Prolapse
Pelvic organ prolapse, or simply “prolapse” occurs when the tissues that support and hold the pelvic organs (the uterus, bowel, and bladder) in their normal positions become weakened. As a result, one or more of these organs prolapse (or “drop”) into the vagina.
There are a number of factors that contribute towards weakening the pelvic floor muscles and causing prolapse. These include pregnancy, labour and childbirth, obesity, longstanding constipation, coughing, straining, heavy lifting, and smoking. Advancing age, and especially the reduction of oestrogen after menopause, leads to further weakening. Some women also have a genetic predisposition towards prolapse.
A small amount of prolapse is normal in many women who have had a baby and if there are no significant symptoms it is not a cause for concern. When present, symptoms vary from minimal to quite distressing, and depend upon which organ is prolapsing and how severely.
Symptoms are often worse after exercise, prolonged standing, or at the end of the day, and may include:
Sensation of a “lump” or “bulge” in the vagina, perhaps even protruding out from the vagina
A pressure or dragging sensation in the lower pelvic area or lower back, worse towards the end of the day or having been on your feet all day
Discomfort with sexual intercourse
Urinary and bowel problems: repeated bladder infections, difficulty emptying your bladder or bowel, bladder leakage with laughing, coughing, or sneezing (see incontinence). Some women may need to press on the bulge in the vagina with a finger in order to initiate the flow of urine and empty their bladder or bowel completely
Bleeding may occur due to irritation and trauma to the prolapsed tissue
Embarrassment and loss of self-esteem are also common symptoms
Treatment of prolapse is generally only indicated for women with bothersome symptoms. In such cases, treatment options include physiotherapy, pelvic floor rehabilitation exercises, vaginal pessaries, surgery, or a combination of these. The choice of treatment will depend upon the extent of your prolapse, the severity of your symptoms, and the acceptability to you of the treatment methods. Even if you have been performing pelvic floor exercises from a leaflet or the internet it is always important to be assessed by a Women’s Health Physiotherapist to ensure that these are being done correctly by activating the right muscles.