Pelvic Organ Prolapse
POP is a condition where the walls or support ligaments and fascia around the vagina have become stretched, weakened or damaged, sometimes from a traumatic childbirth. It’s a bit like a hernia into your vagina. This can affect up to 50% of women who have had children. It is associated more with vaginal rather than caesarean births, but women who have never had children can also develop prolapse!
Symptoms of Prolapse
- stress incontinence: leaking urine when:
- standing up
- inability to completely empty the bladder or the bowel after going to the toilet
- straining to get urine flow started
- a slow flow of urine that tends to stop and start
- bladder frequency or urgency
- a sensation of fullness or pressure inside the vagina
- a bulge or swelling felt in the vagina or seen at the entrance
- Low back ache and/or pain
- Low abdominal pressure and/or pain
- Difficulty inserting a tampon or tampon moving down the vagina once inserted
- Sensation of constantly needing to pass stool or rectal pressure
- Poor wind (flatus) control
- Bowel urgency
- Discomfort during and/or after emptying the bowel
- Decreased sexual satisfaction
- Decreased sexual arousal
- Sexual disinterest
- Vaginal pain or vaginal discomfort during or after penetrative sexual intercourse
- Difficulty with penetration with more severe prolapse
- Possible bladder leakage with intercourse
- The most important take home message about POP is that it can almost always be helped with lifestyle changes, correct toilet technique, exercise changes together with pelvic floor exercises from your Women’s Health Physiotherapist.
Not all POP needs surgery…and if you do then it is really important to get your muscles as strong as possible and understand why you have to make changes in your life to maintain the success of any surgery. Sue Croft is a Women’s Health Physiotherapist in Queensland has a great website/blog and 2 fantastic small books all about pelvic floor problems and surgery.
Factors that put you at risk of developing POP
– Obesity- carrying extra weight causes a rise in the IAP (intra-abdominal pressure) that can push down organs onto a weak pelvic floor
– Smoking /and or chest problems …. causing chronic cough coughing causes huge rises in IAP
– Constant sneezing from allergies…. as above!
– Chronic Constipation…. pressure against the back of the vaginal wall
– Heavy lifting occupations
– High impact; strong’ core’ exercise too soon after a vaginal delivery
Surgery for Prolapse
What kinds of surgery are done for pelvic organ prolapse?
Many kinds of surgery can be done for pelvic organ prolapse.
Types of surgery include:
- Repair of the bladder (cystocele surgery)
- Repair of the rectum (rectocele surgery) or small bowel (enterocele surgery).
- Repair of the vagina /uterus (urethrocele)
- Removal of the uterus (hysterectomy).
What are the risks of surgery for pelvic organ prolapse?
Problems you may have after surgery can include:
- Not being able to empty your bladder
- Pain during sex
- Bladder injury
“Surgery for pelvic organ prolapse is done to treat symptoms caused by one prolapsed organ, so you may still have other symptoms after your surgery. Surgery in one part of your pelvis can make a prolapse in another part worse. Sometimes a bulge in the vagina is ‘helping’ to keep you continent and symptoms of Stress Urinary Incontinence SUI may become evident only after your prolapse repair. This may mean that you have to have another surgery later.
Pelvic organ prolapse can come back after surgery. How well surgery works depends on the type of surgery. But on average, about 3 out of 10 women who have the surgery end up having a second surgery within 4 years.
The chances for success can be higher when a woman has two surgical procedures during the same operation-one to correct the prolapse and the other to help prevent incontinence problems that can arise after surgery. But more research is needed to find out if this is true for all types of prolapse surgeries.”
What exercises can I do?
I see women from early post- natal, right through to post menopause. Careful examination, specific exercises, possible pessary support and lifestyle changes are all things that I can help you with, that do help to reduce the prolapse to an extent that you may not need surgery.
Things that will impact on your risk of POP when considering exercises…
- What was your postnatal recovery like – for your pelvic floor
- How many vaginal deliveries have you had?
- Did you have a traumatic vaginal delivery; (forceps, breech)
- Have you reached menopause and beyond?
- Are you obese or overweight;
- Do you suffer from chronic constipation and straining?
- Do you have a chronic cough?
- Is there a family history of prolapse?
- Do you feel any heaviness or bulge in or around your vagina…at any time during your menstrual cycle?
I hope you have found this information helpful. Prolapse symptoms need to be assessed and then we can work out a plan to help you!