Being diagnosed with pelvic organ prolapse (POP) can be an unsettling and scary event, but it is fairly common, and can be successfully treated with pelvic floor physical therapy. Prolapse of the pelvic organs is when one or more of the organs that are supported by the pelvic floor start to move further down in the pelvis than they are intended to be. Organs may even be outside of the body with a severe prolapse. This may feel like pressure in your vagina, or present as urinary or fecal (poop) incontinence.
There are 4 main types of prolapse which occur.
-Cystocele: this is where the bladder is traveling down further in the pelvis than normal
-Urethrocele: the urethra is prolapsing down into the pelvis
-Uterine prolapse: the uterus is traveling down the vagina
-Rectocele: the bowels are prolapsing
These are the primary types of prolapse, but it is also possible to have multiple organs prolapsing at the same time. In a large study published by the American Journal of Obstetrics and Gynecology, prolapse is found to occur in 14-36% of women, with numbers increasing with age. This means that prolapse is a fairly common condition, even if it’s not commonly spoken about.
Pelvic floor physical therapy has been shown to be an effective treatment for decreasing common issues that arise with prolapse, including urinary and fecal incontinence, pressure on the pelvic floor, and actually reducing the prolapse itself. If you are uncertain about how you would like to have your prolapse treated, you may consider pelvic floor PT prior to considering prolapse surgery, if your doctor feels that it is appropriate. Sometimes prolapse is severe enough that surgery is the indicated treatment option.
When you go into a pelvic floor physical therapist for prolapse treatment, what happens?
During the initial visit for pelvic organ prolapse your PT will take a detailed history including any deliveries you have had, your history of urinary and/or fecal incontinence, and pain with intercourse that may be occurring, and pressure on your pelvic floor happening in your day to day activities.
After taking your history, your PT will complete an orthopedic assessment including how your ribcage is moving, if you have tightness or weakness in your hips, how your back is moving overall, and how you move through different motions. This is a great way for your PT to see how you are using your body, and if they need to address movement patterns which may be contributing to your prolapse.
The next step in a pelvic floor evaluation is an actual muscle assessment of the pelvic floor. The pelvic floor is checked to see if you are able to elevate or contract your pelvic floor muscles, and if you are able to let go of tension in your pelvic floor. The PT will check muscles both on the outside (the vulva) of your body, and the inside (through your vagina and/or rectum) to see how the muscles are functioning and if you are experiencing any pain.
After the pelvic floor muscle assessment is finished, your PT will talk with you to build your individual plan of care, which can include working on letting go of tension in the pelvic floor, safely managing pressure that goes onto the pelvic floor, and potentially strengthening your pelvic floor. Physical therapy working on decreasing tension in the pelvic floor with a goal of allowing the prolapsing organs to have room to be supported within the pelvis has started to show significant promise in research for reducing prolapse symptoms in women, according to the Journal of Women’s Health Physical Therapy.
While being diagnosed with pelvic organ prolapse can be a very unsettling event, know that surgery for organ support is not your only option. Pelvic floor physical therapy can be a very effective way to safely reduce your prolapse symptoms. And, if you have had prolapse surgery, you may want to consider pelvic floor physical therapy to learn how to manage pressure that goes on your pelvic floor and reduce risks of further prolapse.
At Barbelle Pelvic Rehab, we are here to support you as you learn about managing your prolapse and learning how to live well with reduced pelvic floor symptoms.
Citation:
American Journal of Obstetrics & Gynecology (AM J OBSTET GYNECOL), Jun2002; 186(6): 1160-1166. (7p)
Journal of Women’s Health Physical Therapy 45(3):p 135-142, July/September 2021. | DOI: 10.1097/JWH.0000000000000210
Written by Dr. Cathy
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