on surgical options for pelvic organ prolapse, check out this resource from the American Congress of Obstetricians and Gynecologists.

Can prolapse be prevented?

The answer to this is sometimes, but not always.

That said, for prevention patients can avoid chronic straining whether that is with exercise or when having a bowel movement, manage their weight, and maintain strength in the pelvic floor muscles. However, when it comes to pelvic floor strengthening, I’m hesitant to straight out advocate strengthening exercises a.k.a. Kegels. If you’ve read our blog in the past you know we do not recommend Kegels across the board. That’s because many people have restricted pelvic floor muscles and shouldn’t be doing Kegels. That said, if there is a true weakness (without restriction) then Kegels can help.

Please stay tuned for more on this important topic! In the coming weeks we’ll be posting a case study, which will show exactly how pelvic floor PT can help with this very common condition.

All my best,

Stacey

SAStacey Anheier, DPT, treats patients at our San Francisco location.

Comments

  1. I thank you for your information and your website. Due to the info. you offer, I was able to locate a NH GYN who referred me for PT for POP/rectocele….I begin therapy in two days, once per week for a total of five visits estimated.

    1. Author

      Dear Lynn,

      That is wonderful news! Please let us know if you have any questions after you begin treatment.

      All my best,
      Stacey

  2. Thank you for your many educational and enlightening posts. I have utilized the !st-4th degree rating of POP for many years. I know that there is another system now that I have found to be difficult to understand and to measure. What system do you use to grade pelvic organ prolapse at your facilities? I want to be provide the correct standard for documentation.

    Respectfully,
    Kathy

  3. Hi Stacy,
    question – I have pudendal neuralgia, although it’s much better now than when I was first diagnosed with it 4 yrs ago. I knew I had a very slight cystocele and rectocele in addition, no pain involved with that. Just within the last month, my prolapse has increased and I’m due to see my uro/gyno in a month. I’m sure she will recommend a pessary, but I’m so scared to try or wear one thinking it may aggravate that pudendal nerve? Is this a possibility, or is a pessary even a good option for someone with PN in there history? I want my pain levels to stay down. As it is I still deal with central sensitization from the initial injury. What would you recommend I do/try? Are some pessaries better than others?
    Thanks for all you do,
    Debbie

    1. Author

      Hello Debbie,

      Your uro/gyn will be able to explain the different types of pessaries, but your choice will ultimately depend on which is most comfortable for you. I would recommend that you start physical therapy with a PF specialist if you haven’t already done so. If it occurs, your therapist will be able to adequately manage any flare ups or irritation.

      Regards,

      Stacey

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