Let's Talk About Prolapse...

Pelvic Organ Prolapse (POP) is a condition where the pelvic organs start to descend down into the vagina or rectum.  It can feel like you have something in your vagina, or a heavy or full feeling. 

Did you know that up to 50% of women who give birth present with a prolapse?!!  

Crazy eh. Any other significant physical condition that affected 50% of the population we would hear about all the time...but nope, pelvic floor dysfunction still seems to be "too taboo".  In my 18-year long career (+ 5 years at University), I only properly learnt about prolapse since having children myself!  So don't feel bad if you feel late to the party to learn about this stuff.

What causes prolapse?

Simply, we can break it down into two main causes:

1. Too much bearing down - coughing, straining on toilet etc
2. Tearing or stretching from delivery, less muscular support 

Here is an image that will show you the different types of pelvic organ prolapse that can occur.  You can see either the bladder, uterus or the rectum can descend downwards.

Is my pelvic floor safe from prolapse during pregnancy?

The short answer is no.  While rates of prolapse are higher in vaginal births, there are many other risk-factors that play a role in the development in a prolapse, such as genetic factors, menopause, obesity, changes in hormones etc.   Plus during pregnancy there is a huge load on the pelvic floor, which can lead to weakness & poor core strategies.

So what can I do about it?

Ideally you want to have an assessment with a women's health physiotherapist first, to determine what type and grade prolapse you have, as that will determine your exercise prescription.  

*If you are worried that you have a full tear of the pelvic floor muscles then please see your doctor before commencing any exercises!

In a nutshell, here are the main things that will help you (all of which we cover in this course!):

• Learn how to manage pressure in your abdominal canister, and how to not bear down
• Standing tall through the torso (avoiding slouching)
• Try to keep your ribs stacked over your hips when you are lifting or using any force with your body
• Allow sufficient postpartum healing time and don't do more than what your pelvic floor can handle (most common cause of prolapse is "too much too soon")
• Keep up your fibre & fluids to avoid constipation (bearing down)

What about surgery?

For some women, surgery can be a viable option.  This is outside the scope of this course and is something you will need to discuss with your health care provider.  But I do want you to know a few things about surgery options...

• If you have pelvic floor tearing (ie where the muscle tears fully off the bone), surgery, with a skilled surgeon, can be a good option to enable you to regain use of those muscles
• But know this...of the women who have surgery, 58% will have prolapse reoccurrence, but only 29% will opt to have surgery again
• What this shows is that underlying issues, such as pressure management, strength & core strategy are not being addressed yet could significantly help!  Even if you opt to have surgery, spending time on "prehab" first can make so much difference.
• When women are told not to exercise and wait for surgery, this can be a slippery slope.  The best thing to do is to focus on building strength!  Even having a strong upper body will be helpful as when you go to lift/push/pull something (ie apply force), with a stronger body you won't need to use as much force = less pressure on pelvic floor. 

Can I fully heal my prolapse?

The answer is "maybe" or "it depends".  Sorry.  But having a prolapse isn't a life sentence to never enjoy yourself again!  There is so much you can do to improve your symptoms, as mentioned in the list above. 

You can also speak to your women's health PT to discuss pessary options - this basically a silicon ring that you can insert up inside your vagina to help support your organs.  Using a pessary doesn't mean a free ticket...you still need to do your strength exercises...but it can be a great option for times such as playing sports, hiking, surfing etc when you know you will have that extra pressure that you might not be able to manage.

Some women become "functionally healed", which means that when you bear down you'll still have a bulge, but when you get up and move around you you don't!  

If you found this article helpful, please send it onto any mama friends you know who might be struggling with a prolapse.  And if you personally need support, don't hesitate to drop me an email at [email protected] or connect with me on instagram @holisticpelviccare

Love Ngaire x

**If you want to learn how to improve your pelvic floor & core from a whole-body perspective, then make sure you sign up for my Pelvic Floor & Core Foundations Program!