Pelvic organ prolapse (POP) refers to a change in the position of the pelvic organs (bladder, uterus and bowel).
This is due to laxity in the support structures such as the ligaments and muscles.
Women will most commonly describe this as a vaginal bulge or pelvic pressure. Other symptoms include low back ache, splinting/digitation (using fingers) to void, urgency, bladder and bowel voiding difficulties or painful/obstructed intercourse.
Prolapse can occur for a variety of reasons in different phases of life.
Birth history:
● Specifically a vaginal delivery where there has been the use of forceps, pushing for longer than 2 hours, birth size 4kg or larger, an episiotomy or any muscle tears is a risk factor for prolapse.
● A thorough assessment from your Pelvic Health Physiotherapist will help to determine your individual circumstances and treatment plan.
Postpartum:
● Postpartum hormonal changes, especially during breastfeeding, can increase the laxity in the fascia that supports the pelvic organs.
● Pelvic Health Physiotherapists can support you with tailored pelvic floor muscle exercise prescription, advice on what exercises to complete amongst other lifestyle modifications.
Menopause:
● Menopause comes along with a reduction in estrogen levels. This can reduce muscle tone and fascial (connective tissue) strength.
● Research has shown that supervised and tailored exercises of your pelvic floor muscles for approximately 4 months can reduce the symptoms of prolapse.
● Other strategies include pessaries, estrogen creams and exercise advice can help.
Chronic constipation and respiratory conditions:
● These two comorbidities can increase the risk of prolapse.
● The added pressure from straining and coughing can overtime weaken the pelvic floor muscles and fascial tension. Building up the pelvic floor muscle strength, teaching well timed pelvic floor contraction and minimising constipation may reduce symptoms of prolapse.
General hypermobility:
● Can also present as laxity in the support structures in the pelvis.
● Tailored whole body strengthening, but with a particular focus on the pelvic region, can help to support pelvic organs.