Pelvic Organ Prolapse

It is likely that most of us females have never given much thought about the integrity of our vaginas.  However, as a pelvic health physiotherapist, this is one of the main concerns that women have when they come into my office.

What I am talking about is pelvic organ prolapse (POP).  This can be seen in a variety of forms:

  • Anterior vaginal wall prolapse (also known as “bladder prolapse” or “cystocele”)
  • Posterior vaginal wall prolapse (also known as “rectocele”)
  • Uterine prolapse
  • Small intestine prolapse (also known as “enterocele”)
  • Vaginal vault prolapse (sometimes seen after the uterus has been surgically removed)

Symptoms of POP are wide-ranging:

  • Seeing tissues coming out of vagina
  • Problems having intercourse or inserting tampons
  • Feeling heaviness or pressure in vagina or rectum that may worsen with coughing, lifting, standing or as the day progresses
  • Low back pain or lower abdomen/pelvic pain/pressure
  • Urinary incontinence
  • Problems having a bowel movement

What causes POP?

Most people would consider vaginal childbirth as the only risk factor for pelvic organ prolapse.  However, I have seen many patients who have had a cesarean section, or who have never been pregnant, exhibit signs and symptoms of pelvic organ prolapse.  Other such risk factors include:

  • Chronic constipation
  • Persistent, long-standing cough
  • Certain types of connective tissue disorders
  • Genetics – did your mom or other female family member have a prolapse?
  • Repetitive high impact activities that increase intra-abdominal pressure
  • Obesity

What treatments are there?

Depending on the severity of the prolapse there are a number of treatment options.  Yes, surgery is one option but that is typically for significant prolapses.  The good news is there are a number of different surgical methods that are not always complex or invasive.  Pessaries, which are medical devices fit to support the vaginal tissues are also good options for a lot of women.

There is of course Pelvic Health Physiotherapy!

The pelvic health physiotherapist will assess your external and internal parts.  That is, expect the physical exam to include your postural alignment, mobility of your spine, and control of your muscles as well as an internal vaginal and rectal exam.  Internal examination is the gold standard to evaluate the severity of prolapse along with the health of the tissues and muscles on the inside of your pelvis.  Don’t worry, this may sound a little uncomfortable but as health professionals, we are well-trained in doing these exams.  And they need to happen: there is no way to determine what type of prolapse you have if we don’t look.