What Is Prolapse? A Guide to Understanding Prolapse, Causes and Treatment.
Prolapse, also known as pelvic organ prolapse (POP) is one of the top concerns that we treat as pelvic floor physical therapists. In its simplest form, prolapse is when there is a downward shift of the pelvic organs (your bladder, uterus/cervix, small intestine and/or large intestine). Prolapse occurs when there is a stretch to the support structures (mostly the ligaments) in the pelvic floor. The shift is organ position is graded from a slight shift (grade 1) to a significant shift (grade 4).
How common is prolapse?
Prolapse is extremely common and occurs in about 50% of women after a single vaginal birth. After 2 vaginal births, it that number jumps to about 80% of women. However, this doesn’t mean that 80% of women after 2 vaginal births are symptomatic.
What are symptoms of prolapse?
Common symptoms of prolapse include:
pelvic or vaginal pressure or heaviness
the feeling or even the presence of something bulging into the vagina
constipation
stress incontinence (leakage)
lower back pain
We aren’t really sure why some women that have prolapse are symptomatic and why some women have no symptoms. We do know however that many times, patients think the bulge is causing their symptoms, when in actuality tension or gripping of the pelvic floor muscles is what is causing the symptoms. Many of these patients feel like their organs are dropping and as a result tighten their pelvic floor and inner thigh muscles. They then feel the pelvic heaviness as a result of muscle fatigue.
How is prolapse diagnosed?
Through an intravaginal exam, your physician or physical therapist can see whether you have a prolapse. The severity is graded by your physician through a certain assessment tool. Oftentimes we will hear that patients feel they have a prolapse but when they go to their physician, their physician doesn’t find a prolapse. If the physician’s testing is done with you lying down, but your symptoms are present in standing, your physician may not see your prolapse.
What is treatment for prolapse?
There are three main treatment options for prolapse:
Surgery: This should be the last resort and saved for severe cases and cases where there is concern for skin breakdown/infections. Surgery has an extremely high failure rate (50% of surgery will fail in 2 years) so it should not be the first treatment that is tried.
Pelvic floor physical therapy: Research shows that pelvic floor PT should be the first line of treatment. Research also demonstrates that pelvic floor physical therapy can reverse or reduce the grade of your prolapse and significantly improve your function and symptoms. Pelvic floor physical therapy will work on decreasing any tension that is in the pelvic floor, improve the strength of your core and pelvic floor and teach you strategies to reduce progression of your symptoms. This includes teaching bowel and bladder toileting strategies, lifting mechanics and postural concerns that might be affecting your symptoms.
Pessary: A pessary is a device that is typically inserted in the vagina which gives support to the vaginal wall and doesn’t allow anything to push or bulge into it. Often wearing a tampon will help make symptoms better- this usually indicates that you may benefit from a pessary. Poise makes a disposable pessary (called the poise impressa) that we will often recommend patients try to see if they may benefit from a pessary. Pessaries take a lot of trial and error to find the right fit. In order to ensure that it is fitted properly, you will have to make multiple trips to your doctor initially and will have to continue to adjust it as the fit may change overtime.
With prolapse, know that you are not alone and that relief is possible! Interested in learning more about how we can help you? Call us!
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