Prolapse

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Pelvic organ prolapse is defined as the descent/lowering or herniation of the bladder, bowel or uterus into the vagina. This happens because the ligaments, fascia and muscles are not holding the organs in the correct place and they start to sag.

The biggest risk factor for pelvic organ prolapse is vaginal birth but ageing, chronic constipation, chronic asthma and obesity make pelvic organ prolapse worse. Pregnancy also causes incontinence and pelvic organ prolapse.

25 per cent of all women have one or more symptoms of pelvic organ prolapse.

Prolapse can present in a number of ways including:

  • A heavy sensation or dragging in the vagina
  • Something ‘coming down’ or a lump in the vagina
  • A lump bulging out of your vagina, which you see or feel when you are in the shower or having a bath
  • Sexual problems of pain or less sensation
  • Your bladder might not empty as it should, or your urine stream might be weak
  • Urinary tract infections might be reoccurring, or
  • It might be hard for you to empty your bowel
  • Symptoms are often worse at the end of the day and are eased by lying down.

Management of pelvic organ prolapse conditions includes:

  • A thorough assessment of the condition, medical history and current health, including diet and fluid intake, exercise levels and mobility, all the medicines you are currently taking, and any other factors that could affect the prolapse
  • Physical assessment of the pelvic floor function, strength and endurance
  • Rehabilitation which may include pelvic floor muscle exercises, otherwise known as Kegel exercises, changes to lifestyle, bladder and bowel habits, avoidance of straining, losing weight and having a pessary inserted into the vagina.
  • Use of Real Time Ultrasound to facilitate rehabilitation
  • Exercising in a way that does not worsen the prolapse is very important as many women stop exercising yet with the appropriate guidance and testing exercise with a prolapse is still possible.

Outcomes from treatment may include:

  • Correct pelvic floor muscles exercises can increase the size, strength and length of the pelvic floor muscles and alter the position of the pelvic organs.
  • Improved management of the symptoms
  • Improved incontinence, urgency, or emptying.
  • There is the highest level of evidence in research for using pelvic floor muscle exercises in the treatment of pelvic organ prolapse in women. The POPPY study conducted in several countries including Australia identified that pelvic floor physiotherapy and pelvic floor muscle training should be offered as first line of treatment to women with pelvic organ prolapse.
  • For those women undergoing surgery for the management of their pelvic organ prolapse it is often helpful to be seen by a Pelvic Floor Physiotherapist both before and after treatment as the pelvic floor muscles play an integral role in the support mechanism (McClurg et al, 2014).
  • Gradual return to daily activities and sports or exercise routines.