What is Prolapse?

Pelvic organ prolapse is when one or more of the pelvic organs begin to descend down into the vaginal canal or rectum. This can occur with the bladder, uterus, or rectum. While only 3-6% of women may complain of symptoms, studies have found that up to 50% of women have prolapse upon physical exam. This is because many women may not experience symptoms with prolapse.

Symptoms of Prolapse

These are some common symptoms of prolapse:

• Feeling of heaviness, full sensation, or like something is in your vagina or rectum
• Difficulty completely emptying your bladder
• Slowed urine stream, long duration of peeing, and/or frequent urination
• Discomfort with intercourse
• Incontinence
• May or may not have low back, hip, or pelvic pain
• Symptoms are worse at the end of the day or after prolonged walking/running/exercising

There are 4 stages of prolapse. In stage 1, the uterus is in the upper half of the vagina. Stage 2 involves the uterus descending nearly to the opening of the vagina. In stage 3, the uterus protrudes out of the vagina. Stage 4 involves the uterus being completely out of the vagina. The stage of prolapse DOES NOT equal the degree of symptoms you may experience.

Prolapse Causes

The biggest cause of pelvic organ prolapse is too much intra-abdominal pressure downward over a prolonged period of time.

These are some risk factors for experiencing prolapse:

• Menopause
• Obesity
• Previous hysterectomy
• History of pregnancies and childbirths, especially vaginal delivery and instrument-assisted delivery
• Aging
• Chronic constipation (straining and pushing with difficult bowel movements)

How to Improve Prolapse

Strengthen Your Pelvic Floor

Studies have shown that pelvic floor muscle training in women with pelvic organ prolapse is incredibly effective! You should work on both the strength of your pelvic floor (5 max contractions x5) and endurance (10 second sub-max holds x10). Start with performing Kegels in positions in which gravity assists your muscles, such as lying on your back with your knees bent. You can even place a pillow under your hips. Gradually work up to positions in which your muscles are working against gravity (lying down → sitting → standing). Check out the video below to learn how to correctly perform a Kegel.

Pressure Management Strategies

Managing your intra-abdominal pressure is very important in reducing prolapse symptoms. Here are some ways to ensure your intra-abdominal pressure is well-balanced:

• Never bear down! This includes during exercise and while urinating or having a bowel movement.
• Watch your posture. Keep tall through your torso, and keep your ribs stacked on top of your pelvis.
• Limit breath holding. Breathe out when doing something difficult, such as lifting or during exercise.
• Avoid clenching your abs or glutes during walking, everyday tasks, and at rest.

Work on Deep Breathing

The diaphragm moves together with the pelvic floor. When you breathe in, your diaphragm and pelvic floor both move down. As you breathe out, your diaphragm and pelvic floor move up. Using shallow breathing patterns (shoulders moving up and down) places extra pressure on your pelvic floor. That extra downward pressure can contribute to prolapse.

360 Breathing is a deep breathing technique that encourages movement of your entire diaphragm. You should feel movement in your chest and belly, the sides of your ribs, and your back. It should feel like an umbrella opening and closing. This breathing technique decreases pressure on your pelvic floor and can be very helpful to reduce prolapse symptoms. This should be practiced throughout the day, as well as while you are exercising. Check out the video below to learn how to do 360 Breathing.

Strengthen The Muscles Surrounding Your Pelvic Floor

Abdominals

Your deep stabilizing abdominal muscles actually assist your pelvic floor with Kegels and help support your pelvic organs. Try exercises like transversus abdominis isometrics, hooklying marching, or bird dog.

Glutes

Our glutes help us maintain a good position of our pelvis and influence our pelvic floor function. Try sidelying leg lifts, bridges, or fire hydrants.

Deep Hip Rotators

Two of these muscles are also pelvic floor muscles. Thus, strengthening this group of muscles can also improve pelvic floor strength. Try exercises like clamshells or lunge rotations.

Inner Thigh

Our inner thigh muscles work together with the pelvic floor and act like anchors for the pelvis. Try exercises like sidelying hip adduction or hip adduction with a band.

Pessaries

A pessary is a small device that can be inserted into the vagina. It presses the prolapsed organ(s) up and out of the vagina and provides support to the pelvic organs. It can be a long term solution or a short term relief while you’re working on improving your pelvic floor strength and other lifestyle factors. A pelvic floor PT, urologist, or gynecologist can help you decide if this is a good option for you.

Surgery vs Pelvic Floor Physical Therapy

It is often beneficial to try conservative treatment first, even with higher grade prolapses. Pelvic floor PT can be helpful in managing mild to severe prolapse symptoms. Having surgery for pelvic organ prolapse may be an option if you do not get symptom relief with conservative management. However, even if you end up needing surgery for your prolapse, the surgery does not fix your pressure management and breathing strategies, posture, and pelvic floor strength. It is important to address these factors in pelvic floor PT in order to prevent future issues.