Help, I have a prolapse!!

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By Amy Tinetti, Women’s Health Physiotherapist

The word PROLAPSE causes many women a lot of anxiety and stress. The information below will show you there is help out there and here at Wisdom Physiotherapy, we can significantly help you on your journey to reduce your symptoms of prolapse.

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What is a vaginal (pelvic organ) Prolapse?

Your pelvic organs include your bladder, uterus (womb) and rectum (back passage). These organs are held in place by tissues called ‘fascia’ and ‘ligaments’. These tissues help to join your pelvic organs to the bony side walls of the pelvis and hold them inside your pelvis.

Your pelvic floor muscles also hold up your pelvic organs from below. If the fascia or ligaments are torn or stretched for any reason, and if your pelvic floor muscles are weak, then your pelvic organs might not be held in their right place and they may bulge or sag down into the vagina. This is known as a pelvic organ prolapse.

What are the signs of a prolapse?

  • Heavy sensation or dragging in the vagina
  • Something ‘coming down’ or a lump felt in the vagina
  • A lump bulging out of your vagina, which you see or feel when you are in the shower or having a bath
  • Vaginal laxity or looseness
  • Pain during sex
  • Less sensation during sex
  • The feeling of not being completely empty when you wee
  • When weeing the stream might be slower than normal
  • Straining to wee
  • Constantly having urinary tract infections
  • Difficulty emptying your bowels
  • Needing to wee numerous times at night

These signs can be worse at the end of the day and may feel better after lying down. If the prolapse bulges right outside your body, you may feel sore and bleed as the prolapse rubs on your underwear.

What increases your risk of having a prolapse?prolapse physio, womens health physio nedlands perth

  1. Childbirth is the main cause of prolapse.
    On the way down the vagina, the baby can stretch and tear the supporting tissues and pelvic floor muscles. The more vaginal births you have, the more likely you are to have a prolapse. In fact, it is estimated 1 in 2 women who have a vaginal delivery have a prolapse.
  2. Chronic coughing (such as smoker’s cough or poorly controlled asthma)
  3. Heavy lifting constantly
  4. Constipation – constantly straining to empty the bowel can cause prolapse
  5. Aging – after menopause
  6. Being overweight
  7. Genetics- if your mother had one you are more likely
  8. If you are hypermobile (very flexible)

What can I do to prevent prolapse?

Some things are hard to change but some that are in your control include:

  1. Avoiding constipation – if you have constipation and want to know how physiotherapy can help please read this blog on constipation
  2. Keep your asthma under control to avoid excessive coughing
  3. See a Doctor or pharmacist if you can’t get your coughing under control
  4. Stay fit and healthy- to avoid weight gain

What can I do to improve my prolapse?

Non-surgical management:

  1. Strengthen your pelvic floor through specific exercise
  2. Find out what makes it worse and then modify those activities.
  3. Change how you lift objects to reduce the pressure through the prolapse
  4. Discuss the option of a pessary (this is a medical device which adds support for the prolapse)
  5. Improve any constipation issues
  6. Seek treatment for prolonged coughing/sneezing – e.g. hayfever, asthma, prolonged cold/flu

Surgical management:

Prolapse can be surgically managed but non-surgical management is normally recommended first. Depending on people’s health status and childbearing age surgery may not be an appropriate option.

For those women undergoing surgery for the management of their prolapse, it is often helpful to be seen by a Women’s Health Physiotherapist both before and after treatment as the pelvic floor muscles play an integral role in the support mechanism.

What does the research say about prolapse and non-surgical management?

The research shows pelvic floor rehabilitation, under the guidance of a Continence and Women’s Health physiotherapist, is effective in reducing prolapse symptoms and signs.

What not to do

If you have noticed certain activities make your prolapse bulge more or any of the above symptoms worse, then the activity needs to be modified. This could include reducing heavy lifting or stopping high impact exercise until you have spoken to a health professional.

What can a Women’s Health Physiotherapist do?

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  • Diagnose what type of prolapse you have
  • Thorough subjective and objective assessment (current and past history) including discussing your past and present bladder and bowel issues
  • Prescribe an individualised pelvic floor exercise program
  • Fit a pessary to reduce the prolapse and teach you how to use it safely
  • Education on what specific pelvic floor exercises you may require and incorporate these into your current exercise and daily activities
  • Lifestyle advice (including weight loss and modifying aggravating activities)
  • Managing any bowel issues such as constipation or faecal incontinence
  • Managing any bladder issues such as urinary urgency or have problems weeing
  • Discuss strategies specific to your diagnosis
  • Offer Clinical Movement Therapy, incorporating Clinical Pilates exercise with a focus on safe prolapse and pelvic floor exercises

If you think you might have a prolapse, please get in touch and make an appointment with Women’s Health Physiotherapist, Amy Tinetti to find out how to make improvements today. Either call (08) 6389 2947 or click here to make an appointment online.

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