How To Fix a Prolapse Without Surgery
Understanding conservative treatment for pelvic organ prolapse.
One of the most common questions we get asked as pelvic floor PTs is “how to fix a prolapse without surgery”. Let’s first discuss what prolapse is.
Pelvic organ prolapse occurs when there is excess stress to the ligaments that support the organs sitting in the pelvic cavity. Prolapse, and thus the increased stress on the ligaments, can be the result of trauma from childbirth, excessive coughing, excessive heavy lifting, and inadequate pelvic floor muscle strength. Symptoms of pelvic organ prolapse typically include a bulge, feeling of vaginal heaviness, lower back pain, and possibly difficulty passing urine or stool.
When it comes to fixing a prolapse without surgery, this is where a pelvic floor physical therapist comes in.
A pelvic floor physical therapist is a specialized physical therapist with specialty training on the pelvic floor and pelvic floor muscles.
There are several steps that need to be taken if you want to fix a prolapse without surgery:
Step one to fixing your prolapse without surgery is understanding what led to the prolapse in the first place. Was it due to heavy lifting? Childbirth trauma? Excessive coughing? Did it just happen over time? All of these various reasons will result in different treatments, so it is first very important to really understand what lead to the prolapse in the first place.
Step two is figuring out exactly which organ’s ligaments have too much stress on them. The most common organs are the bladder, uterus, or rectum. Some patients have too much stress through one organ, while others have too much stress through multiple organs. It is important to understand which organs are affected in order to know how to best fix a prolapse without surgery.
Step three is figuring out how strong the pelvic floor muscles are. The pelvic floor muscles need to be strong enough so that when you are lifting, squatting, coughing, and really just living life, the muscles are giving support to the pelvic organs. In many cases of prolapse however, the pelvic floor muscles aren’t giving enough support to the organs. Therefore, a large part of how to fix a prolapse without surgery includes pelvic floor muscle training.
Pelvic floor muscle training is more than just trying to squeeze your pelvic floor muscles. We also need to strengthen the surrounding muscles including the glutes, abdominal muscles (core), inner thighs and even your back muscles. Pelvic floor muscle training involves full body strengthening in functional positions like squatting, lunging, lifting, and carrying.
Step four is figuring out behavioral habits that might be contributing to your prolapse. This includes reducing constipation (which leads to straining and therefore can make prolapse worse), ensuring that you aren’t bearing down on the pelvic floor while lifting, and reducing how much the belly muscles are sucking in. If you think about a new bag of potato chips, if you squeeze the middle of the bag, it puts pressure on the bottom of the bag/your pelvic floor muscles and organs. This is why we want to make sure you aren’t sucking the core muscles in all day.
Lasting, fixing a prolapse without surgery may include a pessary. A pessary is a semi-permenant support that is inserted vaginally and helps provide support to the ligaments and organs. They are worn similar to a tampon. Some pessaries need to be removed every night, and some can be worn for a couple of months. Through prolonged use, the ligaments supporting the organs can actually shorten back to their pre-prolapse state. Some pelvic floor physical therapists can fit you for a pessary and can be part of treatment.
Fixing a prolapse without surgery is possible, even in cases of moderate to severe prolapse. If you are struggling with prolapse, seeking help from a pelvic floor physical therapist is essential. To see how we can help you, give us a call!