June is prolapse awareness month. Pelvic organ prolapse affects one in five women worldwide (Nygaard, 2008).
Despite its prevalence, many individuals experience feelings of isolation, frustration, or distress over their symptoms. Others feel very anxious over the prospects of developing a prolapse with pregnancy which takes away from the excitement of bringing a new baby into the world.
What is a pelvic organ prolapse?
Pelvic organ prolapse or POP is the descent of one or more organs that live inside the pelvis. The bladder can prolapse (called cystocele), the rectum (rectal prolapse or rectocele), uterus, urethra, or even part of intestines (enterocele).
*note rectal prolapse is descent of the rectum in its own canal while rectocele is pressure on the vaginal wall from the rectum
Physicians further can classify prolapse based on the extent of the descent of the organs from a 0-IV scale (0 none, I minimal descent to IV more severe)
Symptoms include any of the following but not limited to: a sensation of pressure or heaviness in the pelvic or vagina, a vaginal lump or bulge, incomplete emptying of bowels or during voiding, straining to void or have bowel movement, and pain with sexual activity. Some people with a prolapse do not experience any symptoms at all.
Who is at risk for POP?
Pregnancy is the most significant risk factor for developing a pelvic organ prolapse (Memon, 2012). Contrary to popular belief, a cesarean birth does not spare the pelvic floor although risk for prolapse is lower in those who deliver via cesarean (Glazener, 2010)
POP is not relegated to the prenatal/ postpartum population. Anyone can experience a prolapse. Prolonged excessive straining like with chronic constipation can put someone at risk for a prolapse.
In addition, people with connective tissue disorders where they have excessive laxity are at increased risk for prolapse.
The Do’s and Don’ts
DO learn to breath
Just breathing? Yes, breathing. We work on breath work with nearly all of our patients.
Your diaphragm, your pelvic floor, and deep abdominals work together to form your “core”. Your core isn’t just those six pack abs down the middle.
Your core is a canister that helps manage pressure in the body. With a prolapse, we want to decrease excess pressure from above.
Belly breathing or diaphragmatic breath helps keep the canister moving and pressure managed. The breath is also the fundamental step to activating your deep abdominal muscles
Try this at home!
Stand with your back against a wall and place your hands on the sides of your ribcage.
Inhale and let the ribcage open 360 degrees like an umbrella.
You should feel the hands moving to the side with your inhale and also very gentle pressure of your ribs moving back into the wall behind you.
DON’T swear off running and exercise forever
High impact activity can exacerbate prolapse symptoms. While it’s not wise to continue with high impact activity like running or jumping while symptomatic, don’t swear it off forever.
Scale back the activity you want to do, and build yourself back up.
Try changing the running surface from concrete to gravel or dirt to decrease impact.
Whether jumping or running, land soft. Try increasing your cadence to change the landing point in your stride.
Rigid muscles aren’t great shock absorbers so avoid trying to suck in your core for more support. More on that later in the blog.
Internal supports called pessaries as well as external supports and compression shorts specifically for prolapse exist and can help you return to higher impact activity.
*note, in the US urogynecologists typically do fittings for pessaries
Overwhelmed? There’s a whole lot to think about here. A pelvic floor physical therapist can really help you out when it comes to individualized return to running.
Want to learn more? Check out this awesome blog on running with prolapse: https://www.juliewiebept.com/running-with-prolapse-2/?mc_cid=3f221056a6&mc_eid=e80b90a66c
DON’T neglect the glutes
Strengthening for prolapse? Are kegels the first thing that comes to your mind?
Yes, kegels can be very helpful in many cases (notice the use of many. Some people are overdoing it with their pelvic floor and actually need to improve mobility first). But the pelvis isn’t just floating in space. We need to look at the surrounding muscles too.
We want to build strength throughout your core, hips, and glutes. Not only does strengthening take some of the workload off the pelvic floor, it can help you stand a little taller with optimal posture which can help with symptoms.
Standing with glutes tucked under, or a posterior pelvic tilt, is not optimal for prolapse.
What glute exercise is best?
You can start simple with a bridge. Start with both legs and then progress to a single leg bridge.
DO address constipation
Excessive straining is a risk factor for POP.
Start with diet. Stool should be soft but formed like a banana. Hard lumpy stools or even mushy little pieces are going to be harder to evacuate. The USDA recommends women eat at least 25 g of fiber per day and men eat at least 38g of fiber per day. Most Americans fall short around 16 g (Bliss, 2017).
Play around with toilet positioning. Knees higher than hips can help you relax your pelvic floor to allow passage of stool. The squatty potty is a great tool to help you get into optimal position.
Finally, exhale as you bear down. The exhale will help your abdominal muscles push so it’s not just your pelvic floor doing all the work. Vocalizations like the “grrrr”, “shhh”, or “fffff” noise can be very helpful.
Did you know that a pelvic floor physical therapist can help you with constipation too?
DON’T over engage your core
This one may seem a bit counterintuitive, but hear me out. Rigid muscles aren’t great shock absorbers.
Think about jumping and landing with knees straight. You feel all that force go right to your knees.
Gripping the abdominals will increase intra-abdominal pressure (aka downward pressure on your organs) and won’t allow your body to evenly absorb shock from high impact activity.
There’s a time in place to pull your deep abdominals in like lifting something heavy or during your pilates class, but not for a leisurely walk with your dog.
DO seek out the help of a pelvic floor specialist
Let experts guide you. You don’t have to rehab yourself all on your own. Everyone’s journey with prolapse is different and different strategies work for different people.
We can assess your pelvic floor strength, endurance, and coordination, but most importantly address how your pelvic floor works together with the rest of your body.
Pregnant and worried about prolapse? Come in for some pre-hab sessions. We can work on different pushing strategies and positions to empower you through delivery. We can make sure that your pelvic floor muscles are functioning optimally to support you through pregnancy, delivery, and postpartum.
DON’T beat yourself up about prolapse
Most importantly, prolapse is NOT your fault.
You can do all the right things and still have some level of prolapse. Some of us just don’t win the connective tissue lottery. Many of us don’t know about prolapse until we experience it, and that’s okay too.
If you have a prolapse, you are not alone. Your prolapse does not have to dictate your life.
At Hudson Valley Physical Therapy, we can help you on your healing journey with prolapse.
Glazener, C., MacArthur, C., Bain, C., Dean, N., Toozs-Hobson, P., Richardson, K., . . .Wilson, D. (2010). Epidemiology
of pelvic organ prolapse in relation to delivery mode history at 12 years after childbirth: A longitudinal cohort
study. Neurourology and Urodynamics, 29, 819–820.
Memon, H., & Handa, V. L. (2012). Pelvic floor disorders following vaginal or cesarean delivery. Current Opinion in
Obstetrics & Gynecology, 24(5), 349–354. doi: 10.1097/GCO.0b013e328357628b
Nygaard, I., Barber, M. D., Burgio, K. L., Kenton, K., Meikle, S., Schaffer, J., Spino, C., Whitehead, W. E., Wu, J., Brody, D. J., & Pelvic Floor Disorders Network (2008). Prevalence of symptomatic pelvic floor disorders in US women. JAMA, 300(11), 1311–1316. https://doi.org/10.1001/jama.300.11.1311