Is Surgery My Best Option for Prolapse?

One of the most common questions I get with regard to prolapse is: “Is surgery my best option for prolapse, since that’s the only thing that will make it go away?” This is a tough question because every prolapse is so different. Plus, the symptoms with activity can vary from person to person. Here’s a little more information about prolapse to help you better understand what prolapse is and what treatment options are available to you!

What is Prolapse?

Prolapse is the drop of the uterus, rectum, bladder or vaginal wall. When any of the pelvic organs drop down, they press into the vaginal wall and cause various symptoms such as: 

• Vaginal Pressure

• Vaginal Heaviness

• The feeling of something falling out or bulging externally at the vagina

• Low back soreness/pain

• The feeling of needing to splint the perineum to have a bowel movement
  

Do you experience any of these symptoms? If so, click here to set up a FREE phone or virtual consult to discuss your symptoms further to understand how PT can help you. 

Most often, symptoms will be worse at the end of the day and with more upright activities. The severity of the symptoms does not necessarily correlate the severity of the prolapse. A prolapse can vary from a mild case (an internal dropping only) to more moderate or severe case (where tissue extends or bulges externally outside the vagina). Here’s a great picture of what a mild uterine prolapse could look like. 

Risk Factors for Prolapse

Prolapse typically occurs when the amount of pressure in the abdomen is more than the pelvic floor can sustain. The most common risk factors for prolapse include:

• Pregnancy and childbirth (having a c-section doesn’t exclude a woman from experiencing prolapse, but the chances of prolapse are higher for vaginal births)

• Chronic constipation

• Abdominal or pelvic surgery

• Weak connective tissue

• Obesity

• Hormone changes (such as menopause)

How is Prolapse Treated?

To answer the question, “Is Surgery My Best Option for Prolapse” we’ll lay out the possible treatment options for prolapse. Here are some things you can try:

1. Nothing. If you have a mild prolapse, you may not even have symptoms. And if your symptoms do not seem to interfere with your everyday life, you can choose to do nothing about it. However, just keep in mind even if you have mild symptoms or a mild prolapse it can still be helpful to try some treatment to prevent your prolapse from getting worse in the future. 
   

2. At home exercise. You’ve probably heard that doing more kegels will help your prolapse. This can be true in some cases. If pelvic floor weakness is your only issue leading to prolapse (heads up: usually it’s not the only issue), then trying out some kegels first to see if your symptoms improve is an okay place to start. 
   We recommend starting off slowly with kegels. It is best to only do as many sets/reps as your body allows, meaning that you’ll stop when you feel the squeeze getting weaker or you can’t hold the contraction as long. Additionally, strengthening the muscles that support the pelvis (core, low back, hips, gluteals) can also be helpful to lessen the load on the pelvic floor muscles. 
   

3. Pelvic floor PT. We HIGHLY recommend starting with pelvic floor PT for anyone experiencing prolapse symptoms, despite the severity. The best part is that this is the most conservative and holistic treatment option! Pelvic floor PT can help to manage prolapse symptoms ranging from mild to severe. The interesting thing about prolapse and pelvic floor PT is that while the prolapse usually won’t go completely away with PT, in mild to moderate cases symptoms can be improved. Even if you have a severe pelvic organ prolapse and are considering surgery, we still recommend pelvic floor PT to help your pelvic floor to function at it’s best and to improve your surgical outcomes.
   Pelvic floor PT treatment for prolapse can include:
   1. Education on lifestyle modifications to lessen the extra abdominal pressure

   2. Address breathing and pressure management in the abdomen

   3. Assess the pelvic floor muscles to understand if tightness or weakness is the issue,

   4. Exercise

   5. Posture training, and more!
   

4. Pessary. A pessary is a small device that can be inserted vaginally to help support the organ that has dropped down. Usually these devices are fit by a professional, such as a urogynecologist. Pessaries can be used in a multitude of ways. Some women iuse a pessary for specific activities (such as running). Others will use one to help manage prolapse symptoms all day long. We recommend working with a pelvic floor PT to help assess and treat any pelvic floor muscle issues to continue to keep the pelvic floor functioning properly and to support the pessary use. A pelvic floor PT can help you to determine the right schedule for using the pessary, to promote pelvic floor health while helping to minimize prolapse symptoms. 
   

5. Is Surgery My Best Option for Prolapse? If your prolapse and symptoms are severe enough that conservative treatment didn’t give you the desired results, surgery can be a great option. This is especially true if the prolapse is altering your daily life routines. There are many different surgical options depending on your type of prolapse and severity. We always recommend pelvic floor PT (and so should your doctor!) prior to and after the surgical procedure to be sure your pelvic floor, core, pelvis, and breathing muscles are all working properly to help support the organs as best as possible to help improve your surgical outcomes!

To hear even more about prolapse, check out our podcast episode: Prolapse Support and Solutions