What can you do to avoid repeat prolapse repair surgery?
If you’ve had a prolapse repair your risk of repeat prolapse is increased.
Some women are discharged from care with very little long-term guidance despite the fact that approximately 1/3 of prolapse surgery is for repeat prolapse.1
This Physiotherapist information teaches you 10 ways to reduce your risk of repeat prolapse.
There are 2 overarching principles for managing prolapse repair long-term (shown left):
- Minimising the downward load on your pelvic floor – decreases the risk of straining your prolapse repair
- Maximising your pelvic floor support from below – optimises the ability of your repair to withstand pressure
10 Ways to Minimise Your Risk Of Repeat Prolapse Repair
1. Pelvic Floor Exercises
After prolapse surgery pelvic floor exercises should be a priority and incorporated as a regular part of your routine. Having strong supportive pelvic floor muscles helps you withstand the everyday forces that it needs to resist.
Make sure you’re aware of the correct pelvic floor exercise technique of lifting and squeezing your pelvic floor muscles.
If you’re not sure whether you’re doing your pelvic floor exercises correctly see a Pelvic Floor Physiotherapist to help you. It’s vital that you use the correct lifting technique rather than bearing down (which many women tend to do unknowingly).
2. Use The Knack
The Knack is an exercise technique that can help you counteract downward pressure on your pelvic floor.
The Knack is a strong squeeze and inwards lift of the pelvic floor muscles. The Knack should be used before and during every episode of downward pressure on the pelvic floor; coughing, sneezing or lifting.
3. Avoid Constipation & Straining
Straining with constipation increases the likelihood of prolapse; either with repeated straining or a single episode of intense straining.
If you’re prone to constipation ensure that you:
- Use the correct bowel emptying position and technique
- Adhere to a diet that promotes a soft well formed stool
- Take measures to avoid constipation when travelling
- Speak with your surgeon or regular doctor for prompt assistance if you’re constipated postoperatively; many ladies are prescribed osmotic laxative (e.g. Movicol, Osmolax) during their initial postoperative recovery
4. Manage Diarrhoea
Chronic diarrhoea can strain the pelvic floor with repeated bowel emptying. Some medical conditions are associated with chronic diarrhoea (e.g. ulcerative colitis). Take steps to manage your condition well with a health professional. Diet to manage chronic diarrhoea can assist some women.
A single episode of diarrhoea can impact upon your repair if it’s placed under repeated pressure with bowel emptying. Medications that manage diarrhoea can be readily obtained from your pharmacist.
If you’re travelling to a location with known risk of stomach upsets and diarrhoea pack anti-diarrhoea medication to have ready if needed.
5. Manage Coughing
When you cough the force generated by your abdominal muscles presses downwards onto your pelvic floor. If your cough is forceful and/or repeated your pelvic floor can be forced downwards contributing to repeat prolapse – especially if your pelvic floor lacks the strength to withstand the force of your cough.
If you have a chronic cough manage your condition and exacerbations with a health professional, strengthen your pelvic floor muscles and use The Knack before and during every cough.
If you develop a cough with acute illness consult your doctor sooner rather than later. Appropriate medication may include a cough suppressant, especially when you’re more vulnerable to pelvic floor strain with fatigue and illness.
6. Manage Your Bodyweight
Managing your body weight involves avoiding unnecessary weight gain and losing weight if you’re overweight.
The more abdominal body fat you carry around your abdominal organs, the greater the load on your pelvic floor, especially when you’re upright.
Manage your body weight by eating well and doing regular pelvic floor safe strength and fitness exercises.
Some forms of fitness exercise promote abdominal fat loss over others.
7. Eat Well
Eat well for your prolapse to manage your body weight and your bowels.
Manage food intolerance problems and associated gut disorders e.g. IBS that causes abdominal bloating and alternating constipation and diarrhoea.
Get to know those foods that your bowel reacts to and avoid them where possible. Specialist dietitians can assist with dietary management of food intolerance problems – especially dietitians with understanding of FODMAPS.
Minimise or avoid those foods that cause you to react with wind/gas and bloating. Bloating can increase prolapse symptoms. There is no suggestion in the research to date that bloating increases the risk of recurrent prolapse however some women do strain to pass wind and ease gas pain with bloating and this practice should be avoided.
8. Avoid Heavy Lifting
Heavy lifting is a known risk factor for pelvic organ prolapse so its important to know your safe lifting limit.
Forwards bending, deep squatting, heavy pushing or pulling can all increase the load on the pelvic floor.
Take the time to learn how to lift safely with prolapse issues.
After prolapse surgery modify your regular activities including work practices that involve heavy physical work.
For women in heavy lifting and physical work occupations modifications can be challenging. If you work in an occupation involving intense physical work it’s important to recognise the risks of heavy physical work and repeat prolapse before proceeding with prolapse surgery.
9. Exercise for Strength & Fitness
Keeping your body strong with pelvic floor safe strength training helps you decrease the load of everyday activities on your pelvic floor.
Having good physical strength improves the ease of your everyday activities and reduces your risk of strain with activity. Maintaining a strong body will help you protect your pelvic floor long-term.
Regular strength exercises have the added benefit of increasing your lean muscle tissue. Lean muscle requires energy and helps you burn fat. Lean muscle increases your metabolism helping you better manage your bodyweight (thereby protecting your prolapse).
10. Avoid Inappropriate Exercises
Inappropriate exercises increase the load on your pelvic floor including your pelvic floor muscles and your internal prolapse repair.
Avoid inappropriate exercises including:
- Intense core abdominal exercises
- Unsafe strength training exercises and techniques
- High impact fitness exercises; running, high impact aerobics
Choose pelvic floor safe strength and fitness exercises and avoid or modify inappropriate exercises to keep your body strong and active life-long.
Key Points For Successful Prolapse Repair
If you’ve had prolapse repair surgery there are many things you can do to improve your chances of long-term success.
Don’t just leave things to chance – recognise those risks for repeat prolapse that apply to you and minimise those risks by maximising your pelvic floor support and minimising the strain on your prolapse repair.
1Olsen A, Smith V, Bergstrom J et al 1997 Epidemiology of surgically manage pelvic organ prolapse and urinary incontinence. Obstetrics and Gynaecology 89:501-506.
with Pelvic Floor Physiotherapist Michelle Kenway
Learn how to exercise safely, strengthen your prolapse and reduce your risk of repeat prolapse.
Prolapse Exercises is a complete exercise guide for women after prolapse surgery seeking to exercise safely and protect their pelvic floor.