Pelvic organ prolapse is a common gynaecological condition. It is caused by weakening of the muscles and ligaments surrounding the vagina. One or more of the pelvic organs may drop down or bulge out of the vagina.
Types of Prolapses:
- Uterine prolapse – The womb (uterus) moves down and presses on the vagina
- Cystocele – The bladder pushes into the weakened front wall of the vagina
- Rectocele – The bowel pushes into the weakened back wall of the vagina
For more information about prolapse watch the videos on this page: Understanding Pelvic Organ Prolapse.
What symptoms might a prolapse cause?
- Heavy dragging feeling or a feeling of “something coming down”
- A lump in the vagina
- Low back pain
- Pain or discomfort with intercourse
- Wanting to go to the toilet more than usual
- Leakage of urine
- Frequent urinary tract infections
Physiotherapy
The pelvic floor muscles help to support the organs in the pelvis. Pelvic floor exercises has been proven to improve pelvic organ prolapse symptoms.
Research has shown that up to 32% of people cannot contract their pelvic floor correctly and up to 25% of people are doing the wrong thing when contracting their pelvic floor, which could actually make your symptoms worse. Therefore it is important to ensure you have a pelvic floor assessment before starting pelvic floor muscle training.
Anatomy and Prolapse
So just a little bit of a warning this is a realistic animated picture detailing anatomy including the vagina, the perineum, and anus, which is an anatomically female genital area, so if this makes you feel uncomfortable, just skip this slide. This picture allows you to see an external image of a vulva, also known as a vagina. Here you can see the labia, the clitoris, the urethral entrance, the vaginal entrance, and the anus. The space between your vagina and anus is called your perineum. However, internally, your pelvic floor muscles look like this. The pelvic floor muscle acts as support for the organs that sit within the pelvic structure. As shown in the picture above, there are a large group of muscles that originate at your tailbone, which is also known as your coccyx, and attach onto the front of your pelvis, also known as the pubic bone. The muscles also attach into your sitting bones and create a sling or hammock-type structure that sits at the bottom of your pelvis. The pelvic floor muscles wrap around the opening of your bladder, the vagina, and the bowel, and they support the internal organs accordingly.
So, on this picture, you can see in a strong and normal pelvic floor, the muscles support the pelvic organs, ensuring that they sit in their designated position. In a pelvic floor that’s a little bit weaker, the muscles are unable to support the organs to their full potential, and this can lead to symptoms that we’re going to discuss later within this presentation.
So, what causes a weaker pelvic floor? As you can see, there is a multitude of factors that influence these symptoms. Firstly, pregnancy: we have the hormonal changes, an increase in hormones, and an increase in weight with pregnancy, which can increase the load that’s on the pelvic floor muscles. Childbirth, and how long that pushing and delivery stage of labour was, as well as the weight of your baby, can impact that massively. Any assisted delivery, such as forceps or ventouse, if they had to make any incisions like an episiotomy
When we go through menopause, any hormonal changes, including the reduction of estrogen (which is a hormone that bulks up a muscle), so when we lose that going through the menopause this can weaken the muscles. The longer it has been since menopause, also increases the risk of further pelvic floor weakening. This is why, if you are premenopausal or just starting with menopause, you may notice a change or worsening of your symptoms.
Constipation, if you’re having to push or strain to open your bowels If you’re overweight, this increases the pressure and load on the pelvic floor muscles. Any repetitive heavy lifting also increases the pressure on the pelvic floor muscles. Smoking and general disuse of the muscles—so not using them—they’ll become weaker as a consequence.
So, what is a prolapse? By definition, this is an anatomical change in the tissue that sits within the female pelvis, where there is a downward movement of the pelvic organs into the vaginal cavity.
There are different types of prolapses. We have one that’s called an anterior wall prolapse, commonly known as a cystocele, which is a prolapse of the front wall of your vagina, also known as your bladder. We can have a posterior wall prolapse, known as a rectocele, which is a prolapse of the back wall of the vagina, which is your rectum. We can have a uterine prolapse as well and this can be caused by a weaker pelvic floor muscle.
So, how can we, in physiotherapy, help patients with prolapse symptoms? Well, we can teach you how to do pelvic floor exercises to increase the strength and endurance of the pelvic floor muscles, which will, in turn, improve your prolapse symptoms. We can give you advice on lifestyle changes to prevent any aggravation of the symptoms. We can aim to optimize the outcome of surgery if that is required later down the line, and we can optimize that by improving the strength and endurance of the pelvic floor muscle exercises. But we can also improve any lifestyle changes that need to be put into place and we can prevent worsening of your prolapse symptoms as a consequence.