The pelvic organs include the bladder, uterus and the rectum, as well as their pathways to outside: the urethra, the vagina and the anus. These are all held in place by fascia and connective tissues, as well as the pelvic floor muscles underneath. With tearing to the supporting structures or weakness to the pelvic floor muscles, the pelvic organs may move position a little. This can often be seen or felt through the vagina, and known as a prolapse.
What does pelvic organ prolapse mean?
A prolapse can occur to the rectum, uterus or the bladder. They will be diagnosed on how they affect the vaginal wall. If the structures supporting the bladder start to fail, it results in pressure or bulging onto the anterior vaginal wall (cystocele). Similarly the rectum can do the same to the posterior wall (rectocele), and the uterus down into the top of the vagina (uterine prolapse).
Common symptoms:
- Lump or bulging in or outside of the vagina that you can see/feel
- Heaviness or dragging in the vagina
- Lower back pain
- Difficulty emptying your bladder or bowel.
- Pain with sexual intercourse
- Slow urine stream
- Recurring UTI’s
Some of these symptoms can be worse by the end of the day, and may improve after lying down.
Types and stages of prolapse:
Like we discussed earlier, there are the three main types of prolapse involving the rectum, uterus and bladder onto the vaginal wall. Depending on the amount of stretch to the organs will determine the stage. It relates to how much stretch has occurred, and how far that organ has impacted the vagina. The picture below demonstrates this for a uterine prolapse, but the concept is the same for both bladder and rectal prolapses. Sometimes stage and symptoms don’t correspond, and some with higher stage prolapse only have minimal symptoms. Treatment will also be determined by the impact your prolapse has on your day to day function.
Stages of Uterine Prolapse:
What can cause prolapse?
Childbirth and pregnancy:
The stretching of the uterus and extra pressures onto the connective tissue/fascia during pregnancy in combination with pelvic floor muscle stretch and possible tearing can affect the support of the pelvic organs.
Persistent coughing:
Smoking, bronchitis and asthma which cause chronic coughing can increase pressure down onto the pelvic floor muscles regularly and result in slow stretching or the fascia and resultant prolapse of some of the organs.
Chronic constipation and straining:
Recurrent increased pressures again onto the pelvic floor muscles and fascia when trying to empty the bowels can overtime contribute to prolapse.
Genetics:
Unfortunately it is something that can have a genetic component, meaning if your mother has had a prolapse, the chances of you getting one is also high.
Obesity:
The extra weight onto the supporting connective tissues can also result in prolapse in the overweight population, regardless of going through pregnancy and birth.
Ways to prevent prolapse:
Non surgical:
- Pelvic floor muscle training by a trained physiotherapist, nurse or doctor (read more here about pelvic floor muscle activation and exercises).
- Lifestyle changes including dietary changes, fluid intake, exercise and losing weight
- Altering bowel and bladder habits to avoid straining
- Use of a pessary (silicone device that fits into your vagina) to provide internal support for your pelvic organs.
Surgical:
Certain stages of prolapse can require the need for surgery to repair the stretched supporting structures. There are many different types of surgery depending on the cause and type of prolapse. Most commonly we will trial some conservative management to determine if symptoms can be improved as surgery is the last option.
Seeing a physiotherapist involved with women’s health can benefit to minimise the symptoms related to having a prolapse.
Thanks for reading,
Rani