Pelvic Organ Prolapse in a nutshell

Author: Joh-Ann Gouws

Physiotherapist with a special interest in pelvic function

Pelvic Organ Prolapse is a condition that can be present in many women (people with a vagina) and is often undiagnosed and accepted as “normal”. Terminology describing different types of Pelvic Organ Prolapse have changed over the years, previously terminology referred to the organs moving, but recently it is being described in relation to the position in the vagina where more movement occurs. This movement in the vagina wall allows the pelvic organs to drop from their expected position into the vaginal space.  

This could cause no symptoms in some people, but for others can be painful or impact their function to different degrees.

To access a quick Pelvic Organ Prolapse symptom guide for FREE, click on this link and download the rsourse. Free resources | Pelvic Therapy (thepelvictherapist.wixsite.com) This resource also includes important information on what to tell your doctor when you visit them for a pelvic organ prolapse consult and the questions you should ask about treatment options .

What actually happens when you have a Pelvic Organ Prolapse?

Your pelvic cavity contains multiple organs that are supported by connective tissue and muscles. The vagina is the central space located between the bladder and the rectum (back passage) and is supported at the bottom by the pelvic floor muscles. It connects at the top to the uterus, unless you’ve had a hysterectomy, in which case the vagina will be enclosed and connected to other structures to support it.

When the connective tissue in this space weakens, the walls of the vagina provide less support to the surrounding structures, causing them to protrude into the vagina under certain conditions.

When the front wall of the vagina is affected, the bladder will move backwards into the vagina.

When the back wall of the vagina is affected, the rectum will move forward into the vagina when placed under load.

When the top section of the vagina has a prolapse, the uterus, vaginal vault or small intestines can move down into the vagina.

The amount of movement that occurs can vary depending on how much load the area is under or how fatigued the supporting tissues are. This means that when the muscles providing support are weak or fatigued, the amount of movement can increase and people can feel more symptomatic. The movement can also worsen when these supporting structures are placed under high loads or repetitive loads, like lifting heavy objects or coughing without stopping.

What are some of the common causes of Pelvic Organ Prolapse?

Pelvic organ [prolapse can develop gradually, due to repetitive excessive forces acting in on the vaginal connective tissue, or can occur under extremely high excessive load that happens in one event.

Certain events of changes in a person’s body has been linked to the development of pelvic organ prolapse. Amongst other causes, common contributing factors include:

Childbirth: it is very common to develop a pelvic organ prolapse with having a vaginal delivery. Some factors increase your chances of having a prolapse after a vaginal delivery, like birthing a large baby, having a prolonged second stage of labour and needing forceps to help with the delivery.

Menopause: the hormonal changes that occur during menopause has an effect on the structures in the pelvis. Having lower oestrogen levels can cause the tissues supporting the pelvis to weaken which increases the risk of a prolapse. This would often also be the time when a prolapse that was not bothersome starts to be symptomatic.

Repetitive or long-term pressure: having pressures that are uncontrolled or exceeds the support provided by the connective tissue, especially if it occurs over a long time is a major contributing factor to developing a pelvic organ prolapse. Considerations that account for pressure include obesity, chronic coughing, chronic constipation and repetitive heavy lifting.

Aging: we naturally lose muscle strength and tissue rigidity as we age and this can contribute to the development of a pelvic organ prolapse.

Genetics: for some people, certain genetic factors can predispose a person to hypermobility, muscle weakness and other factors that can lead to prolapse development.

How do you know you have a pelvic organ prolapse?

Some people only find out they have a pelvic organ prolapse when they have an assessment by a doctor or other healthcare provider, because they have no symptoms. Other women, however, can be affected to varying degrees of severity.

Common symptoms can include:

·       A bulging sensation inside the vagina or seeing/feeling a bulge protrude form the vagina.

·       A sensation of heaviness / pressure / dragging in the lower abdominal or pelvic area.

·       Changes in urination or bowel motions.

·       Changes during intercourse.

These are not the only symptoms that could be experienced when you have a pelvic organ prolapse and if you are experiencing these symptoms it doesn’t necessarily mean you have a prolapse. If you are experiencing any of these symptoms, it is important to see a healthcare provider to establish the reason why.

How will a pelvic organ prolapse be diagnosed?

If you suspect you may have pelvic organ prolapse, it is essential to see a healthcare professional for an evaluation. Even if you feel a bulge that you are convinced must be a prolapse, it is important not to assume anything. Other medical conditions could cause the same symptoms and some may require urgent intervention, so don’t delay visiting your doctor.

Seeing your primary care doctor is a good place to start. Your doctor will typically ask you questions related to your symptoms, bladder, bowel and sexual function. They will also usually perform a physical examination with your consent to assess the amount of movement that occurs in the different areas of the vagina. In some cases, your doctor may order some additional tests to confirm or rule out medical conditions.

Can you do anything to help a pelvic organ prolapse?

Treatment recommendations will depend on the severity of your prolapse, your symptoms and what the impact is on your required activities. I will do a separate post on treatment options, but here are some basic recommendations that you can start implementing to help your prolapse symptoms.

·       Avoid chronic straining.

If you are constipated, you need to figure out what you need to change to get a good poo consistency and how to get it out without straining. Often hydrating adequately and eating a healthy balanced diet can soften your poo if it is hard. Other things to consider is the amount of physical activity you include in your life and your position on the toilet. A pelvic physiotherapist can also assist you in figuring out how to best use your muscles to poo without straining.

Managing a chronic cough is also important in pressure management. And learning to lift with appropriate support for your pelvic organs, can help manage the forces acting in on your pelvic organs.

·       Maintaining a healthy weight

·       Strengthening exercises

Working on strengthening your pelvic floor and muscles supporting the pelvis to support the structures is vital for assisting with pelvic organ prolapse symptoms management.

·       Seeing a pelvic health physiotherapist to assist you with an individual program tailored to your needs is a really good idea.

 Pelvic organ prolapse is a common but often misunderstood condition that affect many people, more often women (people with vaginas). It can cause a variety of symptoms or none at all, but it is important to get a proper diagnosis and treatment plan in place to address your specific needs. By staying informed and proactive, you can take steps to protect your pelvic health and live comfortably.