If you’re reading this blog post, chances are you have heard of pelvic organ prolapse. Maybe you have seen someone talking about it on their Instagram page and you aren’t sure what it is, maybe you suspect that you may have pelvic organ prolapse, or maybe you’ve been diagnosed with pelvic organ prolapse and want to learn more about how you can manage it.

First, what is pelvic organ prolapse?

Pelvic organ prolapse is the descent of one or more of the anterior vaginal wall (bladder or urethra), posterior vaginal wall (rectum or small intestine), the uterus, or the apex of the vagina (vaginal vault or cuff scar after hysterectomy). Some patients may also experience a rectal prolapse.

I know that pelvic organ prolapse can sound scary, but many patients with pelvic organ prolapse are (or can become) asymptomatic. When defined by symptoms, evidence has shown that the prevalence of pelvic organ prolapse is around 3-6%, however when based on vaginal exam it may be up to 50% (more on this later).

What are the different types of pelvic organ prolapse? 

Here is a quick list of the different types of pelvic organ prolapse and terms you may hear associated with them:

1)    Cyctocele – prolapse of the bladder

2)    Urethrocele – prolapse of the urethra

3)    Urethrocystocele – prolapse of the bladder and urethra

4)    Rectocele – prolapse of the rectum into the posterior vaginal wall

5)    Enterocele – prolapse of the small intestine into the posterior vaginal wall

6)    Vaginal vault prolapse – prolapse of the vagina

7)    Rectal prolapse – prolapse of the rectum 

Prolapse is typically graded based on how far the organ descends into the vaginal canal at rest and with bearing down. It is important that prolapse is assessed in the position where the patient is most symptomatic (which is typically sitting or standing).

What are symptoms of pelvic organ prolapse?

Common symptoms of pelvic organ prolapse include:

1)    Vaginal “bulging” (a sensation like a tampon is falling out)

2)    Pelvic pressure or heaviness

3)    Low back ache

4)    Bleeding, discharge, or infection

5)    Symptoms are often better in positions where gravity is reduced (such as lying down or positions where the hips are elevated)

6)    Symptoms and visualization of prolapse are often more prominent with straining/bearing down

Common symptoms that may occur with a cystocele or urethrocele include poor or prolonged urinary stream, incomplete emptying, stress urinary incontinence, and post void dribbling.

Common symptoms that may occur with a rectocele include vaginal pressure/discomfort, protrusion from posterior vaginal wall, a need to reposition during bowel movements and a sensation of incomplete emptying of the rectum, and difficulty evacuating the rectum with the use of splinting.

Common symptoms of a uterine prolapse include blood stained discharge, difficulty with bowel or bladder emptying, low back pain that worsens as the day progresses, and increased discomfort with prolonged standing.

Why does pelvic organ prolapse happen?

There are several risk factors for pelvic organ prolapse. Let’s look at a list of a few things that may contribute to or cause pelvic organ prolapse. 

1)    Childbirth/vaginal delivery

2)    Frequent increased intra-abdominal pressure due to respiratory issues such as COPD

3)    Increased intra-abdominal pressure due to frequent straining for bowel movements (secondary to constipation)

4)    Menopause/estrogen deficiency

5)    Pelvic surgeries (such as a hysterectomy)

6)    Congenital issues such as Ehlers-Danlos Syndrome and Marfan Syndrome

Can pelvic floor therapy help patients with pelvic organ prolapse?

The obvious answer here is: of course! That is why I’m writing this blog post ;). Read on to learn why pelvic floor therapy can be a game changer for those with pelvic organ prolapse.

First, remember at the beginning of this blog when I pointed out the prevalence of pelvic organ prolapse was around 3-6%, but with vaginal exam may be closer to 50%? This discrepancy is because many women with pelvic organ prolapse are asymptomatic. This means there may be a visual prolapse observed with bearing down, but they are not experiencing any of the symptoms I have listed above.

 

Why is it that you can have pelvic organ prolapse and not have symptoms? Because your pelvic floor muscles are functioning properly and therefore supporting your organs well. You are managing your intra-abdominal pressure, avoiding constipation, and optimizing your movement and breathing patterns. These are all things we can work through in pelvic floor therapy.

 

One other thing I want to note is that a big goal of mine with patients with pelvic organ prolapse is to reduce fear around movement, activities, and future goals (including future pregnancies and deliveries). There is so much we can do to help you manage your symptoms and help you reach your goals.

 

If you’re interested in learning more about what a pelvic floor therapy evaluation looks like, check out this blog post. If you are dealing with pelvic organ prolapse and want to talk with me directly about how I can help, you can set up your free 15 minute phone consult here or email me at alexis@absolutekineticspt.com.

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS

 

References:

Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013 Nov;24(11):1783-90. doi: 10.1007/s00192-013-2169-9. PMID: 24142054.