The pelvic floor and prolapse are getting a lot of attention on Social Media platforms and on google; some of it is worthwhile, and much of it is scary and not helpful, so we thought it was time to talk a little about prolapse. At Embody Physiotherapy, we work with a number of women with Pelvic Organ Prolapse (POP). Like all of our clients, no 2 of them are the same, and likewise their symptoms and the solutions to address their POP vary. Keeping that in mind, let’s talk.
POP. Pelvic Organ Prolapse. Prolapse. Pelvic Heaviness. “Feels like my parts are falling out.” “OMG…I am not sure what I see, but I don’t think it’s where it should be.” “My doctor says I have prolapse but not to worry, they can do a hysterectomy and fix it.” These statements are some of what we hear. But what is POP?
ACOG (American College of Obstetricians and Gynecologists) defines POP as “a disorder in which one or more of the pelvic organs drop from their normal position.” You may have heard words such as “Cystocele. Rectocele. Enterocele.” The pelvic organs include the uterus and the vagina, the bladder, and the rectum. These organs are supported by ligaments and other connective tissues, and yes, by the pelvic floor muscles. They are at the base of our pressure system (aka “the core”) and are affected by everything that is above them, such as our breath and movement patterns. The ACOG definition sounds pretty scary, but it does not need to be when you understand how it all works together, and what you can do.
Why does POP occur? There are many reasons that prolapse may occur, and why we might see it in one woman but not the next. Remember, the pelvic organs are at the BASE of the core/canister. Women may experience prolapse or descent after childbirth (and we see it with women who have delivered vaginally as well as by C-section, although literature describes it more after vaginal), menopause and change in the tissues with hormonal changes may contribute. Even in women have not had pregnancies, we may see it in women with chronic constipation and straining with pooping (and peeing!). We also see POP in women with disease processes creating different breathing and coughing pattern such as with asthma.
Why me? Was it because of the position I was in when I gave birth? Perhaps, but in truth, it varies from woman to woman. Certainly, we would like to see women delivering when their body tells them it is time and in positions that allow their body to perform the task effectively…we are working on that part!
There may be a genetic component, meaning how our connective tissues support our structures. Breath holding and straining make a difference, and we address constipation/IBS and voiding and bowel habits and training with ALL of our clients with pelvic floor concerns! The answer is that we don’t always know, but we do know how to address it!
Can lifting, jumping, running make it worse? It depends! If you do any activities in “holding or locking out positions”, with breath holding, or with straining, it might contribute to the pressure and to POP. We work with our patients and clients to teach them strategies for strength, movement and function. Always, it is teaching breath and to respond to the task at hand. The demands vary if you are standing to cook Thanksgiving dinner or if you are carrying a squirming 25# toddler. We want you to be able to respond to ALL demands!
Should I not have more children?? What if it worsens? Having more children is a very personal decision. When we work with moms-to-be, in addition to breath, the pelvic floor and core, we can give you birth positions ideas and breath ideas for birth. We will also share information for support and breath strategies post-baby, both for vaginal and c-section moms. Knowledge is empowering, and we want you to have as many tools as possible!
- Stop and breathe! POP is something that we can make a positive difference in.
- See a qualified physical therapist who examines not only your pelvic floor but how you are moving, breathing, using your entire system. One that talks to you about your day, your week, your goals, and how you can incorporate care and solutions into your life. This isn’t about the PT…it’s about YOU! Learn exercises and how to do them properly, postures and positions for day to day activities.
Learn about your anatomy, and how it all works together. At our practice, we utilize RUSI (Ultrasound imaging of the muscles and pelvic floor). Our patients are able to see how they are engaging the muscles and to see what happens with breath holding and bearing down patterns. They can visualize their pelvic floor from the “outside in”.From one of our patients when she saw her pelvic system visualized: “OH!! THIS is why you want me to engage this way!!” Truly, a picture can be worth a thousand words!
- Kegels: “just do kegels.” If kegels solved POP, we would not be writing this! Learn to bring all of the system together!!! Whew...can't say this enough! Learning to work with the pelvic floor and the rest of the core/trunk system is so important! We work with the pelvic floor to strengthen and tone, but we teach you so much more to be able to create positive changes.
- Speak with your MD or midwife. Be aware that many OB/Gyne may not do an assessment beyond “yes, you have prolapse. We can fix it.” We recommend seeing a uro-gynecologist who specializes in POP. They will take baseline measurements that will provide more specific information, and can be very helpful in your PT program, in decreasing your fear and worry, AND as you progress with PT, can give great feedback when you are re-assessed and your POP is stable, or in some instances may have improved.
- "Do I need to wait to see the uro-gyne before I see you? They have a really long wait list!" We can see you as you wait for your appointment. It is never too early to begin to make changes in the pressure and core system, and we begin doing that at your first appointment. Seeing us first also means that we can give you questions to ask the uro-gyne when you have your appointment, and we send a report with our findings, concerns, and recommendations. Schedule a FREE 20 minute phone consult to gain information and determine if seeing a PT before the doctor would be helpful.
Your MD or midwife might suggest a pessary, basically a support for the pelvic organs. Pessaries can be great and allow you to have support during sports, recreation and your day.
6. Don’t get freaked out by what you think you see, by what you have read, or by what someone else tells you about their experience! This sounds glib, but too often women come in expecting the worse because of what they have been told; we love helping them regain confidence in their body! There are good answers out there, and solutions for “Life with POP”. Our clients exercise, hike, bike ride, do yoga, lift their kids and grandkids, have sex (typically, your partner is not even aware of the prolapse!), cough/sneeze/laugh, garden and lift. In short, they live life!
Contact us to learn how we can help you. Request your FREE 20 minute phone consultation here. If you are in our area, give us a call or make an appointment. If you are not in the Western PA area, we do provide distance consults. Not the same as a full eval, but we are often able to provide you with tools to get started. firstname.lastname@example.org
If you would like to find a qualified Pelvic Floor PT in your area:APTA Section on Women's Health and link to “find a PT”
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We can't emphasize strongly enough that prolapse does not need to be an "OMG, how will I live with this" event! There are great ways to address it, and to keep on stepping, jumping, living!