Pelvic Organ Prolapse
What is Pelvic Organ Prolapse?
The pelvic organs, from front to back, are the bladder, the uterus, and the rectum. If you are male, omit the uterus and think of the bladder, with a prostate tucked underneath it, and the rectum behind. In a female, the bladder and vagina share a wall that is connective tissue and not muscle. The vagina and the rectum also share a wall that is connective tissue and not muscle. When the walls of the vagina become more lax than is optimal (think of stretched out elastic) the bladder, uterus and rectum can begin to migrate into the vaginal space. In a worst-case scenario they can fall right out of the vaginal opening. This is prolapse. A prolapsed bladder is called a cystocele. A prolapsed uterus is called a uterocele and a prolapsed rectum is a rectocele.
These organs have ligaments that attach them to the inside body walls and each other, but these ligaments are mainly about organization: for example, the front of your bladder needs to face the front of your body and remain in front of the uterus. Unlike joint ligaments, which are very directional and strong, organ ligaments are made of up a less organized connective tissue and are not for keeping organs up inside the body. The structure that keep our organs up and inside are the pelvic floor muscles. These muscles make a hammock or a sling in the bottom of the body that supports organs from underneath.
Like the water under the ship
Like the buoyancy from the water under the ship that keeps a boat afloat, the pelvic organs create a lift or buoy the organs up from underneath. This is why we need to have a strong, functional pelvic floor for our entire lives.
Will I know if I have pelvic organ prolapse?
A woman with a prolapse may feel a sensation like a fullness in her vagina or a ball between her legs. She might look and see a balloon like shape protruding from her vagina. If she touches this structure and it feels like a balloon, that is likely the bladder or the rectum. If it is hard like the end of the nose, it is the cervix which is at the end of the uterus. Many women with milder degrees of prolapse will not feel anything at all. There are many women who have some degree of prolapse that never have a symptom in their lives.
Is it life threatening?
No, prolapse is not life threatening. Having a prolapse is a quality of life issue. This means, if your symptoms do not take away from your ability to do your life you do not ever have to do anything about this problem. Women commonly choose to do things about the prolapse as it can create incontinence, or poor emptying of the bladder, it can create feelings of chafing or dryness of the exposed inside of the vagina which is irritating and painful, it can take away from a woman feeling sexual interest and, the one that concerns me most, having symptoms of prolapse or fearing making a prolapse worse may prevent a woman from engaging in movement and exercise. Across a lifetime, that makes for some serious health challenges, impacting heart, bone, gut, brain and muscular health.
Can it be cured?
Let’s talk about what ‘cured’ means. In the case of prolapse, it has occurred because the tissue of the vagina has become lax or stretched. While a strong pelvic floor and good movement and breathing habits can hold the organs in a more optimal position so that all symptoms of prolapse are gone, if someone like myself or a gynecologist went and looked inside your vagina, they would always find some evidence of the prolapse. That tissue of the vagina is such that, unlike a muscle, it cannot be trained to resume its shape.
‘Curing’ someone of their prolapse involves the following:
- strong, well functioning pelvic floor muscles that support the organ optimally.
- optimal breathing strategies (watch for habitual breath-holding, overbreathing and no chronic coughing).
- good strategies for movement in the rest of the body, so that movement does not involve increased effort, and even when exerting one’s self, the muscles and diaphragm are co-ordinated in a synergistic way.
What this feels like is that the woman has no symptoms of having a prolapse.
What else can be done?
A prolapse can be supported by a silicone device called a pessary. Traditionally, this device was specially measured to fit the unique architecture of a woman so that she could have it inside her vagina and not feel it there. It can be worn for 3 months at a time, then taken out and cleaned and reinserted. A woman can also learn how to put it in and take it out herself, to be worn when involved in activities that stress her system, such as running and jumping. While this can be a challenging idea for some women, think of it like a knee brace for an unstable knee. It is a passive support system and can work very well to allow a woman to enjoy the full expression of how she moves.
There are now over-the-counter pessary devices that can be bought and inserted. These can be quite well tolerated and are disposable.
A woman with a prolapse that chooses to use a pessary has to have healthy vaginal tissues. These can be best supported with the use of vaginal estrogen therapy that is prescribed by a doctor.
Some women opt for surgery. Surgical procedures can be as simple as a vaginal repair to tighten up the tissue of the vagina along the wall shared by the organ in question or as ‘serious’ as a hysterectomy where the uterus is removed and the vaginal vault is then attached to the sacrum as an artificial support system for the vagina. These surgeries are invasive and should not be the first line of approach to a prolapse as there is a high rate of need for repeat surgeries, and subsequent procedures are often not as effective as the initial procedure.
Some women now are experimenting with the Mona Lisa, a laser procedure that claims to increase collagen levels in the tissues to help make them more robust. There is not enough evidence in these procedures, in my opinion, to recommend them without reservation. It’s exciting to see what might happen in time.
Our bodies are a pressure system and the pelvic floor’s chief function is to work against the downward coming pressure forces of the body to keep our urine, feces and organs inside our bodies, until appropriate to let them out. Living a lifestyle that allows you to minimize excess pressure imbalances is an essential part of pelvic organ health and prevention of prolapse.
Increased chance of prolapse occurs when there is:
- A chronic cough
- Chronic constipation
- A weak pelvic floor
- Poor breathing strategies
- Poor coordination of the core muscles
- Vaginal delivery, especially with a prolonged active pushing stage and the use of forceps or vacuum extraction
- Poor bladder habits – such as pushing to make sure all the drops are out
Pelvic Health Physiotherapy (aka Pelvic Floor Physiotherapy)
A pelvic health physiotherapist is uniquely trained to help troubleshoot the reasons that you might be experiencing prolapse and help guide you on the path to managing and minimizing the impact of this condition in your life. Physiotherapists can get you on the path to your ‘cure’.
About Gillian McCormick
Gillian is passionate about elevating human beings through education, rehabilitation and love. She does this through her role as Pelvic Health Physiotherapist, through public speaking, and advocacy. She works at Canopy Integrated Health in the lovely Lynn Valley.
She is co-host of Small Conversations for a Better World Podcast and is a Clean Beauty Advocate through BeautyCounter. On social media: @physiogillian. Website: www.physiogillian.com
See Gillian live at the following event by Grace Club VYR, “Let’s Talk About Sex, Baby”, on March 9, 2020.
Tickets are available on a sliding scale.