Pelvic Organ Prolapse

Pelvic Organ Prolapse (POP) is a secretive, not often talked about thing.  And yet last week every single day I ended up speaking with people about their prolapse so it just seemed destined that that is what I would write about today!

Prolapse is the descent of one or more internal organs that then push into the vaginal wall.  There are different stages – mild, moderate to extending outside the body.  There are many symptoms, many of which could be attributed to other ailments.

• Urinary incontinence or urine retention – feeling of never fully emptying bladder
• Constipation or faecal incontinence
• Feeling of dragging, like your insides are falling out or heaviness/ache in rectum/vagina
• Lump or bulge in vagina
• Inability to hold a tampon in
• Lower back or pelvis pain
• Vaginal/rectal pain
• Painful intercourse/lack of sensation
• Leakage of urine/stool during sex

The earlier prolapse is discovered the better as there are preventative measures – surgery can be avoided or its severity lessened.  They will also help post-surgery.  Typically one prolapse can lead to another unless steps are taken to prevent this.  Understanding more about how it occurs can also help prevent it.

Causes of prolapse are many and varied

• Childbirth – 50% of all women who have given birth will prolapse
• Menopause and age related drop in oestrogen levels
• Chronic constipation
• Chronic coughing
• Obesity
• Genetics
• Neuromuscular conditions
• Heavy lifting
• Diastasis recti
• High impact aerobic activities – running, jogging, high impact aerobics

It’s worth noting though that POP doesn’t happen overnight – typically many factors over a number of years will build up to cause it.  What’s crucial is intra-abdominal pressure – the build up of this results in bearing down on the pelvic floor. It’s a necessary bodily phenomenon – without it we couldn’t poo – but if there's a constant downward pressure it can be more than the pelvic floor can cope with.

And this is where the knack comes in.  By mindfully contracting the pelvic floor before we stand, lift, cough, sneeze etc. we prepare for the force to come.  Practicing the connection with your outbreath and your pelvic floor contraction can retrain the body and help it to do it's job.

Other things to bear in mind

• Weight control – particularly the amount of abdominal fat you’re carrying
• Lifting technique – never hold your breath.  Always exhale on exertion and lift pelvic floor
• Toilet technique – no straining.  Try to have feet on a stool (2 toilet rolls will do) to raise knees above hips.   Vocalising can also help!
• Exercise – pelvic floor safe exercises for those with a weak pelvic floor, prolapse or have had gynaecological surgery. Gentle Pilates. Core strength and pelvic floor activation. Exercises to avoid – crunches, double leg lifts, full plank position, high impact sports. Ultimately you need to decide what to stop and what to continue with - you can get support for exercise, from supportive shorts to sea sponges and pessaries.

For more information and support see the APOPS website at www.pelvicorganprolapse.support.org.  They also have a private Facebook group – pelvic organ prolapse.  Also Pelvic Floor First at www.pelvicfloorfirst.org.au

Good books - Sherrie Palm, The Silent Epidemic and Sue Coult, Pelvic Floor Essentials.  I have copies if anyone would like to borrow them

Get a kegel app for your phone – lots of free ones but the one most recommended by women’s health physiotherapists is the NHS Squeezy app

And as they say on Channel 4 – “if you have been affected by this” please feel free to get in touch.  I would be glad to give any help and advice.