Pelvic Organ Prolapse: Your Top 10 questions answered

prolapsepelvic floor
Written By Surabhi Veitch
Position of pelvic rest for symptoms of pelvic organ prolapse

Position of pelvic rest for symptoms of pelvic organ prolapse (POP)

What is pelvic organ prolapse (POP)?

Pelvic organ prolapse happens when one or more pelvic organs (the bladder, urethra, bowel / rectum or uterus) pushes into the vaginal wall or, in more severe cases, bulges outside of the vagina.

  • A cystocele occurs when the bladder pushes into the anterior vaginal wall.

  • A rectocele refers to the descent of the rectum into the posterior wall of the vaginal.

  • A vaginal vault prolapse occurs with descent of the uterus, cervix, or apex of the vagina.¹

There are 4 stages of prolapse, varying from Stage 1 to Stage IV. When the pelvic organ protrudes out of the vagina, it can be a Stage III or Stage IV prolapse.

What are symptoms of prolapse?

Symptoms of prolapse include heaviness, a feeling of fullness or bulging in the vagina, a golf ball feeling between your legs, or pelvic fatigue. Some people with prolapse can experience urinary leaks, urinary urgency, difficulty voiding, pelvic pain and pain with sex (dyspareunia), although the prolapse itself may not always directly cause these symptoms. Research shows that 40% of people with POP will present with urinary incontinence, 37% will present with overactive bladder, and 50% will present with fecal incontinence.¹ Prolapse can also mask symptoms of stress urinary incontinence (SUI).¹

How do I know if I have prolapse?

You may be the first to notice that something feels different in your pelvic floor. Prolapse is typically diagnosed by an obstetrician, gynecologist or urogynecologist. A pelvic health physiotherapist, midwife or doctor may be one of the first ones to discover vaginal wall laxity and refer you to see a specialist. If you have any symptoms that concern you, please bring it up with your doctor.

How common is prolapse? I feel like I’m the only one with it.

Pelvic organ prolapse can feel really scary at first and affect your physical, social and psychological well-being.² And yet, prolapse is actually quite common. Although only a small percent of people with prolapse are symptomatic, prolapse occurs in up to 50% of vaginal births.¹ It can also occur after Caesarean births, in people in constipation, in people who’ve never been pregnant, or with increasing age.¹

Remember that you did not cause your prolapse! Prolapse cannot be fully prevented. Since most folks aren’t even aware of the existence of their pelvic floors until after they’ve had a baby, it is possible that some people have laxity in the pelvic floor long before having a baby.

A mild, or Stage 1 prolapse, may be considered a normal finding (after all, half of all postpartum folks develop it!). Prolapse can often be over-diagnosed in postpartum people, especially in the first 3 months of recovery when we can expect that things will feel looser or weaker. Some amount of descent of the pelvic organs is normal with straining, coughing or sneezing. We need not worry about the small movements of our pelvic floors - our bodies are designed to move and stretch! As you give your body time to heal and recover postpartum, you may notice symptoms improve drastically.

Why did I get prolapse? I feel like I’m broken.

A diagnosis of prolapse is often associated with feelings of shame, blame, resentment, shock, sadness, grief, anger, frustration, avoidance, anxiety, and depression... I want you to know: You are not alone. Your feelings are 100% valid. You are not broken.

Prolapse occurs due to a stretching of the ligaments, fascia and soft tissues that hold the pelvic organs in place. This can happen due to pregnancy, poor lifting mechanics, chronic constipation, and genetics, amongst other things. Prolapse is not your fault! Childbirth can create laxity or looseness in the vagina which can allow the pelvic organs to descend into the walls of the vagina. However, as the vagina and pelvic floor heal postpartum, the laxity of the vaginal walls can improve. Your pelvic floor can feel very different at 6 weeks postpartum, 6 months postpartum and 2 years postpartum. Symptoms can improve over time. There is support for you! If you’re ready to access support, book your virtual pelvic physiotherapy consultation here.

How do you fix pelvic organ prolapse?

In the same way that we can’t fully reverse the sagging of our boobs, a total reversal of prolapse may not always be possible. However, prolapse doesn’t mean that you’re broken. You don’t need to be “fixed.” What you need is guidance navigating your symptoms and goals, and support living a functional life.

There are many evidence-supported ways to manage symptoms of prolapse. These include: pelvic physiotherapy, pessaries, and surgery (ask your doc to refer you to a gynecologist or urogynecologist). Often, management of prolapse includes a combination of these modalities.

Pessary

What is a pessary? A pessary is a medical-grade silicone device that sits in your vagina and acts as a sports bra for your vagina, supporting your pelvic organs in place. They're not one-size-fits-all. A pessary comes in different shapes and sizes, and can be fitted by urogynecologists, gynecologists and certain specialized pelvic health physiotherapists. In most cases, you will need a doctor’s referral to see a specialist in order to be fitted for a pessary. Some people benefit from a pessary earlier in postpartum recovery, when the body is still healing. Some may benefit from it for physical activities like running and jumping, and others may wear a pessary for daily use and long-term. Check out my Mom Strength podcast interview with Cara McDougall, lead pelvic physiotherapist and founder of Toronto Pessary Clinic, to learn all things pessary use for prolapse and stress urinary incontinence.

Pelvic health physical therapy

Pelvic health physio can be extremely helpful in the management of prolapse. Pelvic floor rehabilitation and pelvic floor muscle training (PFMT) is effective at reducing symptoms, improving quality of life and is even cost-effective.³ However, pelvic floor treatment goes beyond Kegels! We focus on gradual progression of exercises, full body strengthening, pelvic and hip mobility, as well as breathing and pressure management strategies to prevent further stress going down into your pelvic floor. Pelvic floor therapy also teaches you positions of rest and strategies to provide relief when your symptoms increase. Remember, prolapse doesn’t mean your body has failed you - it occurs in about 50% of vaginal births, after all! Working with a physiotherapist can help to ease anxiety and worries, and give you more freedom and control over your body.

Seek pelvic physiotherapy support to feel more functional and in control of your prolapse

  • For 1:1 support, schedule your virtual or in-person pelvic health consultation by clicking here to book with Surabhi.

  • Not ready for individualized support yet? That’s okay! Grab my Pelvic Strength workshop replay: Learn how to squat, deadlift, and improve the endurance of your pelvic floor, thighs, booty and core without just doing Kegels for months.

Why does mild prolapse feel so symptomatic? It feels like a major problem and is interrupting my life!

A "mild" prolapse refers to the degree of which one of your pelvic organs pushes into your vaginal wall. However, for some people, even a mild prolapse can create major symptoms. You know your body best and you know if something doesn’t feel right. Your experience is 100% valid.

A diagnosis of prolapse is often associated with feelings of shame, blame, resentment, shock, sadness, grief, anger, frustration, avoidance, anxiety, and depression.⁴ Just because many people experience prolapse, it does not mean that it isn’t a big deal for you. A diagnosis of prolapse can feel extremely debilitating. You are not alone and there is support!

Mental health support is highly recommended as you process your feelings and learn to accept the changes within your body. Stress management cannot be emphasized enough. It is crucial to practice techniques to regulate your nervous system, such as breathwork, movement, journaling, mindfulness, yoga, meditation, getting out in nature or whatever it is that helps you feel calm, safe and supported.

If you need support with managing your prolapse, getting strong, and returning to your fave physical activities, book a virtual consult by clicking here.

Can I exercise with prolapse? Should I avoid running and jumping? Should I just rest?

Yes, absolutely, you can exercise! With the support of a pelvic physical therapist and/or specially-trained postpartum fitness coach, you can gradually progress your physical activities based on your stage of recovery and your tolerance.

It is recommended to:

  • build up your exercise tolerance gradually

  • honour your body’s need to rest, especially in the first few weeks postpartum

  • stay hydrated, well-nourished and sleep as much as you can (which I know can be hard with a new baby)

  • manage constipation

  • manage stress, and get support for mental health, as needed

  • learn pressure-management strategies

You do NOT have to:

  • avoid high-impact activities forever

  • exercise only lying down forever

  • lift only 10 lbs (your baby will be more than 10 lbs pretty soon, so this is very unrealistic advice!)

  • just avoid exercise forever and ever

Remember: Your goals and passions matter!

Although many people restrict themselves from participating in physical activities and hobbies,⁵ research does not support movement restriction for prolapse. With the right support, most people can return to activities that they typically enjoy, including baby-wearing, running, jumping, and high-impact activities. As Antony Lo (The Physio Detective) says: holistic women’s health is about more than just saving your vagina. When you avoid physical activities, exercise, and normal movements out of fear of making your prolapse worse, you also lose strength, fitness, joy, freedom of movement and social outings. Your quality of life matters. Your body is designed to move and heal. And it will heal!

Make sure to purchase the replay of my Pelvic Strength workshop. You’ll learn pelvic floor strengthening exercises, glutes and adductors and ab strengthening too!

Can I have sex with prolapse? Can I use tampons or cups? Why does it hurt?

Yes, you can have sex with prolapse! I actually have an entire blog on prolapse, sex and what you can do about pain. Read it here: Blog: Prolapse, sex and pelvic floor symptoms.

Yes, you can use tampons or cups, although you may find your comfort level varies through your cycle. Some people find tampons don’t stay in easily and may prefer cups (cups can almost act as a pessary). However, some people find cups to be irritating, and others prefer pads or period underwear instead.

Tampons and cups may feel uncomfortable to insert if you’re holding a lot of pelvic floor tension during insertion. This is something we can absolutely work on through virtual consultations. Painfree insertion and use of tampons and cups is the goal!

If you’d like to learn more about how to RELEASE tension in your pelvic floor, release SHAME, and learn MOBILITY exercises to help you decrease pelvic fatigue and soreness, grab my Reclaim your Pleasure workshop replay!

Will doing extra Kegels help my symptoms?

While pelvic floor muscle training can help, doing Kegels all day won’t help and neither will being too focused on your symptoms. Get your head out of your vag! Try not to not always focus on what your symptoms feel like. Focus on the things that feel good. When we pay all our attention to our symptoms, we tend to notice them more. Work with a pelvic health professional and a mental health professional to develop tools to help you move away from excess worry or anxiety over your symptoms.

And if you haven’t yet, grab the replay of my Pelvic Strength workshop!

I need support! How can I work with you?

I offer 1:1 in-person (Toronto/GTA) and virtual physiotherapy and virtual fitness coaching to help you develop the strength & mobility you need to move your body with confidence and return to your movement goals.

>> You can book your initial consultation by clicking here <<

 

Resources:

References:

  1. Christine Aboseif and Paul Liu. (2022) Pelvic Organ Prolapse. Accessed from: https://www.ncbi.nlm.nih.gov/books/NBK563229/

  2. Ilias Giarenis and Dudley Robinson (2014). Prevention and management of pelvic organ prolapse. PMID: 25343034 Published online 2014 Sep 4. doi: 10.12703/P6-77 Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166938/

  3. Maxwell M, Berry K, Wane S, Hagen S, McClurg D, Duncan E, Abhyankar P, Elders A, Best C, Wilkinson J, Mason H, Fenocchi L, Calveley E, Guerrero K, Tincello D. Pelvic floor muscle training for women with pelvic organ prolapse: the PROPEL realist evaluation. Southampton (UK): NIHR Journals Library; 2020 Dec. PMID: 33351399. Accessed at: https://pubmed.ncbi.nlm.nih.gov/33351399/#:~:text=A%20multicentre%20randomised%20controlled%20trial,potential%20to%20be%20cost%2Deffective.

  4. Ghetti et al. (2015). The Emotional Burden of Pelvic Organ Prolapse in Women Seeking Treatment: A qualitative study. Female Pelvic Med Reconstr Surg. 2015 Nov-Dec; 21(6): 332–338. doi: 10.1097/SPV.0000000000000190 PMID: 26506161. Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4624225/

  5. Corlia Brandt and Elizabeth C Janse van Vuuren. (2019) Dysfunction, activity limitations, participation restriction and contextual factors in South African women with pelvic organ prolapse. Published online 2019 Feb 28. doi: 10.4102/sajp.v75i1.933 PMID: 30863799 Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407468/

  6. van der Vaart et al. (2021). Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study. https://doi.org/10.1111/1471-0528.16950 Accessed at: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.16950

Surabhi Veitch https://www.thepassionatephysio.ca
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