What’s (POP)pin’…Out Of My Vagina? Pelvic Floor Physical Therapy For Pelvic Organ Prolapse
“It feels like I’m falling out.”
“There is a bulge… down there!”
“Something is in the way.”
“Something just isn’t right.”
“It feels heavy.”
Do any of these sound familiar? These are some of the first things we hear from our patients who are experiencing symptoms associated with prolapse. Pelvic organ prolapse (POP), is the descent of one or more of your pelvic organs. This can be any combination of your bladder, uterus, rectum or urethra. It is often associated with pushing during childbirth, however, we also see POP develop with straining related to constipation or chronic coughing. There’s no question about it… being told that an organ is protruding outside of your body can be scary. Hint: organs belong INSIDE the body. When these organs are not where they’re supposed to be it can lead to bladder, bowel and sexual dysfunction. It can also refer pain into the low back. Luckily, pelvic floor physical therapy is a conservative, first-line treatment for POP. Research has shown that pelvic floor PT is effective in decreasing symptoms and improving quality of life for patients with grades 1-3 prolapse (grade 4 being a complete procidentia requiring surgery). Bottom line: pelvic floor physical therapy can treat prolapse and often avoid major surgeries such as mesh or bladder slings. At the end of the day, prolapse is a pressure management dysfunction. How are you using your muscles, posture and breath to generate force? Seeing as we both have been seeing an influx of ladies with prolapse and Dr. Katie has dealt with it herself, we thought we would answer some questions and debunk some myths!
How do I know if I have prolapse?
Here are some tell-tale signs and symptoms: pelvic pressure or heaviness. Feeling like something is falling out, especially at the end of the day or after being on your feet for a while. You may feel like there is something in the way during sex or when emptying the bowels or bladder. Often patients do what is called “splinting” when going to the bathroom to reposition the organ and allow more complete emptying. Patients may even feel the bulge at the opening of the vagina.
2. How does pelvic floor physical therapy treat prolapse?
Pelvic floor physical therapy encompasses manual techniques, both external and internal, which can help reduce fascial restrictions pulling on the organs. PT also focuses on breath training, lifting mechanics, deep core coordination, voiding technique, hydration, fiber recommendations and therapeutic exercise tailored to your needs. Most often, we find patients who are experiencing prolapse are breath holders (whether during lifting or due to stress) which creates excess intra-abdominal pressure. Prolapse is a pressure management dysfunction. Often, very simple changes and cuing can make huge differences in allowing the pelvic strength to outweigh the abdominal pressure downward.
3. Who is at higher risk for developing prolapse?
Prolapse often gets the reputation of being a geriatric diagnosis (think Grandma who is post-menopausal). We have both seen a wide range of patients from mid 20’s through menopause, up to 90 years old. Yes, as we age and estrogen levels drop, we often have less muscle bulk and strength of the pelvic floor. We also know the soft tissue changes reduce collagen and make our muscles and ligaments weaker. This condition may be present in younger women with little to no side effects and often becomes pronounced as menopause approaches. Prolapse is best treated conservatively at the first sign of symptoms, usually in the first few months after birth, to allow for the efficient and lasting impact.
When we talk about prolapse in our mommas, we know the “sweet spot” for active pushing labor time is between 20 minutes and 2 hours. After 2 hours, we are at higher risk for organ descent considering the prolonged downward force. Women who push less than 20 minutes are at higher risk of tearing the perineum which can affect the dynamic of the pelvic floor muscles and decrease support. There is also a high correlation of having a forceps assisted delivery and prolapse. Women with genetic joint laxity or connective tissue disorders are also at higher risk for instability and prolapse.
4. I’ve never had kids, I can’t have prolapse… can I?
It is possible to experience prolapse without ever having kids. Of course there are a lot of factors at play, including natural laxity, lifestyle and weight. Prolapse can show up in the weightlifting population for those using compensatory strategies such as breath holding to hit that next PR. When we use our breath to our advantage and coordinate our deep core and pelvic floor we can lift efficiently and safely. Like we mentioned earlier, prolapse can develop with excess straining related to constipation or chronic coughing. Squatty potty’s, abdominal massage, fiber and hydration modifications can improve stool consistency and decrease straining on the toilet.
To wrap up, we want to leave you with some key takeaways about pelvic organ prolapse. It is often associated with childbirth and menopause, but can also result from breath compensation, constipation and poor motor control. Although an intimidating diagnosis, POP responds beautifully to pelvic floor physical therapy and often delays or avoids surgery completely. Looking for a pelvic PT near you? Check out pelvicrehab.com or reach out to us to get you on the path to healing!
Brostrøm S, Lose G. Pelvic floor muscle training in the prevention and treatment of urinary incontinence in women – what is the evidence? Acta Obstet Gynecol Scand 2008; 87:384–402
Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996; 175:10–17. 37.
Tan JS, Lukacz ES, Menefee SA, et al. Predictive value of prolapse symptoms: a large database study. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16:203–209.
To greater community and self love,
Dr. Katie & Dr. Carly
