Pelvic Organ Prolapse: What’s Up?
Over the summer, a close fried of mine called me at 10pm. Now this is a big deal because we both have young children, so if she was calling me at 10pm, it must be something bad.
“Something is wrong,” she said. “I have been feeling this pressure at my
vagina for a little while now. Today when I was showering the pressure was pretty significant and when I touched there I could feel a small bulge.” Well, I mean, that’s the gist of what she said. It’s possible she used some more colourful language. My first thought? Phew – no one is seriously sick or in danger! Then it was easy to provide lots of reassurance, education and help her make a plan for what to do.
Maybe what’s going on here is clear to you, maybe it’s not. My friend was experiencing symptoms of pelvic organ prolapse. Pelvic organ prolapse is a term that is used to describe the feeling of a protrusion or bulge at the opening of the vagina. It may or may not be accompanied by perineal pressure, which would be pressure felt in between your vagina and rectum. Often the pain or pressure is worse while standing and some relief can be obtained by lying down. The degree to which these symptoms bother women varies greatly, but can cause significant distress. Other symptoms can also be associated with pelvic organ prolapse: urinary retention, difficulty initiating urine flow, constipation, pain with intercourse, stress incontinence (involuntary leakage of urine) and straining with bladder/bowel movements.
To understand why this happens, a quick anatomy lesson is in order! The diagram below illustrates the pelvic floor muscles in a woman. You can see how they are supporting the pelvic organs, which are the bladder, uterus and rectum. If these muscles are weakened and are unable to support the organs, the organs can descend and push against the wall of the vagina.
- Cystocele: prolapse of the bladder
- Rectocele: prolapse of the rectum
- Uterine Proplapse: prolapse of the uterus
- Urethral Prolapse: prolapse of the urethra (where urine is expelled)
Of course, my friend wanted to know why this happens. The truth is, there are a lot of things that may cause or increase risk for the development of pelvic organ prolapse. Anything that increases the pressure in the abdomen can contribute to weakening the pelvic floor, like pregnancy and childbirth. We also know that prolapse becomes more common with age, as all muscles in our body tend to weaken.
But now for the most important part – what to do! If you suspect you have pelvic organ prolapse you should be assessed by your family doctor, gynaecologist or pelvic floor physiotherapist. Being told you have a prolapse or experiencing some of these symptoms can be a scary thing. Please take some reassurance in the fact that there are a lot of conservative things you can do to address this. Often managing constipation, making changes to posture and breathing, ensuring proper positioning while toileting and pelvic floor muscle exercises can drastically improve or eliminate symptoms. A pelvic floor physiotherapist is able to help with these strategies, especially providing instruction for pelvic floor muscle exercises. In many cases this involves learning how to strengthen them, so that the pelvic floor is better able to support the pelvic organs. In some instances a pessary can be helpful to manage symptoms. This is a removable device that is inserted into the vagina to help support the organs and prevent them from dropping down. For some people surgery is required and this is decided on a case by case basis with your surgeon, usually after trialing some of these other treatments.
As for my friend? She was assessed by her gynaecologist and diagnosed with a cystocele. She connected with a pelvic health physiotherapist that was local to her and after a few months noticed a big improvement in her symptoms. She is continuing to work on strengthening her pelvic floor and getting back to running symptom free! I hope that if this article resonates with you, this information and story can help inspire you to take the first steps on your journey to finding your solution.
Contact Kaitlyn Boyd for more information at:
735 Wonderland Rd. N. Suite 205
London, ON, N6H 4L1