Pelvic organ prolapse is a common condition, particularly affecting older women. Prolapse literally means ‘to fall’ and it occurs when the structures designed to keep organs in place weaken or stretch, so that one or more pelvic organs (the uterus, bladder, bowel or rectum) starts to slip out of place. It is the pelvic floor muscles and supporting ligaments which keep the pelvic organs in their proper position. The pelvic floor muscles may become weakened for many reasons, such as pregnancy and childbirth, ageing, heavy lifting, obesity, chronic straining, surgery or injury.
The most common types of Prolapse:
- Cystocoele (bladder): the bladder drops down and bulges into the front wall of the vagina.
- Rectocoele (rectum): the rectum bulges into the back wall of the vagina.
- Uterine Prolapse (uterus): the uterus (womb) drops down into the vagina and in severe cases it can sit outside the body.
As with many conditions, the prolapse may be mild, moderate or severe and many women with a mild prolapse will be unaware that they have one, and may not experience any problems from it. Other women will be aware of a bulging sensation in the vagina, particularly at the end of the day, or after doing a lot of lifting, or repeated coughing.
Problems women may have as a result of a prolapse can vary:
- A sense of ‘something coming down’ or a ‘dragging feeling’
- Seeing or feeling a lump in the vagina
- Bladder problems – stress, urge or overflow urinary incontinence
- Difficulty emptying the bowels
- Lower back or pelvic pain
- Pain or discomfort during sexual intercourse
Physiotherapy is always carried out in a private treatment room with the same physiotherapist, providing sensitive, professional treatment. It starts with a thorough assessment. You will be asked detailed questions about your symptoms, your bladder and bowel control, your medical and surgical history, pregnancies and births, your diet and lifestyle. A physical examination will then follow, which may include looking at your posture, back, abdominal muscles and likely an internal examination. Once the examination is complete, a discussion follows, explaining the findings and exploring treatment options. It is a good opportunity for you to ask questions to gain a better understanding of your problems.
The goals of Physiotherapy are to reduce the symptoms caused by the prolapse and to improve your pelvic floor support. Treatment will always involve a lot of education, to teach you simple measures which can make a big impact on your comfort and control, for instance instructions on how to pass bowel movements without straining. Treatment is often focused around the pelvic floor muscles – the sling of muscles which help to support and control the bladder. You will be taught how to identify them, how to tighten them (Kegel exercises) and how to use them functionally to help support your pelvic organs during daily activities. Treatment techniques may include computerized biofeedback, to teach pelvic floor muscle awareness, bladder retraining, posture re-education, exercises for the abdominals and other ‘core’ muscles. A home exercise program will always be an important part of your treatment.
Physiotherapy will not be able to return the prolapsed pelvic organ(s) to their original position, but it can help improve the strength of the pelvic floor muscles, so that they provide more support to the pelvic organs to prevent further slippage. Physiotherapy can also play an important part in teaching you how to avoid certain activities and helping you make simple lifestyle changes which will prevent you from causing further damage and stretching of your pelvic floor muscles. It can also teach you how to improve your bladder control.