Pelvic Organ Prolapse: Can it be fixed without surgery?
Prolapse. The word alone sounds scary, doesn’t it? But it doesn’t have to BE scary for you if you are someone who is currently experiencing symptoms or has been diagnosed with any sort of pelvic organ prolapse. You may be trying to find some answers, figure out what the next steps are or what to expect as you navigate through this. This blog post is here to educate you on what a pelvic organ prolapse is and the different types, what factors may cause a prolapse and the hot topic of whether surgery is necessary or not. Aside from that (and also more importantly), this blog post is meant to empower you and help to reduce the fear, panic and anxiety you may be experiencing if you are currently going through this! If you are simply looking for methods of prevention or wanting to learn how to keep a pelvic organ prolapse from worsening, make sure to read all the way to the bottom for my top 10 tips!
What is a pelvic organ prolapse?
Pelvic organ prolapse (POP) is when the bladder, uterus (cervix), or rectum falls into the vaginal canal. This may present with a variety of symptoms, including:
A feeling of heaviness or the feeling a tampon is half in half out
Bulging sensation in the vagina
Dragging, heavy feeling in the pelvis
Lower abdominal or lower back ache
Visible bulge from the vagina
Difficulty inserting or retaining tampons
One key thing to keep in mind with a pelvic organ prolapse is that there can be different levels of severity. For instance, those with a very mild prolapse may experience very minimal to no symptoms…meaning you may not even know that you HAVE a prolapse; while someone with a more severe prolapse may feel pain or discomfort and be VERY aware that something is going on down there.
The 3 Types of Prolapse:
Uterine — Uterus falls into vaginal canal (bottom right image)
Bladder (Cystocele) — Bladder falls backward into vaginal canal (top right image)
Rectal (Rectocele) — Rectum falls forward into vaginal canal (bottom left images)
Factors That Can Cause Prolapse
There can be many contributing factors that may cause or worsen a prolapse, but the main thing to be aware of is the pressure system throughout the core. The pressure that gets distributed from the diaphragm down to the pelvic floor can greatly impact a prolapse. So, if your body has been trained to move pressure down onto the pelvic floor on a consistent and regular basis, and then on top of that maybe add in some pelvic floor muscle weakness, and you’ve got a recipe for prolapse.
Here are some of the MOST common causes of pelvic organ prolapse:
Pregnancy — think about the increase in pressure through the pelvic floor with the added weight of carrying a baby.
Child birth — there are many things that can contribute to a prolapse with child birth, but mostly the stretch that happens to the muscles and organs along with the weakness that is present in the initial phase of healing.
Large baby birth weight — again, think about that added pressure with a large baby
Poor posture — our body is a chain. If something isn’t lined up the way it was designed to up top, that’s going to affect the things below it!
Breastfeeding/hormones (estrogen) — hormones play a role in this as well as the pelvic muscles and tissues are responsive to estrogen, and breastfeeding keeps your body in a lower-than-normal estrogen state which can lead to slower recovery rates in those tissues.
Aging — again, hormonally speaking, estrogen decreases as we age, especially after menopause
Obesity — this is where the increased pressure comes into play again
Disease that weakens connective tissue (genetic disorders) — anything that causes muscle or tissue weakness will definitely increase the risk for prolapse
Hysterectomy — some may think this might be a good treatment for prolapse, but it actually can increase the risk of prolapse as the uterus is the support for the top of the vagina, and with that gone, so goes the support as well.
Pelvic floor injuries — previous injuries to the pelvic floor can definitely increase the overall vulnerability of the tissue affected
Menopause — see “Aging” above…hormones! Not always pleasant side effects.
Continual coughing — linking back to the pressure issue again as a cough causes a sudden and strong pressure flow down onto the pelvic floor.
Very heavy lifting consistently — especially with the pressure management techniques that heavy weight lifters are often trained with, causing direct pressure down onto the pelvic floor.
Is surgery always necessary?
If surgery has been a concern for you, I have some good news - only in rare cases will surgery be needed. And if surgery was the only option you were given to deal with your pelvic organ prolapse, I highly suggest going to see a pelvic floor physical therapist!
But in general, if you are experiencing any of the symptoms discussed above (heaviness, bulging sensation, visible bulge etc.) and they have not resolved, that would be another good reason to see a pelvic floor physical therapist! A pelvic floor PT will be able to address the root cause of the dysfunction and develop an individualized treatment plan for you.
Another alternative option to consider is a pessary. If you’ve never heard of a pessary before, don’t worry, you’re likely not alone in that. A pessary is a tool that can be used to help women with pelvic organ prolapse as a temporary solution to assist in improving support and offering symptom relief! Let’s dive into what exactly it is a little further.
What is a pessary?
It is a device that fits inside your vagina and supports the pelvic organs. It can help with bulging symptoms and leaking urine.
Some pelvic floor physical therapists are specially trained in fitting a pessary. This is something you can absolutely bring up with your OB/GYN to see if it is a good option for you and discuss being fit for one.
The pictures to the right are examples of different kinds of pessaries and how they look when fit properly.
10 Tips to Prevent or Reduce Worsening a Prolapse
Alright, you made it to the good part…the section you’ve been waiting for! These are my TOP 10 TIPS to prevent a prolapse OR if you already have a prolapse, then to prevent exacerbating your prolapse. Check it out!
Fiber Intake — More fiber in your diet can help keep you from getting constipated…and if we’re trying to avoid straining during a bowel movement, then let’s all go grab some artichokes and beans!!
Water — Staying hydrated helps to keep things moving and regular — enough said there.
Squatty Potty — A squatty potty actually helps to get your colon into the right angle to allow an easier exit with…you guessed it…less straining! This one is a great option.
Stool Softeners — This tip is specific for those in the early postpartum. During that time you really want to be protecting and resting your pelvic floor as much as possible, so a stool softener can be a nice supplementary approach.
Inhale to Relax Your Pelvic Floor — Yep, the way you breathe MATTERS! When you inhale, focus on feeling your pelvic floor relax and lengthen.
Exhale and Don’t Hold Your Breath — After you’ve inhaled, don’t forget to let it out! If your focus is to relax and lengthen the pelvic floor during the inhale, make sure that with the exhale you are working on engaging the deep core. For a quick demo of what this looks like, watch this quick tutorial by CLICKING HERE!
DO NOT Strain When Pooping — BREATH through it, and don’t forget some of the tips above to help out as well.
Coughing or Sneezing Quick Trick — Check out this video tutorial linked HERE!
Avoid Pushing Out/Down When Babywearing/Holding — Oftentimes the position of choice when holding a baby is hips forward, shoulders back, but this isn’t a great position for your pelvic floor!
Mind Body Core — My full postpartum, pelvic floor and core rehab program covers this topic and others in depth and walks you through a step-by-step comprehensive program! Click HERE to check it out. I also offer a 4 week program specifically for prolapse and heaviness (this is inside the Mind Body Core program as well), but if investing in the full program isn’t right for you right now, my Prolapse/Heaviness Program might be a good option to start with! Click HERE for all the details.
Prolapse and Early Postpartum
First, I want you to know that it is common to feel a sense of heaviness immediately postpartum. At that time, estrogen is low and can cause low tone within the muscles. Breastfeeding also can contribute to this feeling of heaviness, as it also contributes to the lower estrogen levels. However, this typically subsides within a few weeks. If your symptoms do NOT subside, then it would be a good idea to make a conscious effort to work on those symptoms and take action towards your postpartum rehab.
Next, there are a few things to be cautious of if you in the early postpartum time frame and experiencing prolapse symptoms.
While you may be tempted to make an early return to activities you were participating in prior to giving birth, you want to ensure you have had adequate time and rehab with certain activities like:
High impact exercise
Heavy lifting
Returning to running too soon
While you may not have prolapse symptoms at first, jumping back into these higher impact activities can cause or further exacerbate a pelvic organ prolapse. But that is not to say that you can NEVER return to these types of activities postpartum! It just means that you will want to take it step-by-step and work your way up towards it.
Reach Your Goals Postpartum
Not sure where to start with your postpartum rehab and want to make sure that you keep prolapse at bay when you return to activity? Make sure to check out my Mind Body Core program or reach out to me directly if you have specific prolapse questions!