Pelvic organ prolapse is one of the most anxiety-inducing medical conditions there is. Here's how to lower your chances of having the dreaded p-word, and how to manage it if you do
Prolapse is one of the most anxiety-inducing pelvic health concerns, and even though a staggering 50 percent of women who have had a vaginal birth will have some degree of pelvic organ prolapse (many of whom may not be symptomatic), it remains a taboo topic that isn't talked about enough. By shining a light on the symptoms of pelvic organ prolapse and the role that conservative treatment options can play, we hope to equip women with a toolkit of self-management strategies along with the knowledge—and confidence—to seek medical help promptly if it is needed.
What is prolapse?
Pelvic organ prolapse is described as the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus, or the apex of the vagina (after hysterectomy) (Hayley et al. 2016). The most common symptom is a vaginal bulge or the sensation of ‘something coming down’. Vaginal heaviness or dragging and difficulty emptying the bladder or bowel, or discomfort with penetrative vaginal sex are also common.
Prolapse symptoms arise through weakness in the vaginal support system which consists of connective tissues such as fascia and ligaments as well as several pelvic floor muscles which collectively hold the bladder, bowel and uterus in place. The condition is typically associated with ageing or is a “common change that happens after you’ve had children”, but it is certainly not limited to this narrow scope. It can affect people with a chronic cough, constipation, obesity and people who repetitively lift heavy. Whilst prolapse is not a life-limiting condition and many women have little or no awareness of these changes, for some women symptoms can be significant and have a huge impact on quality of life and the enjoyment of social and physical activities.
What can I do? 3 steps to maintain optimal vaginal support
It’s important that women know treatments are available and pelvic organ prolapse is not a condition to simply put up with. Managing lifestyle factors and exercise therapy play huge roles in the conservative treatment of prolapse. The following tips can help to optimise vaginal support and also help to prevent the occurrence of prolapse symptoms.
- Complete regular pelvic floor muscle exercises
The pelvic floor muscles sit at the base of the pelvis forming a bowl-like structure to support the bladder, uterus and bowel. They attach from the tailbone to the pubic bone like a sling or hammock. Completing regular pelvic floor exercises helps to offload pelvic fascia and ligaments thus preventing the occurrence of prolapse symptoms.
Ideally, women should complete one set of pelvic floor exercises per day for maintenance. Each set should include 10 longer holds up to 10 seconds followed by 10 short contractions which should be performed in a variety of positions.
International guidance recommends pelvic floor exercises as the first line of treatment for the management of prolapse symptoms but this should be supervised and individualised by a pelvic health physiotherapist to be most effective. - Maintain a healthy weight
Maintaining a healthy body mass index (BMI) will result in less pressure and strain through the pelvic connective tissues and pelvic floor muscles which can reduce the likelihood of prolapse symptoms occurring. - Avoid constipation and straining
Chronic constipation and straining over time may result in a weakening of the vaginal support systems. Adopting healthy bowel habits through the intake of dietary fibre and drinking plenty of water can help to improve the consistency of stool. Ideally, you should use a step under your feet when on the toilet so that your knees are a few inches above your hips and your abdomen is relaxed, as this helps to lengthen the pelvic floor muscles and reduce the need to strain.