Pelvic Organ Prolapse – How to Best Protect and Strengthen a Prolapse

Pelvic organ prolapse self management involves prolapse exercises and ongoing prolapse protection strategies.

Read on to learn the health professional answers and techniques for these frequently asked prolapse questions:

• What causes a vaginal prolapse?
• What are the symptoms of a mild and more severe prolapse?
• What is the treatment for a prolapse?
• Do kegel exercises or pelvic floor exercises help a prolapse?
• How to manage a prolapse and prevent it worsening?
• How to exercise safely with a prolapse?

What is Pelvic Organ Prolapse?

Pelvic organ prolapse refers to one more of your pelvic organs slipping down or protruding through a defect in your pelvic floor. Your pelvic organs include your bladder, urethra, uterus, vagina, anus and rectum.

Some common types of pelvic organ prolapse include vaginal prolapse, rectal prolapse and anal prolapse.

Vaginal prolapse

• A prolapsed bladder or cystocoele involves the bladder protruding through the front wall of the vagina. People often refer to a bladder prolapse as a “fallen bladder” or “dropped bladder”.
• A urethral prolapse involves the urethra or urine tube sagging into the front wall of the vagina.
• A uterine prolapse involves the uterus, cervix and top part of the vagina descending into and sometimes out of the vagina. This is also known as a “fallen womb”. A prolapsed uterus can involve the vagina turning inside out and protruding out of the vaginal entrance.
• The rectum can also protrude into the back wall of the vagina and is also known as a rectocoele. This is not the same as a rectal prolapse.

Rectal prolapse and anal prolapse

A rectal prolapse involves the walls of the rectum moving down and protruding out of the back passage. This type of prolapse is also known as a “bowel prolapse”.  An anal prolapse involves the membrane lining the anus protruding out through the anus.

Causes of Pelvic Organ Prolapse

A prolapse is like a hernia. When the strong layers of tissue (called fascia) and the pelvic floor muscle that hold your organs in place become weak or damaged, this allows the organs they support to bulge through this tissue.

To understand a vaginal prolapse, think of when you stretch really thick plastic. The weakened floppy areas that you see in the plastic are like the weakened areas in the walls of your vagina. When thin floppy vaginal walls cannot support the pelvic organs (bladder, uterus, bowel) and they protrude into the vagina.

Pelvic Organ Prolapse Symptoms

Prolapse symptoms for a small to moderate size prolapse

A prolapsed bladder or bowel prolapse commonly present as a lump or a bulge that you can feel and sometimes see coming down out of your vagina. You will notice that it tends to bulge more when there is an increase in pressure inside your abdomen, such as when you cough or open your bowels. The bulge usually lessens when you lie down. A prolapse may also create a feeling of heaviness within your vagina which may be worse when you are standing up, or even immediately prior to using your bowels. In general, in the case of a small- or moderate-sized prolapse, sex is not usually uncomfortable or problematic.

Prolapse symptoms for a moderate to large size prolapse

As a prolapse becomes larger, the vaginal lump usually becomes more obvious. Many women describe their prolapse as an “egg” at the entrance of their vagina, and they can feel it when washing. As a prolapse gets bigger, some women describe a dragging sensation in their pelvis. In the case of a large uterine prolapse, sex can be very uncomfortable and in some cases not possible if the prolapse blocks the vaginal entrance. With a larger prolapse, sex can cause pain, and some women experience low back ache and difficulty inserting a tampon. If the prolapsed tissue drags on your underwear, it can cause bleeding.

You may experience bladder prolapse symptoms such as frequent and/or urgent need to empty your bladder. Some women find that having a bladder prolapse makes it difficult to fully empty their bladder. This can cause chronic bladder infection. Bowel prolapse into the back wall of the vagina can make using your bowels difficult, and some women need to use their hand to support and lift the tissue between their vagina and anus.

Pelvic Organ Prolapse Treatment

Vaginal prolapse treatment involves:

1. Preventing a prolapse if you are at risk of having a prolapse.
2. Managing your existing prolapse and preventing your prolapse from worsening with vaginal pessary devices and/or Kegel exercises for pelvic floor muscle training. Read more on prolapse management below.
3. Vaginal surgery for pelvic floor repair.

Kegel Exercises for Prolapse

Kegels may help you to prevent or manage pelvic prolapse:

• If you can learn to contract your pelvic floor muscles before pressure is placed upon your prolapsed tissue, such as before you cough or lift, this may reduce your prolapse symptoms and prevent your prolapse from worsening.
• Pelvic floor exercises or Kegel exercises can make your pelvic floor into a stronger, thicker and firmer support, which may also prevent your prolapse from worsening or may reduce your symptoms.

Inside Out by Pelvic Floor Physiotherapist Michelle Kenway and Urogynaecologist Dr Judith Goh guides you step by step through how to do kegel exercises or pelvic floor exercises effectively. Inside Out also includes core workouts to teach you how to use your pelvic floor muscles to reduce the pressure of everyday activities on your prolapse and your pelvic floor.

Prolapse Management Strategies

A prolapse will not go away once you have one. You may, however, reduce your prolapse symptoms and avoid worsening your prolapse with the following measures:

• Stop smoking – Coughing associated with smoking may over time cause or worsen a prolapse.
• Manage your weight- If you are overweight, you will increase the pressure on your pelvic floor and your prolapsed tissue.
• Avoid constipation and never strain-Repeated straining with constipation will weaken your pelvic floor, increase your risk of prolapse and potentially worsen your prolapse symptoms.
• Avoid heavy lifting and the wrong kind of exercise-Heavy lifting and inappropriate exercise (see below) will increase your risk of prolapsed tissue and pelvic floor muscle weakness.
• After prolapse surgery, do all the above to avoid further pelvic floor dysfunction- Previous pelvic floor surgery, including vaginal surgery for prolapse, is likely to increase your risk of further prolapse in the future.
• Try wearing quality briefs or support underwear-Some women find that support briefs help to reduce prolapse symptoms, especially when they are on their feet or working for long hours.

Safe Exercise with a Prolapse

The wrong kind of exercise will make your prolapse symptoms worse and may increase the likelihood of recurrent prolapse after prolapse surgery. Having a uterine prolapse or prolapsed bladder does not mean that you cannot exercise. If you have a prolapse or have had pelvic floor surgery, you need to know how to exercise to get the best results AND protect your pelvic floor at the same time.

Avoid high-impact exercises that involve having both feet off the ground at once or stepping heavily, as these exercises increase the likelihood of pelvic floor dysfunction. Choose from the list of appropriate low-impact exercises and read all about those exercises to choose and those to avoid in Inside Out – the essential women’s guide to pelvic support.

Avoid specific exercises that increase downward pressure on your pelvic floor and increase the likelihood of pelvic floor dysfunction. Inside Out describes these exercises, and the exercise classes that may worsen your symptoms and increase the likelihood of repeated prolapse following pelvic floor surgery. If your pelvic floor is weak, avoid abdominal curl or sit-up exercises that will force it downward. Avoid specific Pilates exercises such as Table Top with both of your legs in the air.

Pelvic organ prolapse is a common problem in women and yet many women lack the understanding of best to exercise and protect their prolapse. This pelvic organ prolapse information has been written to inform women and assist prolapse self management.

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This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition.
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