Prolapse Basics: What You Need to Know
Jun 04, 2024Prolapse can be a scary word.
Often referred to in hushed tones as 'women's troubles', it is a really common condition that affects up to 50% of women.
The most important thing to understand is that prolapse is not an inevitable part of ageing.
For many, it is a preventable and treatable condition.
What is Prolapse?
Pelvic Organ Prolapse (POP) is when one or more of the pelvic organs descend from their original position in the pelvis. This is often described as a bulging sensation in the vagina which doesn't cause pain. It is often accompanied by urinary incontinence and/or constipation symptoms.
Types of Pelvic Organ Prolapse (POP)
There are a few different types of prolapse which can occur independently or together.
Cystocele/ Anterior Wall Prolapse
This is when the bladder bulges into the front wall of the vagina.
This is the most common type of prolapse. People with cystocele can experience bladder problems including frequency (going to the toilet a lot), urgency (strong need to go), and urinary incontinence (leaking wee). They will also have a feeling of something coming down.
Rectocele/ Posterior Wall Prolapse
This is when the rectum (bottom part of the colon) bulges into the back wall of the vagina.
This often causes a small pocket to form which makes it more difficult to empty the bowel fully. People with this kind of prolapse may need to use a finger to support the vaginal wall in order to empty fully.
Rectal Mucosal Prolapse
This happens when lining of the bowel sticks out of the anus after you do a poo. At first this may only happen when you do a poo, but eventually it can become constant.
Uterine Prolapse
This is when the uterus (womb) moves down from its usual position into the vagina. This is often described as feeling like you have a tennis ball in your vagina.
There are 4 grades of prolapse:
Grade 1: a small slippage from the original position
Grade 2: some bulging into the vagina
Grade 3: bulge is at the vaginal opening
Grade 4: tissue bulges out of the vaginal opening
How are the Pelvic Organs Held in Place?
Our pelvic organs (womb, bladder and rectum) are kept in place by interactions between two different systems.
The pelvic floor muscles support from below. These muscles can be strengthened and trained to hold the pelvic organs in place.
The pelvic connective tissue (ligaments and fascia) suspends these organs in the pelvis and stops them moving around.
Any weakness, tear, or over stretching of these supportive structures can lead to a prolapse.
What causes Prolapse?
Prolapse is often caused by a number of different factors occurring over time.
There are many risk factors and how these risk factors affect you will depend on your unique body and lifestyle. Just because you have some of these risk factors does not necessarily mean you will develop a prolapse.
Risk factors include:
- pregnancy and childbirth
- menopause (drop in oestrogen levels)
- high BMI (>30)
- chronic cough/ asthma
- chronic constipation (pushing/ straining when pooing)
- heavy lifting (especially with poor technique)
- connective tissue disorder/ hyper mobility
- family history of prolapse
- standing for long periods every day
- high impact exercise
What does it feel like?
Prolapse can only be diagnosed by a physical internal examination combined with the symptoms you're experiencing.
Prolapse symptoms feel like a heaviness, dragging feeling, or pressure in the pelvis. Many people describe feeling like something is coming down.
There are often continence issues as a result of a prolapse so you may also experience urinary incontinence symptoms (leaking wee or urgency) or struggle with constipation or emptying your bowel.
If you have a grade 3 or 4 prolapse, you may be able to see some tissue at the entrance to the vagina if you have a look in the mirror.
What To Do If You Think You Have a Prolapse
Prolapse can only be diagnosed by a professional so make an appointment with your GP or women's health physiotherapist.
You can download our Symptom Tracker to help you build a complete picture of what's going on to discuss with them.
If their examination doesn't tally with your experience, ask to be examined standing up as this is when prolapse symptoms are most pronounced.
How to Prevent and Protect a Prolapse
Our daily activities can both prevent and protect prolapse or exacerbate and increase our risk of prolapse so it makes sense to learn a little bit more about how we can support our bodies in their vital job of keeping these organs in place.
Changes in abdominal pressure and the influence of gravity can make a big difference to prolapse symptoms and your experience of them so a lot of interventions deal with managing these two forces.
- Maintain a healthy BMI (ideally < 30) Higher BMI will add extra load to your pelvic floor muscles which can tire and become weaker over time. A healthy body weight and strong pelvic floor muscles can counteract this.
- Pace yourself throughout your day As the day goes on, you may find your symptoms worsen. You can improve your symptoms by exercising in the morning before the muscles tire and rest lying down for 10 minutes a couple of times throughout the day. Lying down takes the pressure off the muscles and allows them to rest. Rest is a vital component in the muscle strengthening cycle. This can look like taking a phone call lying down, answering a few emails on the floor, doing a short meditation, or having a quick nap.
- Find your pelvic floor support There are lots of strategies to support your pelvic floor and a combination of the following might be the right fit for you. Pelvic floor exercises maintain and build strength and flexibility in the pelvic floor muscles. These are especially important as we age and our levels of muscle protecting oestrogen drop. If you'd like to learn how to do these exercises and incorporate them into your routine, check out our on demand course, The Pelvic Floor Connection. Some GPs, gynaecologists and women's health physiotherapists can fit pessaries. These are small silicone or PVC devices that sit inside the vagina and provide structural support for the pelvic organs. You can't feel them in place and some can stay in for up to 6 months. These are a great option for those who want to avoid surgery and can manage to insert and remove the pessary themselves. There is a bit of trial and error here finding the right pessary to suit your anatomy but it is worth persevering as some women report life changing results with these. You may also want to try some external support - particularly while exercising. Compression garments that specifically support the pelvic floor, like these from SRC Health, can help encourage the pelvic floor muscles to support the pelvic organs more effectively from below while improving blood flow to the area. If you'd like to give them a try, you can get a 10% discount using the code SHEELA at checkout.
- Avoid constipation and straining Chronic constipation and straining can lead to prolapse so it makes sense to avoid these where you can. Stay hydrated and eat plenty of fibre (whole plant foods) at every meal. Avoid pushing and straining on the toilet - read this PDF for more tips.
- Support your immune system to limit respiratory infections Avoiding chronic coughing is easier said than done - especially in this post covid world. Do what you can to support your immune system including eating a healthy diet high in fibre, protein and plant nutrients, exercise regularly, and get enough sleep. You can also learn 'the knack' to support your pelvic floor during those times you are coughing or sneezing more than usual - you'll find our video on how to do that here.
- Find an exercise regime that works for you Over 30% of women with pelvic floor issues identify their issues as a barrier to exercise and 2 out of 3 of those women have stopped exercising entirely. This is tragic because exercise is not only vital to prevent heart disease, diabetes and cancer, it can also help you prevent and manage prolapse. Impact exercise (running/ jumping) increases abdominal pressure so you may wish to limit these activities while you are symptomatic and work on building your pelvic floor muscle tone. Swimming, cycling, yoga and pilates are all great prolapse friendly exercise choices. Strength or resistance training is important to prevent muscle loss if you're over 30 so you may need some professional guidance on how to protect your prolapse as you build this into your routine. Work with a physiotherapist or other trained professional who will guide you on correct technique, modifications for your unique circumstances, and build up your ability over time. For more pelvic floor friendly movement tips, watch this video.
If your symptoms are more severe and the interventions above don't improve your quality of life enough, then you might want to explore surgical options. Your GP or women's health physiotherapist can refer you to a specialist who can discuss these options with you.
Whether you've been diagnosed with a prolapse or are worried you might have one, the thing to remember is whatever your unique circumstances, it is always possible to improve things. The interventions above are all proven to have an impact but the combination that improves things for you will depend on your physiology and your lifestyle.
There's never been a better time than this moment to start taking care of your pelvic floor.
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Sources:
Pelvic organ prolapse: The lived experience
What’s new in the functional anatomy of pelvic organ prolapse?
https://stmichaels.ie/pelvic-floor-centre-new/videos/#video-3
https://www.nhs.uk/conditions/pelvic-organ-prolapse/
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