By Jillian Giannini, DPT, PHRC Los Angeles
Did you know that Pelvic Organ Prolapse (POP)is more common than you think and that the severity or stage of the prolapse does not always correlate with symptoms?
One review found that 41 – 50% of women had POP on examination, though only 3 – 5% of women report symptoms.
Many people understand that POP can happen after vaginal delivery, but POP can occur for other reasons too, including global pelvic floor dysfunction. The risk factors for developing POP include:
- Vaginal delivery
- Menopausal status
- Chronic constipation
- Connective tissue disorders
Some of the symptoms related to pelvic organ prolapse include:
- A feeling of heaviness in the vagina
- A feeling of “something is coming out”
- Urinary incontinence
- Incomplete emptying with urinating and bowel movements
These symptoms can occur with any stage of prolapse, so the severity of your prolapse does not determine your complaints. To learn more about the various types of pelvic organ prolapse check out our blog Taking a Closer Look at Pelvic Organ Prolapse.
Treatment options for POP can range from conservative to surgical. Like so many other pelvic health syndromes, pelvic floor physical therapy should be offered to all women with prolapse concerns! Even if someone eventually needs surgery, pelvic floor physical therapy can help optimize the pelvic floor and girdle muscles which will only improve surgical outcomes. Pelvic floor physical therapy for POP can include the following:
- Training for proper bladder and bowel habits/techniques. This will help reduce strain on the pelvic floor muscles and the connective tissue support to our pelvic organs.
- Lifestyle changes (i.e. proper lifting mechanics, avoiding constipation, etc.)
- Neuromuscular re-education to the pelvic floor muscles. Your PT will help you regain control of your muscles so you can contract them at the right times (when exercising), and relax them at others (to have a bowel movement without straining
- Manual therapy to the pelvic floor and girdle muscles when appropriate,ie tight/short muscles
- Therapeutic exercise to help improve pelvic floor and core strength, endurance, and control
- We may suggest that you speak to your healthcare provider to determine if a pessary is right for you
Donut Fear , Pessaries Are Here!
If you are interested in seeing in more detail how pelvic health physical therapy can help with pelvic organ prolapse check out our blog The Case of Pelvic Organ Prolapse . Outside of pelvic health physical therapy, one of the treatments that seem to be overlooked or under recommended are pessaries. It’s a silicone device that can help support the descent of the uterus, bladder, or rectum into the vagina. A pessary fitting can be done by your doctor or nurse practitioner.
Up to 92% of women can be fitted for a vaginal pessary successfully, which is amazing because it is an effective nonsurgical treatment option. There are a plethora of vaginal pessary options and may require multiple trials/fittings to see what is the best fit for the individual, along with finding one that suits your lifestyle. There are ones that you can remove and re-insert yourself daily, and for individuals unable to remove and insert, there are pessaries for longer duration and they go to the office for cleaning and examination every ~three months per provider’s request.
It’s also important to note that Hanson et al. (2006) found that estrogen therapy was important to successful pessary fittings. Women who used vaginal estrogen had higher fitting success. This is to help keep the vaginal tissue healthy and plump. Especially when women in menopause are more susceptible to POP.
So what are some pessary indications?
- To relieve prolapse symptoms
- Avoid surgery
- Diagnostic tool, to identify occult stress incontinence
- Prediction tool to see likely surgical outcomes
- Prevention of increasing prolapse and related morbidity
They come in all shapes and sizes. A few include:
- Ring pessaries
- Cube pessaries
- Gehrung pessaries
- Gellhorn pessaries
- Inflatable pessaries
With the various stages of prolapse one study showed that women with a stage II, a ring pessary were 100% successfully fitted, 71% for a stage III, and with a stage IV the Gelhorn was more frequently used and 64% successful.
Some symptoms that pessaries can help with include:
- Improve bladder emptying
- Sensations of bulge, heaviness, and pressure
- Urinary incontinence
- Urinary urgency and frequency
- Fecal incontinence and urgency
- Difficult or incomplete emptying of bladder and bowels
Common Pessary Care Instructions:
- Three to four month follow ups with MD
- Local devascularization or erosion: remove pessary two to four weeks and have local estrogen therapy
Just like any treatment there are some complications and precautions when using pessaries. Some of these include vaginal infection, persisting vaginal erosion or ulceration, new symptoms of discomfort and pressure and/or pain. If these occur you can discuss with the provider who fitted you.
With now knowing that up to 92% of women can be successfully fitted for a pessary, a conservative form of treatment, you DONUT have to fear POP because pessaries are here! If you or know someone with pelvic organ prolapse share our post! It’s so important to know all the various treatments and options. Knowledge is power!
The American College of Obstetricians and Gynecologists and the American Urogynecologic Society INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect the US Food and Drug Administration order to stop the sale of transvaginal synthetic mesh products for the repair of pelvic organ prolapse. Pelvic Organ Prolapse, Female Pelvic Medicine & Reconstructive Surgery: 11/12 2019 – Volume 25 – Issue 6 – p 397-408 doi: 10.1097/SPV.0000000000000794
Atnip, S., & O’Dell, K. (2012). Vaginal support pessaries: Indications for use and fitting strategies. Urologic Nursing, 32(3), 114-125.
Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
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