Discovering that you may have a vaginal pelvic organ prolapse can be shocking, very scary and worrying. You may have first seen it whilst you were showering, wiping yourself, or it may have been a feeling that you became aware of - like a heaviness or a pain - and didn’t know where it was coming from, or what it was.
It is important to try not to panic. The good news is that there are a few treatment options available to you, and your symptoms can improve or resolve with the right management.
Pelvic organ prolapse (POP) is very common and can affect up to 50% of women at some point in their lives. It occurs when one or more of the pelvic organs - the bladder, bowel, or the uterus - sag or protrude into the vaginal walls creating a bulge or a feeling of heaviness. An anterior vaginal wall prolapse is descent of the urethra or bladder into the front vaginal wall, a posterior vaginal wall prolapse is descent of the rectum into the back wall of the vagina, and a uterine descent is into the top of the vagina.
(Image of pelvic organ prolapse from www.mypfm.com)
Risk factors may include:
Pregnancy and vaginal delivery
Assisted vaginal delivery
Obesity
Hypermobility
Menopause
Chronic constipation
Chronic cough
Chronic breath holding or abdominal ‘sucking in’
Symptoms can vary and may not correlate with the stage of prolapse. Commonly there is a feeling of vaginal heaviness, a visible bulge, urinary frequency or leakage, incomplete emptying of the bladder or bowel, or pain.
In the first instance, getting yourself assessed by a GP or a pelvic health physiotherapist will be helpful. We can assess the stage and type of prolapse and advise on management.
According to the NICE guidelines the first line of management for vaginal prolapse is pelvic floor exercises, followed by a vaginal pessary, and finally surgery.
Pelvic floor exercises may help, but this is not the only way, sometimes the pelvic floor muscles (PFM) may need to be down trained. There may be too much pressure being generated from above, causing the organ to descend. Scar tissue in the perineum or abdomen could be causing the organ to distort out of alignment. The PFM don’t work in isolation, you may need to load the PFM more, or incorporate other full body rehab exercises.
A vaginal pessary is like using a sports bra; it holds the organs up and allows the PFM to work in a normal way. It will take the vaginal pressure, bulge, or symptoms away. Pessaries come in many shapes and sizes. They are available to purchase online, whereby you can order a sizing kit to work out which size fits you best. Or they can be fitted by medical professionals, at a GP surgery, hospital, or in some private physiotherapy clinics.
You can find out more about vaginal pessaries in the next blog.
Surgery may be indicated if you have explored conservative treatments and you have decided with your medical professional that this is the best option.
Lifestyle changes that may help:
If you are early post-natal then allow your body time to heal; rest when you can, eat well (especially plenty of protein to help your tissues heal), keep yourself hydrated (this will help your healing process).
Managing your constipation or chronic cough
Avoiding excessive bearing down when lifting or toileting
Resting with your pelvis on a pillow if your symptoms worsen after activity
If peri to post-menopausal age, then vaginal oestrogen may help reduce vaginal dryness, soreness and rubbing. This can be prescribed by your GP
It is important to remember that:
Symptoms of POP can improve
You may not need to give up the exercise that you enjoy, and some research suggests that exercise may even improve your symptoms.
Sex doesn’t make POP worse. Using a lubricant or varying positions can really help.
You can find more information on POP in this booklet.
You can find your local pelvic floor physiotherapist via the Squeezy app, Mummy MOT, or the POGP (Pelvic, Obstetric and Gynaecological Physiotherapy).
Any questions please do get in touch.
Bally