What Is Prolapse and Why Don’t I Know About It?
Many patients come to me with fear and concern when they feel symptoms such as vaginal heaviness or may even see a bulge when they look down there. It can be scary when you’ve never heard of it and don’t understand what is going on! This is why I feel it is important to answer the question “what is prolapse and why didn’t I know about it?”.
I think the old medical model of your doctor deciding when to tell you something versus when to not share information that could potentially illicit fear should quite literally be tossed out the window! With constant access to information (and misinformation!!) at our fingertips, I feel like it is imperative to instead inform our patients, identify possible risk factors, ways to reduce risk and how to manage symptoms if they do develop!
They say knowledge is power and I think having knowledge about your body is vital! So let’s begin answering that question, shall we?
What Is Prolapse?
Pelvic organ prolapse, sometimes referred to as “POP” or simply “prolapse”, is when one of the pelvic organs descends or bulges into or outside the vaginal canal. It can be due to weakened or stretched ligaments or pelvic floor muscles. This can happen with the uterus, bladder or rectum or a combination.
I know, that sounds terrifying! So let me calm your mind a little! Many people that have a stage 1 or 2 prolapse are asymptomatic and it doesn't cause them any issues. Many are typically unaware of what stage of prolapse they have unless someone tells them.
Unfortunately, that isn’t the case for everyone so that is why it is important to know the types, signs and symptoms!
Common symptoms of prolapse may include:
Feeling of vaginal heaviness
Report of something inside the vagina–feels like you have a tampon in when you don’t
Feeling of something falling out
May have difficulties with bowel or bladder (feeling of incomplete emptying stool or bladder, difficulty initiating the stream of urine,
Pain or discomfort during sex
The most common types of Prolapse are:
Uterine Prolapse: Uterus descends
Anterior Vaginal Wall Prolapse: (also referred to as a cystocele) the bladder moves down and backwards and bulges into the anterior wall of the vagina
Posterior Vaginal Wall Prolapse: (also referred to as a rectocele) rectum moves forward and bulges into the posterior wall of the vagina
Just to clarify, this doesn’t mean that the pelvic organs are damaged but rather the fascia and/or the pelvic floor muscles are stretched or weakened causing the prolapse. .
Why Haven’t I Heard about Prolapse?
Oftentimes, providers don’t talk about prolapse unless it is necessary because they are worried about scaring people or “causing a problem that isn’t there”. If a provider tells you that you have a stage 1 prolapse, then you may begin to worry and have unnecessary fear (because a stage 1 prolapse may or may not have been your baseline, stage 1 is often asymptomatic, etc).
This is where I disagree!---I think it is important to identify your individual risks and risk factors of prolapse, teach you about how your body works, breathing techniques, core engagement and all management options!
Also, I think there is a misnomer that it is something that just happens with age. Prolapses are often associated with old women in nursing homes, but the reality is that you can have a prolapse at any age, even in pediatrics (although not near as common!).
So What Can We Do About Prolapse?
Pelvic floor therapy is a non-surgical approach to managing prolapse.
Although we can’t change the facial support to the prolapse, there are many ways pelvic floor therapy can address prolapse:
Exercise Modification
Pelvic Floor Muscle Strengthening
Constipation Management
Core Engagement
Stress Managment
Mobility
Breathing Mechanics
Symptom Relief Strategies
Other Management Options
Some pelvic floor therapists, including myself, are also trained to fit pessaries.
A pessary is also a non-surgical approach to managing pelvic organ prolapse. It is a device that you can insert into the vaginal canal to hold up the pelvic organs, similar to how you would insert a tampon.
There are different kinds of pessaries, depending on your needs. As a pelvic floor therapist with advanced training in prolapse and stress incontinence, I feel confident in fitting pessaries. I am highly trained to assess the pelvic floor muscles, the descent of the pelvic organs and identify which type of pessary would work best for your specific symptoms and goals.
Again, pessaries are often thought of as something that only old ladies get when their bladder or uterus prolapse. However, they can be used postpartum as a tool to reduce prolapse symptoms or the risk of developing more symptoms, for incontinence, as support during exercise or on an as needed basis such as during your period.
I also think empowering women with the knowledge of prolapse and pelvic floor therapy as an alternative to surgery is important. Some patients with more progressed prolapses may need surgery, however, not everyone is a candidate for surgery or even wants to undergo surgery. Surgery shouldn’t be offered as a first line strategy. And I hate to be the one to say it but sometimes, surgery fails! If symptoms can be managed, there isn’t a true need for surgery.
I also believe it’s important to discuss risk factors of prolapse (as well as potential for birth trauma) both prenatally and postpartum so they can make an informed decision about their delivery options, pushing techniques and postpartum care.
I understand that prolapse can be very alarming. Working with a provider can help to calm your fears. This should be someone that can:
explain your symptoms
discuss all of your options
show you how to manage your symptoms
and provide individualized, appropriate treatment
If you're experiencing pelvic organ prolapse, pelvic floor therapy can help! I work with women in Lancaster and Columbus, OH.
You can schedule a discovery call here or take a free questionnaire to learn more about pelvic floor dysfunction symptoms.
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