Prolapse 101: What is Prolapse?
Have you ever felt like your lady parts might be falling out? It’s a scary, not to mention unpleasant, feeling of pelvic pressure, heaviness or bulging.This is one of the big signs we see in patients with Pelvic Organ Prolapse! In case you don’t know the answer to the question: What is prolapse? We’re going to dive into what is prolapse, why it happens, and what your next step should be if you suspect you have one!
Prolapse is when one or more of the pelvic organs drop or press into or out of the vagina. There are 3 different types of prolapse, depending on the pelvic organ that's affected. The organs that can be involved are:
Bladder (also called a cystocele)
Uterine (pictured below)
Rectal (also called a rectocele)
Symptoms
Vaginal bulging typically noticed when wiping
Pelvic pressure or the feeling of a “lump” in the pelvic area
Low back discomfort
Incomplete emptying (bowel or bladder)
Increased urgency or frequency as a result of incomplete emptying
Position changes required to finish emptying (bowel or bladder)
Pain or discomfort with intercourse
CLICK HERE FOR A FREE CONSULTATION
Understanding Your Prolapse
To understand prolapse, let’s talk about the anatomy involved with this diagnosis. When the bladder, uterus, and rectum are all in their ideal position, they are supported by the pelvic floor muscles underneath and held in place by fascia and ligaments above the organs. So any change in the position of the organs, strength of the pelvic floor muscles, or tone of the ligaments and fascia can result in that ‘drop’ of a pelvic organ.
To help diagnose how far the prolapse has dropped within the pelvis, there is a 4-point grading system:
Grade 0: normal, no descent of the pelvic organs
Grade 1: mild, prolapse is 1 cm or more above the vaginal opening
Grade 2: moderate, prolapse is at or within 1 cm of the vaginal opening
Grade 3: major, prolapse is more than 1 cm outside the vaginal opening
Grade 4: prolapse is entirely outside of the body.
While we use this grading system to determine the severity, it’s not a perfect system. There is alot of variability throughout the day based on where you are in your cycle, what activities you did, and how fatigued you are. Many people report that the symptoms experienced with prolapse are worse later in the day, due to the effect of gravity in upright positions such as prolonged standing. This can change the “grade” of your prolapse.
It’s also important to note that women have a wide variety of symptoms and severity of symptoms regardless of their “grade” so it’s always important for your medical professional to know how it’s limiting you throughout the day.
Causes of Prolapse
The biggest cause of prolapse is too much intra-abdominal pressure over a prolonged amount of time. Simply put, it’s poor pressure management within your trunk. Certain activities are notorious for increasing our abdominal pressure such as coughing, holding our breath while lifting, straining to have bowel movements, and poor posture. Over time, this pressure puts more strain on the ligaments supporting the pelvic organs and can lead to prolapse. There are also other factors that can increase your risk including:
Hormone Levels. One cause of prolapse is menopause and changes in hormone levels. This affects the strength and tone of the pelvic floor as well as the integrity of the ligaments that hold the organs up. As hormone fluctuations cause weakness and atrophy at the pelvic floor, the pelvic organs can lose support from above and below. This means that in periods of increased intra-abdominal pressure (i.e. lifting, coughing, or standing) the pelvic floor isn’t able to keep the organs from dropping further down within the pelvis.
Ligamentous Laxity. The fascia and ligaments above the pelvic organs can also be compromised in individuals with poor connective tissue strength such as during pregnancy or those with general hypermobility. As these tissues loosen, there is less force holding the organs up against gravity or times of increased intra-abdominal pressure.
Pregnancy & Childbirth. This is commonly associated with increased risk for prolapse for a few reasons. The first is that there is displacement of abdominal and pelvic organs as the baby gets bigger, causing the organs to shift and fit into a less than ideal position leading up to delivery. The second is that as the baby gets bigger, there is constantly extra pressure on the organs and the pelvic floor that can contribute to prolapse without a strong pelvic floor. The last reason is the amount of pushing during childbirth causes extra pressure and stress on the pelvic floor, especially with prolonged pushing times.
Constipation. When we are constipated, this increases the risk for prolapse because of the straining and pushing associated with difficult bowel movements. Over time, the repeated strain on the pelvic floor and pelvic organs can lead to prolapse especially when combined with other risk factors (i.e pregnancy, menopause).
How do I fix it?
If you think you might have a prolapse, you should make an appointment to get evaluated by a Physical Therapist who is specialized in Pelvic Floor Treatment. A pelvic floor physical therapist can determine what is causing the symptoms of your prolapse and the proper way of treating it. They are also trained in how to help you decrease the pressure on the prolapse, which can make the severity of it worse.
In the meantime, be mindful of your symptoms and notice what makes them worse or what helps them feel better. It will help you know which activities to avoid temporarily in order to prevent worsening your prolapse. Once you’ve been assessed by a pelvic floor physical therapist, your physical therapist can help you get to the root of your symptoms and work to increase the support of the organs in this area.
In physical therapy, the goal is to improve the symptoms of the prolapse. Likely with conservative treatment the prolapse will not change greatly in terms of the grade, but the symptoms associated with the prolapse can be resolved. This will allow you to perform everyday activities without that pelvic heaviness! Prolapse can sound scary, but the good news is that with a mild prolapse the symptoms of prolapse can greatly improve.