Let’s Talk About Organ Prolapse

Pelvic Organ Prolapse (POP), is defined as weakness of the muscles, ligaments and connective tissues of the vaginal wall,  causing descent of the pelvic organs. This weakness can result in bulging of the urethra and bladder, cervix and uterus, small intestine or rectum into the vaginal wall.

Causes of prolapse are:

1) childbirth

2) weak pelvic floor muscles

3) repetitive straining or bearing down

4) heavy lifting

5) chronic coughing

6) family history of Prolapse

7) Hysterectomy

8) decreased estrogen

9) constipation

Signs and symptoms  of prolapse are:

1) feeling of something falling out of the vagina

2) lower back painpainful bladder

3) constipation

4) painful intercourse

5) groin pain

6) heaviness, fullness or pressure in the vagina

7) incomplete emptying of bladder or bowel

Types of Prolapse:

Cystocele – (anterior vaginal prolapse) – When the bladder protrudes in the vaginal canal

Rectocele – (posterior vaginal prolapse) – When  part of the rectum pushes into the back of the vaginal canal

Uterine – (apical/superior prolapse) – When the uterus descends into the vaginal wall. In those women who have had a hysterectomy, the top of the vagina can descend into the lower half.

stages of pelvic organ prolapse
stages of pelvic organ prolapse hysterectomy, the top of the vagina can descend into the lower half.

Enterocele – When the small bowel protrudes into the front or back of the vaginal wall.

A recent article published in the British Journal of Obstetrics and Gynecology, informed the readers that 50% of women undergoing a routine gynecological internal assessment, had an identified prolapse. Pelvic organ prolapse often significantly impacts their functional daily activities.

Childbirth (parity) is a well established risk factor for the development of prolapse. According to current body evidence, the alteration in pelvic organ support, during pregnancy and birth, may increase a woman’s risk for POP to eight-fold after one vaginal delivery, and a twenty-fold increase after three vaginal deliveries, compared to women who have had cesarean sections.

During pregnancy, due to circulating pregnancy hormones and increased weight of the expanding uterus and fetus, the pelvic floor muscles often relax. Pelvic organ prolapse at 36-38 weeks of gestation, first trimester body mass index, newborn birth weight and smoking status almost are variable with affect on POP development. More research is needed regarding mechanisms leading to persistent and/or progressive pelvic organ prolapse after childbirth labor.

Women’s Health Physical Therapy can offer the following care for POP (pelvic organ prolapse):

a. Pelvic floor strengthening, with supervised education. Recent research has concluded that a well adhered to exercise program for six to eight weeks will reduce prolapse one-half to a whole grade.
Pelvic floor strengthening, with supervised education. Recent research has concluded that a well adhered to exercise program for six to eight weeks will reduce prolapse one-half to a whole grade.
d. Femme - an orthotic that supports the pelvic floor and reduces gravitational pull causing descent of organs.
Femme – an orthotic that supports the pelvic floor and reduces gravitational pull causing descent of organs.
c. Electrical stimulation - a tampon sized probe is inserted into the vagina to stimulate, thicken and increase the activity of the muscle fibers of the pelvic floor muscles.
Electrical stimulation – a tampon sized probe is inserted into the vagina to stimulate, thicken and increase the activity of the muscle fibers of the pelvic floor muscles.
b. Trunk stabilization: The pelvic floor and deep abdominal muscles are linked. By activating the trunk correctly you can also strengthen your pelvic floor muscles and help support the pelvic organs.
Trunk stabilization: The pelvic floor and deep abdominal muscles are linked. By activating the trunk correctly you can also strengthen your pelvic floor muscles and help support the pelvic organs.
e. Pessary - an orthotic device which is designed to lift the pelvic floor muscles, connective tissue and ligaments.
Pessary – an orthotic device which is designed to lift the pelvic floor muscles, connective tissue and ligaments.

Many women have questions about prolapse and whether they may have this diagnosis. Please let us know if you have any questions or comments in regards to POP or how to ways to strengthen your pelvic floor. 

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