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. 

National Women’s Health Week

2009WHW

We all realize the importance of setting aside time to take care of ourselves, but how many of us actually do it on a regular basis? Our lives seem to get so hectic and the “should do’s” start to pile up fast. This ever-increasing list can cause unneeded stress to our already busy lives, and guess what….stress is not healthy!

As part of this year’s National Women’s Health Week, we encourage all women to pick a few things from the list below and add them into their lives. These healthy reminders may seem simple enough, but can make a world of difference in how we feel!

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As a women’s health specialist, I encounter women of all ages, activity levels and body types. I always encourage my patients to find an exercise routine that they enjoy…eat foods that make them feel vibrant, to be aware their your posture, engage their pelvic floor during activity, and so on.

Let us know which aspects from the list YOU are focusing on! Is there anything you would add to this list?

Happy National Women’s Health Week!  

Women Deserve to Know: the Stretched Pelvic Floor Muscles (PFM) can recover after delivery!

Women Deserve to Know: the Stretched Pelvic Floor Muscles (PFM) can recover after delivery!
Pelvic floor muscles are very important because
 a. they respond to stretch during sex which facilitates an orgasm
 b. they support and promote function of the pelvic organs
 c. they contract to delay urination or defecation
 d. they relax to permit voiding or defecation
The pelvic floor, or pelvic diaphragm, is like a trampoline that spans the entire pelvic cavity. Urethra, vagina, and rectum pass through the diaphragm.
superficial and deep pelvic floor muscles
The trampoline-like structure of the superficial and deep pelvic floor muscles
A recent study done in Norway  done by Jette Star-Jensen and others was published in the March 2015 issue of Obstetrics and Gynecology looked at the postpartum changes in pelvic floor connective tissue which included muscles in a group of first time mothers. Throughout their pregnancies transperineal ultrasounds were taken at five times, 21 weeks, 37 weeks, and 6 weeks, 6 months, and a year post birth. Women were asked to be at rest, bear down (known as Valsalva), and contract the pelvic floor muscles. The connective tissue of the pelvic ring was assessed as the levator hiatus area, as well as bladder neck mobility.
 valsalva
85% the 274 women assessed before birth delivered vaginally, the others had cesarean deliveries. There was no difference in the women who delivered by c-section. The vaginal group displayed significant increased in all three measurements with comparing 12 months postpartum to 21 weeks of pregnancy.The group of women who had c-sections compared to the ones who had vaginal births were able to reduce the pelvic opening with muscle contraction more than those who had vaginal deliveries.
The ability of the deep diaphragm muscle and connective tissue to stretch might help protect the muscle during delivery(parturition). However, the stretch offers less stiffness to support the organs and hold the skeletal pelvis together. The levator ani (deep pelvic floor muscles) do not seem to recover completely twelve months after delivery. At twelve months, the vaginal and cesarian delivered women displayed no significant differences in an enlarged pelvic outlet. This phenomena might indicate persistent pregnancy changes as in other studies. Women need to be aware that the most change occurs during the first six months post delivery, but changes might persist. The pelvic floor appears to have great potential for recovery from pregnancy and birth, Due to the significant changes in the pelvic floor muscles during pregnancy and birth, the pelvic floor might be less able to develop pelvic floor disorders when other risk factors such as weight gain, poor deep synergistic trunk muscle strength and endurance, breath holding (valsalva) when having a bowel movement, excessive coughing with allergies. Therefore, we at Women’s Health Physical Therapy urge every women during the postpartum period to seek a pelvic health therapist for supervised individually tailored exercises to regain the strength, endurance, coordination and proper timing of contraction and relaxation of the pelvic floor muscles for proper function in isolation and with the other deep trunk muscles.
Pelvic-Floor
The pelvic floor is made up of a network of various superficial and deep muscles, which can be seen in this illustration.
The Diaphragm, back muscles (multifidus), stomach muscles (Transversus abdominis) and muscles of the pelvic floor all work in a synergistic way to provide stability, strength and controlled movement.
The Diaphragm, back muscles (multifidus), stomach muscles (Transversus abdominis) and muscles of the pelvic floor all work in a synergistic way to provide stability, strength and controlled movement.
Please contact a Pelvic Floor therapists in your area. If you are in the Richmond, Virginia area, you may contact Women’s Health Physical Therapy for more information about Postpartum Strong – from the Inside Out!

Why Didn’t I Know . . . that I could help prevent prolapse and incontinence?

As a specialized pelvic health physical therapist in the United States for the last twenty years, I have heard this comment so many times. The clinical evidence from research is now published in journals for urogynecologists, physical therapists, urologists, as well as for obstetricians and gynecologists, supporting the need for assisted pelvic floor recovery after childbirth. Just recently Dr. Ingrid Nygaard, a urogynecologist at the University of Utah, wrote an editorial in the March 2015 Journal of Obstetrics and Gynecology describing pelvic organ prolapse (POP), which does not typically develop to end stage until decades after vaginal birth. This morphological change can be affected by performing exercises to facilitate closing of the pelvis and regaining more stiffness of the muscles and connective tissue.

two women expo

In order to understand how pelvic organs descend, a woman needs to understand the remarkable pelvic floor muscles and connective tissues that form a trampoline-like mat in the lower pelvic region. This tissue offers a certain level of stiffness to hold up the pelvic organs so they can function optimally, and accommodates varying degrees of intra-abdominal pressure when laughing, coughing, sneezing, or exercising. Holding your breath, known as performing a valsalva, places  pressure on the pelvic floor which can initially create hypertonus,(too much contraction), or pelvic floor relaxation from fatigue. A certain degree of stiffness of the tissue must be achieved otherwise the load from above due to increased pressure in abdomen when having a bowel movement, delivering a baby, excessive weight gain, or exercise can cause a descent of the pelvic organs. When a pelvic organ descends, women often complain of a bulge in their vagina or a deep lower pelvic pressure.

pelvic floor pic for blog

The structure of the pelvis also changes during pregnancy due to pregnancy hormones. During the 21-38 weeks of pregnancy, the pelvis opens in preparation for birth. For some people whether due to genetics or an easy non-stressful birth the body snaps back. But for 27% at six weeks the tissue was not recovered, and at 6 months 15% had a larger opening than the normal of 25cm2. An analogy would be a woven cane chair that no longer offer good support when someone sits upon it, but that it sags in the middle. As we examine our physical bodies, it is possible that women have muscle variations and differ in mechanical stretch that their connective tissue can withstand. Previous research illuminates for us that torn muscles can heal.

pelvic separation

The call to action to help prevent prolapse is to rehabilitate the pelvic floor muscles during the postpartum period. Most muscles significantly change in six weeks, but depending on how stretched the muscles became or trauma from decreased blood supply, a longer period might be required. The body is magnificent in changing during the childbearing year. Just like recovery from a strained muscle in sport, pelvic floor muscles appear to respond well to rehabilitation post birth in an effort to regain form, and isolated function as well as coordinated and proper timing of function with the other deep trunk muscles like the back extensors and transverse abdominus, while coupled with exhalation. With the research that is now being published there is no reason why a woman should not know what happens to their pelvic floor during birth and how they can regain the best function possible.

LOGO JPEGTo learn more, you may visit our website: obgyn-physicaltherapy.com

or call to set up an appointment: 804-379-3002

Every woman who has a child deserves to be postpartum strong from the inside out!

Did you know that current research reveals……. 1 in 3 women will have bladder leakage, 36% of postpartum women will discover they have separation of the their abdominal muscles, and 30-50% of postpartum women will experience a heavy feeling that could be descent of the pelvic organs?

Become postpartum strong so you do YOU DO NOT HAVE TO LIVE WITH ANY OF THESE CONDITIONS!

Did you know that a physical therapist, who has advanced training in the women’s health specialty, can perform a musculoskeletal assessment to determine if you present with one or more of these postpartum dysfunctions.

Why Didn’t I Know?

Take a minute to answer this 5 question check list . . . 

1) DO YOU LEAK WHEN YOU LAUGH, COUGH, AND/OR SNEEZE?      ⃝YES      ⃝NO

2) DO YOU HAVE PAIN OR DISCOMFORT WITH INTERCOURSE?        ⃝YES      ⃝NO

3) DOES YOUR BACK ACHE WITH LIFTING, FEEDING, OR CHANGING YOUR BABY?    ⃝YES   ⃝NO

4) DO YOU SOMETIMES FEEL “PRESSURE” OR A “BULGE” IN YOUR PELVIS?    ⃝YES   ⃝NO

5) WHEN PICKING UP YOUR HEAD WHILE LYING ON YOUR BACK, IS THERE A BULGE OR DO YOU

FEEL A SEPARATION IN YOUR STOMACH MUSCLES?    ⃝YES    ⃝NO

If you answered YES to any of these, you’re definitely not alone! Ask for a musculoskeletal assessment. A physical therapist women’s health specialist can assess pelvic floor muscle function, abdominal separation, and postural alignment, and functional use of your back, abdominal and pelvic floor muscles coupled with proper breathing. Even if you have none of the above, you could benefit from attending a screening and learning how to regain or improve the strength, endurance, and coordination of the deep intrinsic trunk muscles to prevent the above listed concerns.

eval4

 All insurances will cover physical therapy for muscle disuse and incoordination post delivery. Women across the world who just had a baby with no delivery problems are screened and offered rehab. 

                                   “You too deserve the best so that you can give your baby the best!”

Pre-Natal/Post-Partum Care

Pre-Natal/Post-Partum Care

A pregnant woman undergoes a myriad of physiological changes, which in turn results in physical changes. However, an understanding of the pregnant body is crucial to adapt to its changing state.

“DID YOU KNOW?” Most physical discomforts that you will experience during pregnancy can be treated with pelvic floor physical therapy. A very common complaint during pregnancy is lower back pain. This is treatable with physical therapy and will include modalities such as proper body mechanics, relaxation techniques, and strengthening exercises for the pelvic floor and core muscle groups. As most of these common complaints carry over into the post-natal period, it is of utmost important for pregnant women to return for physical therapy for specific postpartum care as well

back pain.

Pre-Natal Conditions

First Trimester:

  • Lower Back Pain
  • “Morning Sickness” – Nausea

Second Trimester:

  • Diastasis Recti (separation of abdominal muscles)
  • Lower Back Pain

Third Trimester:

  • Lower Back Pain
  • Frequent urination
  • Low Energy – Fatigue
  • Constipation/Bowel Issues

Post-Partum Care:

Your body is amazing!  And…yes, your body does change after having a baby.

After giving birth, women should seek out a women’s health physical therapist who is trained in the proper exercise, stretching techniques and other modalities. For some women, they will notice changes directly after childbirth that they might not have experienced while being pregnant. It’s great to know that these discomforts can be treated.

  • Incontinence (leaking urine when laughing, coughing and jumping)
  • Diastasis recti (separation of abdominal muscles)
  • Scarring from C-Section, episiotomy, or perineal tear
  • Pelvic floor weakness
  • Prolapse (or feeling of a bulge or heaviness in the pelvis)
  • Pelvic pain and pain during intercourse

Back Pain:

Lower Back Pain is a common discomfort that very often manifests in the sacro-iliac joints, or lumbo-sacral joint. More times than not, the pubic symphysis is also affected. This postural dysfunction can appear in any of the trimesters and may result in sciatica pain and discomfort.

So What Causes This Pain? The discomfort felt in the lower back and pelvic region is due to postural changes to accommodate the growing baby, ligament laxity, chronic weak abdominal wall and hormonal changes, to name a few.

Treatment Options Available: postural evaluation by a pelvic floor physical therapist who will evaluate your body mechanics, deep tissue massage, stretching, strengthening and other modalities such as ultrasound therapy and low-level laser therapy.

Diastasis Recti:

During and/or following childbirth, women may notice a weakness and separation in their abdominal muscles. A Diastasis Recti is the separation of the rectus abdominis muscle. Many women notice this separation when laying down and lifting their head up. A separation of these muscles of 2 cm or greater is considered significant and will need to be treated. Some factors that may contribute to this condition include weak abdominal tone and hormonal changes. This separation may appear in the second trimester and contribute to lower back pain.

Shouldn’t I Just Do More Crunches? NO! If you have a diastasis of your abdominal muscles, going back to your regular exercise routine may actually make the condition worse.  Pelvic floor physical therapists are trained in specific abdominal strengthening exercises, coupled with proper breathing. With careful healing of your abdominals, you can get back to your regular routine in no time!

Physical Therapy Treatment Includes:

  • Soft Tissue Mobilization
  • Therapeutic Exercise
  • Myofascial Release
  • Deep Tissue Massage
  • Posture, Biomechanics and Proper Breathing
  • Low-Level Laser Therapy
  • Ultrasound Therapy