In previous blog posts (like this one) we have talked about the link between the pelvic floor and hip pain. In this blog post we talked about the link between pelvic organ prolapse and hip pain. But what about pain further down the leg? Could pelvic organ prolapse be causing leg pain outside of the hip? Let’s dive in.

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. You can learn more about the different types of pelvic organ prolapse and symptoms of prolapse in this post.

How does the pelvic floor affect pelvic organ prolapse? 

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%. Why is this? Because many women may have a visual prolapse on exam with bearing down, but do not experience any symptoms of pelvic organ prolapse.

How can you have a prolapse without 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!).

In contrast, those who ARE symptomatic with pelvic organ prolapse likely have some pelvic floor muscle dysfunction, aren’t managing intra-abdominal pressure well, may be constipated, and may not have optimal breathing or movement patterns. These same dysfunctions may cause pain into the low back, hips, and even further down the legs due to compensations or nerve irritation. 

So what does this connection between pelvic floor function, pelvic organ prolapse, and leg pain mean? 

Although we don’t have significant evidence that pelvic organ prolapse is the specific cause of leg pain, pelvic floor function and pressure management can have a significant effect on both POP symptoms and leg pain. Here are a few examples of how leg pain and POP may be connected.

1)    Constipation. Constipation causes increased pressure in the pelvis and can worsen POP symptoms. It can also place pressure on lumbar and sacral nerves that innervate the legs, therefore causing radiating pain or nerve symptoms further into the legs.

2)    Movement compensations. Pelvic floor muscle tension is often found in conjunction with tightness, pain, and tension in the low back and hips. We’ve all seen someone walk with a limp due to low back or SI joint pain. This altered gait pattern can lead to things like foot pain or knee pain.

3)    Nerve impingement. As mentioned above, nerve involvement can occur when the pelvic floor muscles are guarding due to pelvic prolapse. There are a lot of nerves that also live close to these muscles that can be impinged due to muscle tension. Again, that can cause symptoms further down the leg.

It’s also important to note that this can go the other direction as well, meaning pain or dysfunction in your legs may worsen pelvic prolapse symptoms. For example, if you have a stiff or weak foot, it likely isn’t absorbing forces well. This causes your pelvic floor muscles to have to work harder to absorb forces, which can increase pressure in your pelvis and worsen POP symptoms.

By improving pressure management, full body strength, pelvic floor function, and reducing muscular and neural tension, both POP symptoms and leg pain can improve.

If you are experiencing hip pain, symptoms of pelvic organ prolapse, or both, pelvic floor therapy and pelvic health coaching can help! We work with women both in our office in Collierville, TN and virtually. Schedule your free 15 minute phone call here.

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

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