I just got diagnosed with prolapse...what the heck does that mean? What are my options?

First, don’t panic! You are not alone. We are here to support you.

According to the National Institute of Health, “Pelvic organ prolapse (POP) when defined by symptoms has a prevalence of 3-6% and up to 50% when based upon vaginal examination” (Barber, 2013). Being diagnosed with prolapse can be very emotionally laden. We hear various stories in our clinic such as “my doctor told me I have this but I don’t know what that means” and “I am terrified that I will make something worse.” Continue reading to learn the basics of what prolapse is and know that you have options.

Let’s first explain what prolapse is so everyone is on the same page. In the female pelvis, the pelvic organs are considered the bladder, uterus, and rectum. The bladder sits most forward, uterus with the vaginal vault in the middle, and the rectum furthest towards your back. Prolapse is when one or a combination of the three of these organs starts to move lower, towards the entrance of the vagina. When it is the bladder that is pushing back and down into the vaginal vault, this is called a cystocele. When the uterus is descending into the vaginal vault from the top, this is a uterine prolapse. When the rectum is pushing forward and downward into the vaginal vault, this is known as a rectocele. The rectum can also push down towards the anal opening and this is called a rectal prolapse.

Signs of prolapse may include:

• heaviness/pressure in your pelvic floor/lower abdominals

  • this discomfort may increase later in the day, after more intense activities, after prolonged standing

• Frequent urination and feeling that you are not able to completely empty your bladder when you void

  • this typically occurs with cystoceles. You see, when the bladder is pushing in towards the vaginal vault it can sometimes create a little pocket that urine gets trapped in. When you sit down to void, your bladder empties but then when you stand up to leave the bathroom, gravity moves this little “pocket” and can give the sense of having to void again

• Feeling more tissue “down there” or bulging of “something”

  • In more advanced prolapses, the organ that is lower than typical may sit realllly close to the vaginal opening or even push out through the vaginal opening.

When in doubt if something feels “weird” or “different” down there, get it checked out

Now if you have any of these symptoms with or without a formal diagnosis, what are your options?

Well, in my extremely biased opinion.... go see a trained pelvic floor therapist!

Pelvic floor therapy can assist with:

• Educating you on positioning ideas to help decrease the discomfort

• Assessing and improving your breathing mechanics to help with pressure management. This starts up at your rib cage. As I explain it, the rib cage wraps around you like a barrel. If your ribs are only able to expand part of the way (typically only the front part) then your body can’t absorb as much pressure. That pressure has to go somewhere and typically it’s down to your pelvic floor

• Teaching toileting ideas to help with both the feeling of incomplete emptying as well as positioning to limit straining to pass stool...again, pressure management is key here

• Ensuring your abdominal muscles are well coordinated in their action to help with pressure support. This may include treating a diastasis recti, teaching to release upper abs to improve pressure balance, and overall strengthening

• Assessing and improving your pelvic positioning and mobility in order to allow the pelvic floor to function better

• Discuss postural changes that might be “quick wins” to help decrease pressure being shoved towards the front of your pelvic floor (closer to the the vaginal opening)

• Progressively load your tissues by increasing the challenge of exercises/movements to train your pelvic floor to support appropriately for real life activities.

• Even if you have had, or will have surgery, seeing a pelvic floor therapist pre- or post-surgery can also help with all of the above bullet points in hopes to either delay surgery or help prevent re-prolapsing after surgery

Additional options:

• Support

  • Pessaries are devices that are inserted and can be removed by you when desired. These devices have various shapes and sizes made from a flexible type of plastic. Pessaries need to be fit by a trained individual, typically a urogynecologist

  • Impressa is an over the counter product. These look and are inserted the same way as a tampon.

  • Tampons. In a bind or to try a “quick fix” some people will insert a tampon for internal support for short bouts of activity

  • Compression shorts or pelvic support belts to provide assist from below

• Surgery

  • Surgery is an option to help support the position of the organs. If you have heard of someone getting a “bladder sling” this is the surgery to address a cystocele. The “sling” is placed to help support the bladder to sit forward and up out of the vaginal vault. If the uterus is the organ prolapsing, oftentimes a hysterectomy is performed to remove the uterus.

In summary, if you feel you may have a prolapse, get it checked out. As I always tell my clients, you know your body better than anyone else. Know that you have options on treatment and if you have read this far, than you know I would first recommend going to see a pelvic floor therapist 😀

Reference: Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013 Nov;24(11):1783-90. doi: 10.1007/s00192-013-2169-9. PMID: 24142054.