How to Fix Vaginal Prolapse: Top 5 Considerations for Pelvic Organ Prolapse
If you feel symptoms of a vaginal prolapse or have been told that you have one, you may understandably feel scared, overwhelmed, and confused. If you’ve gotten any information at all, you may have been given worst case scenarios, only very invasive treatment options such as surgery, or extremely restrictive advice for how to live your life. And I want to shout it from the rooftops that IT DOESN’T HAVE TO BE THIS WAY!!!!
Pelvic organ prolapse or POP, refers to the shifting of one of the pelvic organs into the vaginal canal. Because of this movement, there becomes a bulge of the vaginal walls that you may see or feel. Other common symptoms associated with vaginal prolapse may include:
Pressure in the lower abdomen
Heaviness or dullness in the pelvic area
Difficulty fully emptying the bladder
Having to push in the vaginal area with your fingers to start or complete urination
Having to push on the vagina or around the rectum to have or complete a bowel movement
When identifying/classifying the type of prolapse you have, we need to take into account which organ is moving as well as how much movement is actually happening.
The three main organs that can prolapse into the vaginal canal include:
Bladder(Cystocele): The bladder can descend toward the vaginal canal from the front
Rectum (Rectocele): The rectum can descend toward the vaginal canal from the back
Uterus or vaginal vault (Apical prolapse): The uterus (or cervix/vaginal cuff if the uterus has been removed) can lower from the top of the vaginal canal
The four stages of prolapse are based on the noted position of the bulge under load, such as the pressure of gravity during upright movements or a bear down motion if you are being assessed while lying on your back. These include:
Stage 1 (Mild Support Change): The lowest part of the bulge is >1cm above the vaginal opening
Stage 2 (At the Opening): The lowest part of the bulge is within 1cm above or below the vaginal opening
Stage 3 (Beyond the Opening): The lowest part of the bulge is >1cm below the vaginal opening
Stage 4 (Maximum Descent): The organ is fully extending beyond the vaginal opening
Now, I’m going to guess that hearing these clinical definitions isn’t yet calming your nerves about potentially having a prolapse, so let’s add some context. First, many people make the reasonable argument that Stage 1 prolapse may be insignificant and within the range of “normal.” After all, our pelvic organs aren’t supposed to be cemented in place, and minor movement with our daily movements and activities may be expected. Additionally, studies actually show that ~40-50% of women have signs of prolapse based on a physical examination and yet only ~3-6% of women have symptoms associated with their prolapse. To me, two main points stand out with this information: Prolapse is pretty darn common and having an objective prolapse does not mean you have to live with symptoms (which is why I’m glad you are reading this blog!)
So what exactly can we do to “fix” a prolapse? One more clarifying conversation first.. “Fix” is a pretty loaded word and if you have a prolapse, you are not broken so don’t need to be fixed! But I understand that you still want answers, so next I’d ask you to reflect on what exactly you want to change. There is a difference between changing the actual organ movement vs. changing the symptoms that are impacting your ability to live and function fully. While many available interventions can help with both, I would argue that living an unlimited, symptom-free life is likely more important to you than an arbitrary measurement done at your vaginal canal. And the good news is that there is a lot you can do to mitigate symptoms and take back control of your life.
Make sure your pelvic floor is strong: Organs are held in place by a combination of connective tissue and ligaments helping to suspend them from above as well as pelvic floor muscle support from below. If there is damage to connective tissue, we have limited ability to change that with conservative treatment. However, bolstering your support system from below can go a long way. Additionally, if you are early postpartum after a vaginal birth, the opening in your pelvic floor muscles is widened. Being mindful to give your body adequate time to recover so that the gap in support lessens is also important to minimize prolapse.
Make sure your pelvic floor has good mobility: This may seem in opposition to having a strong pelvic floor, but we actually need both for good pelvic health. For this reason, I also am not a fan of doing endless kegels, because this can often lead to excess tension in the pelvic floor which can actually worsen prolapse symptoms. There are a few reasons for this. First, the pelvic floor should be suspended from the pelvis in a hammock-like position. With increased tension, the pelvic floor can stay more elevated/flat which moves the area of your vaginal canal that has sensory input closer to your pelvic organs. If you have a mild prolapse higher up in the vaginal canal but then we move the zone of sensation up, you can start feeling symptoms of the prolapse that you wouldn’t normally feel. Additionally, increased tension in the pelvic floor can sometimes put pressure on the nerves traveling through the area. If the nerves are even slightly compromised, it can impact the ability of the pelvic floor muscles to activate well, which can then decrease your pelvic floor strength and support.
Manage the load you place on your pelvic organs: No, I don’t mean limit your activities. In fact, it is one of my biggest pet peeves when people are told they should never lift above 15#, go running, or whatever else they want to do when they have a prolapse diagnosis. What I mean when I say manage the pressure/load put down on your pelvic organs and pelvic floor is that I want you to make sure you are doing whatever activities you are engaging in well. For example, if you are exercising, are you using good form? Are you holding your breath when you move through life? Are you constipated and needing to strain to have a bowel movement? Is your posture directing force downward when it doesn't need to be? These are all things that we can look at to make sure your movements and activities are efficient, coordinated, and supported so that we aren’t exacerbating your prolapse.
Consider a pessary: A pessary is a device that can be inserted vaginally to help support your pelvic organs. They are most often made of medical-grade silicone, are flexible, and should be virtually unfelt while in place. There are multiple types and should be sized to the person. A provider who fits you with a pessary should also ideally be able to check not only that it is comfortable, but that it provides the necessary support and relief during your activities. Pessaries act almost like a sports bra for your internal organs and can be an excellent option to keep you doing the activities that matter to you. Depending on the situation and type of pessary being used, some people keep it inserted for several months at a time, some remove it every day or few days, and some only wear a pessary during exercise or challenging activities. Even for significant stages of prolapse, a pessary can provide the relief that is needed without surgery for many people.
Surgery: For some variations of prolapse and when other options have not provided adequate relief, surgery may be indicated. However, this shouldn’t be the first line of defense in almost all cases. Even if surgery ultimately is the best answer, it is important to address any underlying impairments as mentioned above to have the best chance of success during surgery and minimize risk of prolapse recurrence.
The bottom line is that prolapse is not a one-size-fits-all diagnosis and because of this, there should also not be a one-size-fits-all approach to treatment. In addition, there are many conservative ways to manage a prolapse and surgery should not be viewed as the only or even the best solution. Most importantly, you can still have a full, active life while living with prolapse if you have the proper guidance and support!
If you are located near Richland, WA and worried about pelvic organ prolapse, Tri Cities Pelvic Health provides comprehensive pelvic floor physical therapy including care for vaginal prolapse. We can thoroughly assess your prolapse and all factors that might be contributing to it and help you with your pelvic floor strength, coordination, and loading of the pelvic floor. Plus, we are the only pelvic floor physical therapy clinic in Tri-Cities, WA to provide pessary fitting services. Give us a call or fill out our contact form to get scheduled today and take the first steps in regaining your confidence!