Pelvic Organ Prolapse Solutions

POP solutions

It's been a while since my first blog about prolapse and a few things have changed since then.  So I thought I'd do a couple of updates

There are two ways you can look at helping with POP symptoms - what can you do to prevent things getting worse and what can you do to make things better.

So first we'll look at preventing things getting worse

One of the key things with this is looking at intra abdominal pressure (IAP)

IAP is the pressure within the abdominal cavity and is reliant on the fluid and the abdominal walls

This pressure is balanced with the pressure contained in the thoracic cavity - everything within your ribcage

There are normal fluctuations in this pressure when we breathe.  We utilise a higher IAP when we brace, which helps to support our spines.   And increasing IAP is also the way we get stuff out of the body - be it poo, a baby or a sneeze!

But having a higher IAP over a greater length of time is going to put a lot of pressure on the pelvic floor and the pelvic organs.  So we want to try and minimise that by introducing better techniques

1.  Constipation

Straining to go to the loo is a driver for pelvic organ prolapse so we want to combat it in two ways:
  • avoid getting constipated - so make sure you drink enough water, try to walk 20 mins a day, massage your stomach and keep an eye on your nutrition. When you feel the need to go, go - don't wait. The longer the poo stays in the system, the more water gets absorbed, so you end up with harder poo.
  • avoid straining to go - use the three steps below 
  1. use a stool for your stool, so your hips are higher than your knees
  2. keep your feet flat down on the stool - so make sure it's big enough without having to go on tiptoes
  3. lean slightly forwards - rest your elbows on your thighs.  This is usually helpful for most people.  However, if you have a rectocele and have what feels like a 'pocket' and never fully feel like everything's out, you may find it better to sit more upright.  Hypopressives helped me lose that sensation

This all helps to put you in the best position for pooing - it should feel almost like a squat.

And for a little added extra help - try a low hum! This can relax you and your pelvic floor and help you to go without the need to push
It's also important not to strain when you're weeing either - you should just relax to let wee out. 

2.  Standing up from seated

Going from a seated to a standing position increases intra abdominal pressure and can push down 9kg of weight onto the pelvic floor.  If you are holding a baby that is even more weight to lift!

So this is one time we can be conscious of our pelvic floor and use it to help counteract that pressure. Essential if you already have a prolapse but also important to practice if you haven’t, especially if you are up and down out of your seat a lot!

Ideally you start off in a nice upright position - sat evenly on your sit bones, feet under your knees, knees in line with your hips

  • inhale - relax pelvic floor and hinge your upper body slightly forward
  • exhale - engage pelvic floor
  • continue to engage as you stand up
  • inhale - relax pelvic floor
Use your hands on your thighs for support if you need to, just make sure you're not bearing down into them.

Once you practice it enough times it should become more reflexive - and happen without having to cue it.  I always suggest first practicing after you've been to the loo - less likely to get funny looks as you focus on the technique.  Plus you'll get to practice it a number of times through the day!
Also consider how you get up from lying down - you need to roll to your side rather than sitting straight up

3.  Bending 

This carries on from the previous technique but with the added weight of whatever it is you're lifting, or extra time spent in the position

You need to make sure you hinge at the hips rather than bending from your upper body, keepoing your spine in alignment throughout - you're not just rounding forward from the shoulders.

From there you can squat or lunge to go lower

Then bring whatever you are lifting close in to you first.  Then when you are ready to stand exhale to engage pelvic floor and keep engaging as you come back up, using your lower body to lift. Then release your pelvic floor at the top

Bum and leg strength are so important!!  This is what should power the movement, not your arms or back

Think of engaging the pelvic floor to the degree it’s needed - so it will be more if picking up a child, less if it’s a toy. Same action, less effort required 

And breathe...  Lifting is one of those tasks we often hold our breath for and bear down as we do it.  Breathing out on the effort is going to help avoid this

4. Sitting

Research has looked at IAP in conjuntion to recovery positions for post-operative patients, as lower IAP has better outcomes

Lying flat has the least change in pressure, but obviously you can't spend the day flat on your back!

But interestingly one of the highest pressure positions was propped up - how often are you in this semi-recline position?  Chair, sofa, bed - it may be worth just looking at the positions you use most often and switching them out a bit.

Least pressure of all was the Trendelenburg position, where you're lying in an inverted position, feet higher than your hips.  This is why it's a really comfortable position to go into if you are feeling symptomatic - put a bolster underneath your pelvis whilst lying on your back, so your hips are slightly higher than your head.  You can have your knees bent, feet flat on the floor or resting on a chair/ sofa/gym ball (straight or bent legs), or have your legs up the wall.  These are all good options for resting positions at home.

5.  Exercise

When I prolapsed the only real information out there was that you need to stop.

Stop any abdominal work

Stop any impact

Stop lifting weights

I'm happy to say that I am doing all of these things now without it having any effect on my prolapse or symptoms at all!

Research shows that there is a wide range of IAP for all of the exercises that are normally seen as 'bad'.  And within a wide range of ages/body types/mums or not.  So this shows that it is not the exercise itself, it is the technique used

So if you find a certain exercise makes you feel symptomatic, you may want to stop it for a short while, whilst you re-learn techniques that make the IAP more manageable.  

It may be that you don’t need to give up your favourite exercise - I know I never gave up weights or squats. I did stop ab work and impact but have since restarted them with no issues at all.

Things you can look at instead:
  • cueing the pelvic floor with exertion
  • breathing technique
  • posture
  • gait
  • range of movement, speed or number of repetitions
  • starting position
  • alternative exercises
  • using a pessary
Exercise is so important for physical and mental health, prolapse should never be a reason to stop!

Next we'll look at ways you can make things better


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