Pelvic Organ Prolapse
Pelvic Organ Prolapse is a fairly common condition after pregnancy. Although common, not many women know about this condition and are not educated before or after birth. It is important for women (esp expectant and new mothers) to know about prolapse, not just to be able to manage it but also to try and prevent it from happening in the first place.
What is Prolapse?
Pelvic Organ Prolapse is a condition where the organs of the pelvic cavity – mainly bladder uterus and rectum droop down ( towards the feet) from their position. Depending on the degree of prolapse, these organs may be visible outside the vaginal opening. There are different grades of prolapse, ranging from invisible descent to a complete prolapse where entire organ may be seen outside the vagina.
Cause of prolapse?
- Pregnancy – Normally, the three main pelvic organs- bladder, bowel, and uterus sits inside the pelvic cavity and are supported by various ligaments and muscles of abdominal and pelvic cavities. During pregnancy, these ligaments and pelvic floor muscles often undergo chemical changes and get “stretched out” or become weak. Excessive or prolonged pushing during labor and childbirth can cause these organs to be pushed out as well. Finally, instrument assistance like forceps delivery may predispose women more to prolapse.
- Chronic Constipation – Chronic habit of pushing or bearing down to have a bowel movement can predispose you to develop prolapse as there is a chronic strain on the organs.
Although your symptoms may differ slightly, you may notice any of the following with a prolapse –
- A bulge in your vagina that ranges in size from quite small to very large
- Discomfort or pressure in your pelvis or vagina
- Difficulty having a bowel movement
- Trouble emptying your bladder
- Pain with intercourse
- Lower back pain
- Increased discomfort with long periods of standing
- Improved discomfort with lying down
Can physical therapy help prolapse?
Yes. Generally, physical therapy can help prolapse by managing intrabdominal pressure and strengthening pelvic floor.
It is important for patients to learn how to defecate properly without bearing down, understand the anatomy of pelvic organs, strengthen the pelvic floor and correct poor breathing patterns that create increased pressure into the pelvic cavity. There are specific exercises and postures that can provide some temporary relief as patients work towards developing a more robust pelvic support. Weight management is also a very important aspect of prolapse management.
Prognosis often depends on the extent of prolapse. While a low-grade prolapse may be completely reversible with physical therapy, a high-grade prolapse may need surgical or other interventions. Even with surgery, research shows that best outcomes are when women do pelvic floor exercises before and after the procedure.
If you think you have prolapse, or just want to get a postpartum checkup, contact me.
Nidhi Sharma, PT, DPT, OCS, WCS
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