Hi friends, did you know that one in five women suffers from pelvic organ prolapse (Nygaard, 2008)? We often think of pelvic organ prolapse as a consequence of pregnancy and delivery, but if you’ve never had children you may be wondering how you could have developed pelvic organ prolapse.
Many factors in labor and delivery can increase our risk of pelvic floor muscle dysfunction and developing pelvic organ prolapse including: pushing more than 2 hours, a larger baby, shoulder dystocia, and forceps/vacuum delivery (Ashton-Miller, 2009; Shek, 2010). While it’s true that pregnancy and delivery factors are a large portion of the reason for pelvic organ prolapse, there are so many other conditions that can contribute to prolapse as well—meaning you don’t have to have been pregnant and delivered a baby to be at risk for pelvic organ prolapse!
Here are some of the common (non-pregnancy related) causes of prolapse:
Chronic coughing (like with COPD and asthma) Heavy lifting
Straining with constipation (Irion, 2010)
Hysterectomy
All of these causes can either put pressure and strain on the pelvic floor muscles or remove support. Let’s talk about what prolapse is to help you understand.
Pelvic organ prolapse is the descent of the bladder, cervix, or rectum into the vaginal canal due to insufficient support.
Pelvic floor muscles start at the pubic bone in the front and stretch to the tailbone in the back, functioning like an internal hammock at the base of the pelvis. Pelvic floor muscles are designed to stretch, support, and rebound under stress. In females, this hammock cradles the bladder, the uterus, and the rectum.
Pelvic organ prolapse happens when the forces from above (gravity, intraabdominal pressure, etc.) exceed the forces from below (pelvic floor muscles, fascial support, etc.). If these muscles are damaged or weakened, like with straining and heavy lifting, they may be unable to support the organs--resulting in the collapse of these organs into or through the vaginal canal walls. (Strauhal, 2016)
There are three common types of prolapse: bladder, rectum, and uterus.
Bladder (Anterior Prolapse/Cystocele) (Bradley, 2014)
A cystocele occurs when the pelvic floor muscles are unable to support the pelvic organs, and part of the bladder "falls" into the front wall of the vagina. A cystocele is the most common form of POP.
Rectum (Posterior Propalse/Rectocele)
A rectocele occurs with the pelvic floor tissue between the rectum and the vagina weakens or thins and part of the rectum may “fall” into the back wall of the vagina.
Uterus (Apical/Uterine prolapse)
Uterine prolapse occurs with weakened pelvic floor muscles and ligaments. This is when the uterus slides out of place and "falls" into the vaginal canal.
All this information may be overwhelming, but there IS hope! Pelvic organ prolapse IS treatable. You CAN have a happy, healthy, active life with pelvic organ prolapse! It is not the end of the world.
In fact, pelvic floor muscle training (PFMT) is the #1 recommended intervention for pelvic organ prolapse! It helps increase muscle thickness, elevates the bladder neck, decreases muscle length, reduces symptoms and much more.
Ask your provider for a referral to a pelvic floor therapist, or find one near you at www.mypfm.com/find-a-pt. There’s even more good news: our Power Over Prolapse e-course is FREE this month! This course includes loads of information and research on prolapse including the basics of pelvic floor muscle training and DIY strategies.
To learn more about your pelvic floor muscles, check out these great resources:
Watch our YouTube playlist on Prolapse and the Pelvic Floor
Watch Netflix for Your Pelvic Floor at Pelvic Flicks
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Visit our Amazon store for our favorite pelvic health products
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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
Written by Emily Reul, PT, DPT
References
Ashton-Miller JA, DeLancey JOL. On biomechanics of vaginal birth and common sequelae. Annu Rev Biomed Eng. 2009; 11: 163-176.
Bradley CS. Cystocele (prolapsed bladder). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/cystocele-prolapsed-bladder. Published March 2014. Accessed November 3, 2019
Nygaard, I., et al. (2008). Prevalence of Symptomatic Pelvic Floor Disorders in U.S. Women. JAMA; 300(11): 1311–1316.
Shek KL, Dietz HP. Intrapartum risk factors for levator trauma. BJOG. 2010; 117: 1485-1492.
Strauhal MJ, Swenson C, Rosenman A. Pelvic organ prolapse. Our Bodies Our Selves. https://www.ourbodiesourselves.org/book-excerpts/health-article/pelvic-organ-prolapse/. Published August 3, 2016. Accessed November 3, 2019.