05 Mar Prolapse: What To Do When Things Aren’t Sitting Where They Used To!
By: Talia Diamond, RPT, Pelvic Health Physiotherapist
One of the most common conditions we see at Vital is Pelvic organ prolapse. The name “Prolapse” sounds like a scary phrase and conjures up many scary and uncomfortable thoughts. But, here at Vital, our goal is to get rid of that fear, educate you and empower you to take charge of your body and show you all of the terrific treatment options that are available to you (Hint: Pelvic floor physiotherapy!!)
Women of all ages and stages can experience Prolapse- so it is important to share this information with your loved ones– your mom, your aunt, your sister and all your friends – so that they can both relieve their symptoms and PREVENT them!!
The pelvic floor muscles are a group of three layers of muscles, which are shaped like a bowl and sit at the bottom of the pelvis. One of the very important jobs performed by these muscles is to support and hold up all the organs inside the pelvis. For women, this includes the bladder, uterus, cervix, rectum and small intestine. Each of these organs is held in place from above by ligaments and from below by the pelvic floor muscles. When the ligaments stretch or when the pelvic floor muscles are no longer able to do their job- either because they are too weak, too tight, too overworked or poorly coordinated, one or more of the organs may start to descend out of their proper, supported position and into the vagina or rectum. This is called pelvic organ prolapse.
As pelvic physiotherapists, we rate the degree of prolapse (using a scale of 0-4) by how far into, or out of, the vagina or rectum the organ is descending and we name the prolapse based on what organ has shifted. The picture below demonstrates what the anatomy looks like without prolapse and a couple examples of what it would look like with prolapse.
How do you know if you have some degree of prolapse?
One of the symptoms clients often describe is a sensation of pelvic heaviness or pressure. That said, there are some other signs and symptoms that may suggest some degree of prolapse:
- The inability to complete empty your bladder or bowel (still feeling “full”)
- Feeling like your vaginal or rectum is “loose”
- You notice something bulging out of the vagina
- Lack of sensation vaginal sensation
- Urinary or fecal Leaking
- Constipation (going less frequently than your “normal”)
- Painful Sex
- Reduced sexual sensation
It’s important to note that although there are some signs that prolapse is present, many clients experience no symptoms at all. This is very common and a reason why it often goes undiagnosed for years and is the reason why we encourage every person who has ever been pregnant to get their pelvic floor assessed!
So why does this happen? Well, there are a number of reasons why a prolapse could happen but common risk factors include childbirth, advanced age, chronic constipation, high intensity exercise, chronic breath holders, weight and menopause.
A weak pelvic floor is also a frequent reason that prolapse happens or worsens over time, which is why improving your pelvic floor strength, is SO important. Pelvic floor strengthening exercises should be done regularly (use them or lose them!!) to both prevent and treat prolapse. In fact, a 2011 study by Hagen et. al. concluded that pelvic floor strengthening should be recommended as first line therapy for a prolapse!
It is easy to get caught up on the pelvic floor strengthening, or kegel-only framework. However, we know that the pelvic floor doesn’t work alone: They work together with our three other core muscles- our breathing diaphragm, our innermost abdominal muscle, called Transversus Abdominis, and our inner most back muscles, called the multifidi, to stabilize and support the body and act as our pressure system. These four muscles actually have to work together in a coordinated way- so we need to train the pelvic floor to work with its team! It’s important that these muscles are not only strong, but well-coordinated and well-timed with its other core muscles. Many people know how to activate their pelvic floor muscles but are not able to release them fully. So- it’s important that you get your pelvic floor assessed so that you can be placed on the training program that is right for you and your body!
In addition to pelvic floor strengthening, lifestyle and activity modifications can really make a difference in reducing the downward pressure on your organs and pelvic floor. These include things such as proper posture, making sure you aren’t holding your breath during daily tasks (e.g. lifting a heavy grocery bag), considering lower intensity activities such as swimming and walking in favour of high intensity activities like jumping jacks, limiting straining on the toilet and being cautious with ‘core based exercises’ such as sit ups or crunches.
However, as pelvic physios, it’s our job to get you back to the activities you love. SO- if you absolutely love CrossFit and you suspect you have a prolapse- don’t put off being assessed for fear of being told not to do the activities you love. We will give you tips on how to perform your favourite activities while ensuring that the pelvic floor is working optimally. Sometimes, this involves using a tool to help manage the symptoms of a prolapse, such as a pessary. A pessary is a soft, removable device that is inserted into the vagina to help support the prolapsed organ into a better position. We call this a “sports bra for your vagina”. Sometimes its as simple as strengthening your pelvic floor and teaching your pelvic floor the proper timing and coordination in order to train at the intensity you desire.
Whether you prefer to sit on your couch watching Netflix or spending time at your bootcamp class, prolapse should be something that you take into consideration. But, not something that limits your daily function!
We hope you have found this helpful!
We would love to hear from you all about your experiences with prolapse! Please email us @ firstname.lastname@example.org!