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5 Tips If You Have Pelvic Organ Prolapse

Hello friends! Did you know that pelvic organ prolapse (POP) affects one in every five women—that’s millions world wide (Nygaard, 2008).  POP is a condition in which one or more of the pelvic organs begins to fall into the vaginal canal. It is staged from one to four based on the severity; with stage one being the least, and stage four being the most, severe.  Being diagnosed with POP can be scary, but know you are not alone!  Here are 5 tips if you’ve been diagnosed with POP.

 

1. Weigh All Your Options

It is not uncommon for surgery to be recommended to correct a prolapse.  While surgery can be a successful treatment, in many cases, surgery is not the only treatment option.  If symptoms do not impact the quality of life, it is recommended to treat conservatively unless symptoms become severe.

 

“Watchful waiting” is recommended for POP that are stages one, two, or three if symptoms are not severe because they may improve (Bo, 2015).  What does conservative management entail? It may include pelvic floor muscle training, lifestyle modifications, and/or the use of a pessary. Some research has shown that pessary use can help to improve or prevent worsening of prolapse symptoms (Bo, 2015)

 

Surgery to repair POP may be indicated if pelvic pain is present, if there is difficulty performing daily activities, or if conservative management has not been successful.



 If you and your providers decided that surgery is right for you, be aware there is a high incidence of new compartment prolapse and recurrent POP after surgery (Bo, 2015). Seeing a pelvic floor therapist for pelvic floor muscle training and lifestyle modifications may compliment surgical repair (Bo, 2015).   Regardless of your decision to have surgery, it is a personal decision and should be made by you and your providers. Many people live happy lives with POP and you can, too!

 

*Remember that this is not medical advice and is solely intended to be educational. Only you and your provider can make the decision of what is best for you.

 

2. Use Internal and External Supports

Internal and external supports are a great conservative, non-surgical option.  Internal supports are inserted into the vagina to provide physical support to the pelvic organs while external supports provide support outside the vagina.

 

A pessary is an internal support that is fitted by a physician or nurse in the United States. In other countries, some other healthcare professionals, like pelvic floor physical therapists, can also fit pessaries. Pessaries come in many shapes and sizes so fitting works by trial and error. It may take 2-3 different pessaries before finding the best one. 70% of women can be successfully fit with a ring-shaped pessary. You are able to remove and insert this type of pessary on your own, and it can also be worn during sex.

 

There are several other internal support options that do not require a fitting by a healthcare professional. These can include:

 

*As always, this is not medical advice and be sure to follow manufacturers guidelines for any products that you use.



External supports, also called perineal supports, provide an extra support or “lift” around the vagina to the area called “the perineum.” Perineal supports can help with symptoms of prolapse as well as varicose veins. While perineal supports can’t stop the organs from falling inside the vaginal canal, they can help to stop them from prolapsing outside of the vagina. External supports can be a game changer for many individuals. Some of our favorite supports are the Cabea belly band and the Prenatal Cradle.

 

If you don’t want to purchase an external support, wearing tight clothing like leggings or compression shorts can help to provide some of the same relief.



 3. Learn How to Breathe

We can use our breath to help manage intra-abdominal pressure, and prevent excess pressure on the pelvic organs, by breathing out as we lift or exert ourselves. Breathing in, or inhaling, engages the diaphragm muscle. Engaging both the abdominal muscles and diaphragm at the same time greatly increases intra-abdominal pressure (Hodges, 1985). This means that if we brace the stomach muscles and breath in at the same time we can significantly increase the intra-abdominal pressure. Breathing out will cause less of an increase in this pressure, allowing the pelvic floor to manage leakage and support our organs better.

 

Use breathing and the core brace to help with both day-to-day activities (like lifting a laundry basket) and with exercise.

 


 4. Get Exercise

Certain types of exercise, like running and jumping, can make prolapse symptoms more evident so some individuals avoid exercise.  However, when we don’t exercise, our muscles tend to get weaker overall.  Exercising women generally have stronger PFM strength and larger muscles compared to non-exercising women (Bo, 2020).  While you may not want to perform high impact exercises if you are having symptoms, don’t avoid exercise completely.  Seeing a pelvic floor therapist can be a great option to help you exercise effectively.  To learn more about how exercise impacts the pelvic floor, read our blog here.

 

5. Manage Constipation

People with constipation often strain to have a bowel movement which increases stress on the pelvic floor muscles and can lead to dysfunction and incontinence as well as prolapse (Irion, 2010).  It is important to avoid constipation and straining to poop when prolapse is present.  There are many different ways to manage constipation, but you can read more details in our blog here.



 To learn more about your pelvic floor muscles, check out these great resources:

 

For providers, check out our online courses to help your clients. Consider joining our Ambassador Program and most of our courses are included with your membership!

  • External Support: The Missing Link with Jeanice Mitchell PT, MPT, WCS, BCB-PMD

  • Office and Surgical Management of Prolapse and Urinary Incontinence with Dr. Sarah St. Loius MD, FACOG, PFMRS

 

Written by Emily Reul, PT, DPT

 

References

  1. Bo K, Nygaard IE. Is physical activity good or bad for the female pelvic floor? A narrative review. Sports Med. 2020;50(3):471-484.

  2. Bo K, Berghmans B, Morkved S, Van Kampen M. Evidenced-based physical therapy for the pelvic floor bridging science and clinical practice. 2nd edition. 2015. 230-242.

  3. Hodges PW, Gandevia SC. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol. 2000;89(3):967-76.

  4. Irion JM, Irion GL. Women’s health in physical therapy.  Lippincott Williams and Wilkins; 2010.

  5. Nygaard, I., et al. (2008). Prevalence of Symptomatic Pelvic Floor Disorders in U.S. Women. JAMA; 300(11): 1311–1316.

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