Pelvic Organ Prolapse: What You Need to Know

Pelvic organ prolapse (POP) is often treated like secret women’s business that few women know or want to talk about until it is far too late. Yet, according to the Continence Foundation of Australia (CFA), one in five Australian women will require medical help for a prolapse during their lifetime.

What Is A Pelvic Organ Prolapse?

Pelvic organ prolapse can occur when a woman’s pelvic floor muscles weaken or supporting ligaments tear, resulting in one or more of the pelvic organs such as the bladder, urethra, uterus, cervix, or rectum and bowel protrudes into the vaginal canal. In major POP instances, tissues can push through the vaginal canal and bulge outside of the body.

Could I Have A Pelvic Organ Prolapse? The Questionnaire

Many women suffering from a pelvic organ prolapse don’t display major symptoms. When women do experience symptoms, they can range from comparatively minor to seriously debilitating.

The most critical issue in dealing with a suspected pelvic organ prolapse is to discuss your symptoms with your doctor. If you experience pelvic, vaginal or rectal symptoms for three months or more, take this simple questionnaire.

Did you experience a difficult labour or have an assisted delivery with either forceps or suction?

• Can you feel tissues bulging from your vagina?
• Are you going through menopause?
• Do you leak urine when you sneeze, cough, laugh or exercise?
• Do you have difficulty with starting urination?
• Do you experience stool leakage?
• Do you suffer from chronic constipation?
• Do you experience chronic coughing?
• Do your tampons come out of place?
• Do you feel pressure in the vagina or rectum?
• Is intercourse painful for you?
• Do you have reduced sensation during sex?

You can use your answers to these questions to start a healing conversation with your GP or women’s physiotherapist in a clinic such as The Brisbane Spine Clinic about Pelvic Organ Prolapse.

Different Forms Of Pelvic Organ Prolapse

There are five primary forms of POP. Pelvic organs may bulge through the front wall of the vagina, through the back vaginal wall or the uterus may actually drop down into the vagina

1. Cystocele (Bladder Prolapse)
Cystocele arises when the vagina’s front wall weakens, resulting in the bladder bulging into the vagina. The urethra also may prolapse into the vagina creating a urethrocele.

2. Enterocele (Small Bowel Prolapse)
An enterocele occurs when the front and back vaginal walls separate, resulting in the small bowel pressing against or bulging into the vagina. This condition is more common following a hysterectomy.

3. Rectocele (Rectum Prolapse)
A rectocele occurs when the rear of the vaginal wall weakens and the rectum presses against or bulges into the vagina. This condition can produce a bulge that is noticeable during a bowel movement.

4. Uterine Prolapse
A uterine prolapse occurs when the ligaments supporting the top of the vagina weaken causing the front and back of the vaginal walls to weaken, producing a prolapse of the uterus. There are 3 stages of this condition:

• First-degree: The bottom part of the uterus enters the vaginal canal
• Second-degree: The uterus enters the lower portion of the vagina
• Third-degree: The uterus protrudes through the vaginal opening

5. Vaginal Vault Prolapse
The uterus helps support the top of the vagina. Following a hysterectomy, the upper section of the vagina may drop toward the vaginal opening. This condition occurs in about 10 per cent of women who have had a hysterectomy.

Common Causes Of Pelvic Organ Prolapse

• Vaginal childbirth: Complications from forceps, suction or big birth weight deliveries
• Menopause: Lower estrogen levels impact the strength, elasticity and density of pelvic floor muscle tissue
• Chronic Constipation: Irritable bowel syndrome, poor diet and exercise impacts regularity, downward pushing compresses pelvic tissues down repetitively
• Chronic coughing: Allergies, bronchitis and smoking, trigger chronic coughing jerking tissues down
• Heavy lifting: Repetitive heavy lifting during weight training or carrying children
• Aggressive exercise: Downward pounding of internal structures while doing aerobics, jogging or running marathons
• Genetics: Genetics can predispose patients to POP
• Neuromuscular diseases: Joint hypermobility and tissue fragility caused by diabetic neuropathy, Ehlers-Danlos Syndrome, MS and Marfan Syndrome.

Potential Treatments

It is preferable to prevent prolapse than try to remedy it! Pelvic floor exercises can keep pelvic floor muscles strong, regardless of age. However, if you’re experiencing symptoms it’s important to have your pelvic floor muscles checked by an expert such as our women’s physiotherapist Ms Jiaming (Caroline) Sui at The Brisbane Spine Clinic in Eight Mile Plains.

The treatment strategy for vaginal prolapse depends on the cause of the condition and the severity of its symptoms. Specialist women’s physiotherapy offers multiple non-surgical treatment options for POP. This reflects the unique needs of the individual patient.

Often women will opt for a combination of two or three treatment options for the best improvement of their symptoms. Non-surgical treatment options include:

• Kegel exercises
• Core and pelvic floor strengthening exercises
• Pessary
• Hormone replacement therapy
• Biofeedback
• Electrical Stimulation
• Support garments and
• Tibial nerve stimulation.

Note: often surgical intervention is required for pelvic organ prolapse. These surgeries include laparoscropic repairs, trans-vaginal repairs and abdominal repairs.
Final Observation

Even today, many women experiencing pelvic floor prolapse symptoms have little understanding of what is happening to their bodies, as they are embarrassed to discuss their symptoms with their doctor or a physiotherapist. However, women’s physiotherapy for pelvic floor/organ prolapse, together with lifestyle changes may help prevent prolapse or keep it from worsening.

*Please note, content within this article is for educational purposes only and treatment and advice mentioned may not be suited for everyone. Please consult a team member at the Brisbane Spine Clinic or your General Practitioner for specific advice.