Pelvic Organ Prolapse (POP) can occur to up to 50% of ladies and commonly occurs after during pregnancy/after childbirth and/or during menopause. However causes are not isolated to these life events, other traumatic events, or high load impact sports may also contribute to prolapse.
For me it was childbirth and the lack of awareness around effective birth preparation, postnatal recovery and safe return to exercise. I’ve been through the embarrassment and loneliness, thinking I was the only one because no one talks about it. I’ve been through the symptoms, the emotions and frustrations, sought many opinions and management strategies. The thing is, no one size management or treatment will fit all but what I’ve now learnt is that, despite common belief EXERCISE IS NOT OFF THE TABLE, in fact when done in the right way it may just improve your symptoms like it did mine.
Let me enlighten you on POP so you too can feel empowered to either prevent it through effective birth prep and postnatal recovery strategies or navigate management of your prolapse. Be sure to leave me a message at the bottom and let me know if this helped.
What is POP?
Pelvic Organ Prolapse (POP) is when one or more of the pelvic organs may have begun to lose their position in the pelvis and slump downwards into your vagina. This can happen to varying degrees of severity and occurs due to a weakness or damage to surrounding connective tissue or pelvic ligaments (your pelvic system support ropes) within pelvic floor muscles. Imagine a ship in water, the water is the pelvic floor muscles supporting the ship (the pelvic organs/bladder, vagina, bowel) and the ropes holding the ship to the dock are the ligaments. If the ropes are stretched or torn the ship will drop lower.
Symptoms of prolapse
As I said above, symptoms will occur to varying degrees, some days might be good, some might not be so good. You might feel pelvic symptoms such as:
Bulging
Dragging
Heaviness
Like something is in the way or falling out
Sexual pain
Trouble holding in a tampon
Incontinence
There are DIFFERENT TYPES of prolapse depending on which organ or wall of your vagina is affected. (See diagram). Your bladder may collapse into your vagina (cystocele), your rectum may collapse into your vagina (rectocele) or the uterus can collapse down.
THE DEGREE of prolapse is graded by how close the tissues are to the exit of the vagina (see diagram above).
THE RISK FACTORS or CAUSES for POP usually come from situations where the pressure is increased, such as Pregnancy and childbirth. During pregnancy the weight of the baby places a lot of downward pressure on the pelvic floor support system and during labour damage can occur to the surrounding muscles, connective tissues or ligaments creating the opportunity for reduced support of the pelvic organs. I always, always, always advise my new Mumma’s to honour your body, pregnancy, birth and recovery process as returning to exercise too soon and too hard can increase your risk of more severe prolapse and symptoms like it did for me. There are certain exercises that I recommend to help with your Postnatal Recovery; in fact you can follow along my entire Re-energised Postnatal Recovery Program right here so you know you’re on the right track.
However ladies who have never been pregnant can also have POP and the risk factors for that may include:
Chronic/long term respiratory illness with prolonged coughing or changes to lung/breathing pressures
Obesity
Hysterectomy, Gynaecological surgery or cancers
Chronic constipation
Heavy physical work or high impact exercise/sport
Breath holding throughout exercise or daily activities
Family history of POP
Connective tissue disorders
Managing Prolapse
It is advisable to have an assessment and management plan set by a Women's Pelvic Health Physio. During this assessment she will chat through a thorough assessment and for best assessment and guidance will do a physical internal assessment. This will involve inserting two fingers into your vagina to assess for and grade a prolapse along with other pelvic floor muscles assessments.
Management of a prolapse will depend on its severity and symptoms, but types of options available for managing prolapse might be:
Correct pelvic floor exercises and core connection for incorporating full body exercise that doesn’t worsen symptoms. During exercise, it is important you don’t hold your breath or bear down as this puts pressure on the prolapse. Using a core connection breath to exhale on exertion can help with lifting heavier weights. Modifying exercises to utilise the effects of gravity by changing standing exercises to sitting or lying exercises for more pelvic floor support and/or control.
Including breathing, intra-abdominal pressure and tension management, alignment, optimal nutrition and hydration to ensure pelvic floor muscles are not straining with passing bowel motions
Pessary fitting - a variety of silicon devices are available that can be placed in the vagina like a tampon that can help hold your vaginal wall up and organs in place. Some can be placed permanently, some are removable and only needed for exercise/sports. This would usually be fitted by a pelvic health physio, gynaecologist/urogynecologist or nurse specialist.
A variety of surgery options
More about conservative prevention and management
Ultimately reduce the risk of having a prolapse by preparing well for birth then recovering safely and confidently postpartum by following my online Re-energised Postnatal Recovery Program.
Including and targeting the right muscle groups that are commonly altered during pregnancy/birth and postnatal recovery you will enable your entire body to heal, recover and function effectively and strongly around your pelvic floor muscles. Just doing your pelvic floor muscle exercises a few times will likely not cut it, in fact you might need to focus on your pelvic floor exercises often for the rest of your life along targeted exercises for the rest of your body for best results.
You’re entire body needs to be strong for your prolapse symptoms to be at their best, this includes how you breathe and manage pressure in your core system as well as how you stand and hold your posture throughout your daily life and activities. Who would have thought there’s this much too it.
Choosing the right exercise for your symptoms will also be important at least in the rehab phase along with the execution and technique of your exercises too.
Often lower impact exercises will be better tolerated my ladies with prolapse, myself included but if you need impact in your life, heck sometimes just chasing or playing with your kids can include impact and aggravate your symptoms, so it’s likely you are going to need a management strategy.
With the right exercises you might even be able reverse your POP severity by a degree and improve those symptoms, exercises to get started with include:
Regular and consistent pelvic floor exercises (2-3 sets per day). Often ladies don’t actually know how to do their pelvic floor exercises correctly and may in fact be clenching surrounding muscles likes their butt or core or pushing down on pelvic floor muscles. You can discover how to do you pelvic floor exercises correctly right inside my Postnatal Recovery Program and for best results, also have a Women's Health Physio assessment and management plan made for you.
Lastly, ensure the exercise you are doing being guided by a qualified trainer who is experienced with pelvic floor and core integration as well as prolapse friendly exercises.
Manage your toilet habits, constipation can be a huge culprit! Fibre and hydration will go a long way towards managing bowel health, we want no straining to reduce the downward pressure you are placing on your organs and pelvic floor muscles. Get yourself a step-stool to put your feet up on when pooing, it helps straighten out your rectum to pass your poo easier.
Ready to Re-energise your life, reduce your POP symptoms and live your life without restrictions, let me know in the comments what changes you are going to make and how it's going for you!?