Pelvic organ prolapse is a condition in which the support mechanism of organs in the pelvis start to fail, slip out of place and fall downward. This usually occurs due to overstretching of the supportive structures like pelvic floor muscles that become weak or overstretched. The bladder, urethra, uterus and rectum are structures most affected. The prolapse typically occurs from overstraining with childbirth or chronic constipation. Pelvic surgery like a hysterectomy can also change organ support.
Prolapse is very common when you’ve had children, especially multiple children. Carrying and delivering the baby puts a lot of pressure on the organs, specifically the uterus, bladder and rectum.
That pressure can push down on those organs and push them out of the vaginal or rectal canal and cause pressure or discomfort in the low back or it sometimes causes a dull type pain in the vaginal area or rectal area (not common put some people come in with that). You can have constipation, because the rectum, if that’s fallen enough, blocks the opening so you might feel like you have to move something out of the way in order to have a bowel movement.
It’s nothing to be scared about, it’s not a medical emergency. But you don’t want to walk around with a prolapse.
The first thing I would recommend is to see your gynecologist and see if they think it’s significant enough and what to do about it.
We’re fortunate in the Philadelphia/Main Line area to have wonderful hospital systems and many gynecologists are conservative and they will recommend pelvic floor physical therapy as a more conservative treatment. However, if you were told to go straight to surgery, especially if it’s mild to moderate, I highly recommend getting evaluated by an integrative holistic pelvic floor physical therapist.
What I mean is that someone who’s not just going to give you Kegel exercises to do for strengthening your pelvic floor. That was the old model for how to treat prolapses conservatively way back. We’ve come to the understanding that it’s not just doing Kegel exercises to strengthen the pelvic floor that’s going to keep these organs up.
One of the big things you also have to address when treating a prolapse is the alignment of the body.
Your organs sit in your pelvis. Depending on the posturing of the body, if you tilt in one direction more, the organs will sit in a position based on the alignment of your body and push down in a different direction. When you’re in good alignment, the normal pressure in the body will push them forward toward the pubic bone versus down through the opening of the vagina and the rectum. When your alignment is off, you’re going to have an imbalance of pressure and that pressure can push things down outside of the canal.
There’s a lot of things such as stretching, strengthening, soft tissue and hands on work to improve this that will help to balance the pressure so it’s pointing more forward instead of down. And then if we need to go in to teach you exercises to strengthen the pelvic floor we may add that in addition to a lot of other things.
For some of you experiencing pain, as well as having a prolapse, vaginal pain in general, rectal pain in general, pain with intercourse, IBS, the pelvic floor could actually be TOO tight. There are many people who have tightness of their pelvic floor AND they have a prolapse. You don’t want to strengthen your pelvic floor if it’s already too tight because that will just create more imbalance and more pain.
Your body works as a whole, it doesn’t work in different pieces. We need to look at everything in an integrative fashion – everything in your body works together.
For those of you experiencing a pelvic organ prolapse, I highly recommend getting evaluated by an integrative pelvic floor therapist prior to getting surgery.
Think you might have a prolapse? You can schedule a complimentary phone consultation to discuss your symptoms here.
Surgery can be indicated if the prolapse is severe enough but conservative treatment can include physical therapy to help increase strength of the pelvic floor and other pelvic muscles to reduce pressure/pain. At Rebalance Physical Therapy, our treatment for prolapse consists of a holistic approach beyond strengthening pelvic floor muscles. We differ from traditional therapy treatments by looking at the whole body to identify contributing dysfunctions with individualized evaluation and treatment. We use the Integrated Systems Model (ISM) for Pain & Disability (Lee & Lee, 2007) as framework for treatment to interpret the unique picture of each individual patient. The goal of the ISM approach is to facilitate better strategies for posture and functional movement to eliminate the prolapse symptoms.
An underlying postural dysfunction often accompanies prolapse. The consequent muscular gripping patterns that accompany it cause greater intra-abdominal pressure on the pelvic organs. This pressure causes falling of the organs in the pelvic cavity increasing strain on the support structures. Because all areas of the body are linking and interacting with each other during total body function, by treating the underlying postural and movement dysfunctions, the prolapse can be better reasoned, explained and treated appropriately.