Whether you have a diagnosed prolapse or you are concerned that you might have one, there are many different risk factors that can contribute to prolapse. Keep reading to see if any of these risk factors apply to you! 

What is it?

Let’s do a quick review of what prolapse is! Pelvic organ prolapse is the lowering of pelvic organs towards the vaginal opening. It can happen to any of the organs in your pelvis such as the bladder (cystocele), the bowel (rectocele), or uterine prolapse. There are different levels of severity based on how far down it is, but the severity can fluctuate depending on your position, the time of day, or even where you’re at in your menstrual cycle!  

One of the biggest causes of prolapse is repeated or prolonged increase in intra-abdominal pressure. This makes things like pregnancy, childbirth, obesity, constipation, chronic cough, and frequent heavy lifting major risk factors. Another common cause of prolapse is laxity or weakness of the connective tissues that support and maintain the ideal position of the pelvic organs. This occurs with aging, menopause, fluctuations in estrogen levels, and genetic predispositions for hypermobility. 

Pregnancy and Childbirth

During pregnancy, your pelvic floor is constantly supporting the increased weight of the baby and the increased pressure within the belly. If the pelvic floor muscles don’t have enough endurance to support that weight against gravity at rest and during activity, the pressure can push down on the organs in the pelvis and lead to a prolapse. 

With childbirth, the risk comes from repeated straining during delivery which can drastically increase intra-abdominal pressure, especially if the 2nd stage of pushing was prolonged. The pelvic floor muscles are fatigued and overstretched during delivery which doesn’t allow it to provide the support needed to handle the increase in pressure. The risk of developing a prolapse after birth is also increased if the delivery involved use of forceps or instruments. 

Other Causes of Increased Abdominal Pressure

Constipation is correlated with prolapse due to the repeated straining when attempting to have a bowel movement. Most people tend to hold their breath and ‘bear down’ which only increases the pressure in the abdomen even more. Because of this, it is very important to be aware of your toileting position and breathing! By having good ergonomics and focusing on exhaling as you have a bowel movement, the pressure is reduced and so is your risk of prolapse! 

Obesity increases the amount of abdominal weight that the pelvic floor has to support on a daily basis. The extra resistance causes fatigue in the pelvic floor and leaves the pelvic organs unsupported against the increased pressure. Weight management can be an effective way to reduce the risk of prolapse as well as reduce any symptoms you might be having. 

Chronic coughing and repeated heavy lifting increase the risk of prolapse due to the temporary, but large, increase in intra-abdominal pressure associated with these activities. The pressure during heavy lifting can be even more problematic if you hold your breath as you lift. It is important to activate your core and exhale as you lift in order to prevent unnecessary strain on the pelvic floor and overall reduce the risk of prolapse. 

Aging and Menopause

As age increases and menopause sets in, the decrease in estrogen weakens the ligaments and connective tissues in your body, including the tissue responsible for maintaining the position of the pelvic organs. This allows the organs to shift and lower within the pelvis, resulting in prolapse. It is also possible that a prolapse may have occurred earlier in life, possibly after pregnancy and childbirth, but never caused any symptoms until later in life due to this change in strength of the connective tissue. 

As changes in estrogen levels during menopause contribute to prolapse, symptoms of prolapse can worsen just before the start of the menstrual cycle for similar reasons. The change in symptoms 

Hypermobility

Hypermobility of connective tissue contributes to prolapse as the ligaments holding up the pelvic organs have increased laxity, allowing more descent of the organs within the pelvis. This can affect anyone with the genetic predisposition for hypermobility and it can happen at any age. It is very important to focus on stability and strength to make up for the increased motion throughout the whole body, but especially at the hips and pelvis. 

Signs and Symptoms

If any of these risk factors apply to you, you may have a prolapse. Here are some of the more common signs and symptoms you might be experiencing:

• Pelvic pressure 

• Bulging in the vagina

• Symptoms that progressively get worse by the end of the day

• Standing aggravates symptoms

• Sitting or laying down relieves symptoms

• Low back pain 

• Feeling of incomplete emptying of bladder or bowel

• Need for splinting during bowel movement

• Discomfort with sex

• Incontinence with sneezing or coughing
  

Do I have to deal with this forever?

The diagnosis of prolapse can be overwhelming, but there’s hope! Pelvic Floor Physical Therapy has been shown very effective in helping manage and improve the symptoms of prolapse. While PT isn’t necessarily going to reverse the prolapse, it will help strengthen and coordinate the pelvic floor muscles to support the pelvic organs. PT can also address other contributing issues such as proper breathing techniques and good form for bowel movements to minimize unnecessary strain and extra pressure on the pelvic floor. 

If you think you may have a prolapse, call or email us at Revitalize Physical Therapy at 414-331-2323 or contact@revitalize-pt.com to schedule an evaluation with a pelvic floor Physical Therapist. 

References:

Lyons, Michelle. Understanding Prolapse. MedBridge, 2019, www.medbridgeeducation.com/courses/details/understanding-prolapse-michelle-lyons-pelvic-rehabilitation-physical-therapy.