Pelvic Organ Prolapse

What is pelvic organ prolapse?

Pelvic organ prolapse is the descent of one or more pelvic organs towards the vaginal or anal opening. It is caused from lack of support in the pelvis, including from the pelvic floor muscles and/or connective tissue. There are several types of prolapse:

• Bladder: Cystocele
• Uterus: Uterine prolapse
• Rectum: Rectocele
• Small Intestine: Enterocele
• Rectal Prolapse: Prolapse of rectum out of the anus
• Vaginal Vault Prolapse: Prolapse of the vaginal post-hysterectomy

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The prevalence of prolapse is widely variable depending on the source of study, but in general it's estimated that at least 50-75% of women will have some degree of vaginal wall change during their lifetime.

Risk Factors for Prolapse:

• Pregnancy (each pregnancy increases risk)
• Vaginal Delivery (especially with forceps)
• Increasing Age
• Chronic Cough (as in asthma)
• Levator Ani Avulsion
• Hysterectomy
• Increased BMI
• Family History
• Constipation
• Connective Tissue Laxity

Prolapse can occur due to times of increased intra-abdominal pressure for extended periods of time.

What does pelvic organ prolapse feel like?

• Feeling or seeing a vaginal bulge
• Pelvic pressure or heaviness
• Low back ache
• Difficulty emptying bladder or bowels
• Vaginal laxity or air bubble sensation

There are 4 grades of prolapse, but the severity of symptoms do not always match the grade. For example, someone could have a lot of symptoms with a grade 1 prolapse and someone else could have very little symptoms with a grade 3 prolapse.

What can you do about prolapse?

Pelvic floor physical therapy has been shown to help improve the support of the prolapse and improve symptoms! All of the following components are involved in treatment of pelvic organ prolapse and are addressed through pelvic floor physical therapy:

• Pelvic floor muscle function (including strength, endurance, and flexibility) and pelvic tissue laxity
• Fluid intake and constipation management
• Deep core coordination and intra-abdominal pressure management strategies
• Exercise modifications and progressions
• Abdominal and hip muscle function
• Tissue tension

It's important to understand that you can still run, jump, exercise, and play with your kids with prolapse with the right kind of support!