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I Have Symptoms of Prolapse, But My Provider Couldn't See Anything

Hi friends! Have you been checked by your provider for pelvic organ prolapse and been told you do not have any but still experience symptoms of pelvic pressure, heaviness, and bulging? This week we are going to talk about the different positions to check for pelvic organ prolapse and why it matters.

Pelvic organ prolapse is the falling of one or more of the pelvic organs (bladder, uterus, small intestines, or rectum) into the vaginal canal. Sometimes the organ(s) stay inside the vaginal canal, but it can prolapse (bulge) outside of the vagina. Some of the common symptoms of prolapse are pelvic heaviness and pressure and feeling vaginal bulging. Other signs of prolapse can include difficulty emptying your bladder, difficulty emptying your bowels, low back pain, pelvic pain, tailbone pain, pain with sex, and more!

Most times, your physician will check for prolapse lying down on your back. However, because gravity is eliminated in this position, prolapse may not be obvious. There is nothing wrong with this position, but in some cases it can miss seeing prolapse.

Another position that can be used is semi-reclined. This position allows you to remain lying down and still provides a good visual for your provider but allows slightly more pressure on the pelvic floor muscles and pelvic organs to expose any possible prolapse.

If your provider cannot see prolapse in either of these positions, you may want to ask them to check in standing. Testing for prolapse is often not done in standing because of challenges for the provider. The provider will likely need to squat down on the floor to see (a mirror can make this easier). The provider will also need an extra source of light (like a headlamp) to be able to better visualize the vaginal opening and the perineum. Standing puts more pressure on the pelvic floor and can make prolapse more visible.

The last position that can be used to check for prolapse is squatting. This is often done with one foot up on a step stool or chair. This can expose prolapse because this position stretches the pelvic floor. When the pelvic floor is stretched, it has to work harder to support the pelvic organs and keep them lifted in the pelvic cavity.

Keep in mind it is not necessary to check for prolapse in all four positions. However, if you are checked lying on your back and told you do not have prolapse but you experience symptoms in your day-to-day life, you may want to consider asking your provider to check you in other positions.

Another factor that can play a role in prolapse testing is the time of day. Many individuals do not have symptoms in the morning but begin to feel them later in the day or evening. If your provider tested you in the morning but you only experience symptoms in the evening, they may not be able to see the prolapse.

If you are diagnosed with prolapse, remember there is hope to live a happy, healthy life! Check out the tips below for living with prolapse.

Here are some great resources to help you learn more about prolapse:

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

Written by Emily Reul, PT, DPT


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