Understanding Pelvic Organ Prolapse

What is Pelvic Organ Prolapse?

Prolapse refers to the loss of support for the uterus, bladder, colon or rectum leading to the descent into the vagina of any of the pelvic organs. There are four types of prolapse:

• Anterior vaginal wall prolapse (cystocoele), where the bladder bulges into the anterior vaginal wall.
• Uterine prolapse, where the uterus descends into the vagina.
• Vault prolapse, where the upper portion of the vagina descends into the vaginal canal. This can occur in conjunction with a uterine prolapse or following a hysterectomy.
• Posterior vaginal wall prolapse (rectocoele), where the rectum bulges into the posterior vaginal wall.

Prolapse occurs when the connective tissue and muscles supporting the pelvic organs are overstretched or ruptured. The connective tissue affected will determine the type of prolapse.

How Common is Prolapse?

An estimated 50% of women who have had children experience symptoms of prolapse. Prolapse can occur at any age but is more common with advancing age. 

What are Common Pelvic Organ Prolapse Symptoms?

Symptoms will vary depending on the severity and type of prolapse. The most commonly reported symptoms include:

• Lump or bulge in the vaginal
• Lower abdominal or backache
• Dragging or heaviness sensation in the vaginal area
• Sluggish urine flow or incomplete emptying
• Difficulty emptying bowels
• Pain during intercourse

What are Common Pelvic Organ Prolapse Risk Factors?

Obstetric-related risk factors include:

• Parity – the number of children you have had
• Mode of delivery – a higher risk with vaginal delivery compared to C-Section
• Infant birth weight – a higher risk with heavier babies, >4kg
• Age at first delivery – high risk with delivery at a more advanced age

Other risk factors include:

• Obesity
• Aging
• Constipation

What Can Be Done To Help?

As the causes of pelvic organ prolapse have two components—a connective tissue component and a muscle component—prolapse treatment is multidimensional, targeting either or both of these components.

Physiotherapy aims to help with the muscular component and advice regarding symptom management. Some conservative and preventative strategies to help manage prolapse are:

• Pelvic floor muscle training.
• Be proactive with general exercise your whole life, and modify exercises as appropriate to focus on prolapse exercises or pelvic floor-safe exercise.
• Be aware of activities of daily living that may increase your risk of prolapse, and learn to appropriately activate your pelvic floor muscles during these activities or modify/avoid them.
• Keep your weight in a healthy BMI range through a healthy diet and regular gentle exercise.
• These can be useful in the short-term as you begin pelvic floor muscle training or as an alternative to maximising options prior to considering surgery. They can also be useful to self-manage in the long term, as some can be inserted only with activities that increase the risk or symptoms of prolapse, such as exercise or lifting.

If there is a greater connective tissue component, there are surgical options. However, keep in mind that stronger pelvic floor muscles can help to offload the ligaments that also support the pelvic organs. This can clearly be shown with the boat theory.

Imagine the boat as your pelvic organs, the ropes holding the boat to the dock as your pelvic ligaments, and the water as your pelvic floor muscles. If the water level is high (strong pelvic floor muscles), then there is less load on the ropes (pelvic ligaments) to hold up the boat (pelvic organs).

 If you need help with issues with pelvic floor, please call 9416 4410 or book online via this website to see one of our women’s health physios. We can provide you with the appropriate pelvic organ prolapse treatment based on physiotherapy techniques, including lifestyle changes and pelvic floor exercises.