Prevention and Treatment For Pelvic Organ Prolapse
Pelvic organ prolapse occurs when the pelvic organs descend over time with gravity and most women have a degree of organ prolapse. The degree or amount of prolapse is on a continuum with grade I being mild and grade IV being severe prolapse, often requiring surgery. Prolapse of the bladder is known as cystocele. Prolapse of the urethra is known as urethrocele. Uterine prolapse is known as vaginal vault prolapse. Bowel prolapse through the vagina is known as rectocele, whereas a rectal prolapse can occur through the rectum. Often more than one organ has descended.
Pelvic organ prolapse has many causes...pregnancy, childbirth, chronic constipation or coughing, improper lifting and decreasing estrogen levels with age, to name a few. Weakness of the deep core muscles is present in most women with organ prolapse, in addition to pelvic floor dysfunction.
Panic often sets in when a woman discovers or feels something outside of her body when showering. Symptoms can also include urinary leaking or urgency, or the sensation there is an object in the vagina, like a marble or a stuck tampon. Symptoms can vary with some days better than others. Physical therapy is a conservative option for grades I to III. Unfortunately, many women undergo surgery as a first option, which is a risk factor for adhesions and more dysfunction. Patients at our clinic are typically seen 4-5 times for organ prolapse. If the symptoms haven’t resolved within that time frame, I recommend getting an opinion from a surgeon, such as a urogynecologist. However, underlying musculoskeletal dysfunction must be addressed.
Here are my recommendations for both PREVENTING and TREATING pelvic organ prolapse:
Avoid bearing down and holding your breath, especially as a result of constipation. To avoid straining during elimination, open your mouth and say "ah" since all the sphincters communicate. When the esophageal sphincter opens, the rectal sphincter also opens and relaxes.
EXhale with EXertion, which includes lifting during daily tasks such as groceries or weights during exercise. Breathe out through your mouth when lifting any amount. This is one of the reasons I recommend mindful diaphragm breathing on a daily basis.
Use gravity to help restore the position of your organs along with engaging the hip rotators and deep core muscles via PELVIC RESTORATION EXERCISES (see below).
Use your hip rotators to lift the pelvic floor from the sides, much like pulling the ends of a hammock. The obturator internus muscles attach the hips to the pelvic floor.
Stay sexually active, which keeps your pelvic floor muscles healthy and also helps to push the organs back in place. Some women also find it helpful to wear a tampon during exercise, which acts as an orthotic to keep the vaginal wall from collapsing.
Improve deep core muscle activation. The deep core muscles work synergistically (together) to create atmosphere pressure to hold the organs in place. For example, if you put a straw in a cup of liquid and plug the top, the liquid stays in the straw as you pull it out of the water.
Address diastasis recti, if present. See our BLOG to identify if you have a midline split in your abdominal muscles.
Know your limitations; get help with heavy lifting (groceries and laundry baskets) and avoid prolonged periods of time on your feet, especially during menstruation.
I have treated many women with pelvic organ prolapse who have not only been able to avoid surgery, but are empowered in their bodies to help themselves and prevent other problems. I have organ prolapse after having three babies and a lifetime of constipation and straining. Knowing my risks and following the above recommendations, I have been able to manage my symptoms effectively.
PELVIC RESTORATION EXERCISES
BRIDGE POSE with NEUROMUSCULAR BALANCING
Lie on your back with hips elevated on a yoga brick or pillow. Inhale while rotating your toes outward and gently pushing into a theraband for resistance. Exhale while rotating the toes inward and gently squeezing the ball between your knees. Repeat 10 times daily.
BRIDGE WITH BALL SQUEEZE
Lie on your back with knees bent and a pillow or small ball between your knees. Exhale, push your arms into the floor, gently squeeze the ball or pillow and lift your hips off the floor until your body is in a straight line. NOTE: allow for pain-free range of motion only and stop if pain occurs. Repeat 10 times daily.
PILATES POSTURE OF POWER
Lie on your back with heels together, knees straight, glutes squeezed (imagine a pencil between your buttocks), shoulder blades towards your back pockets and chin on a shelf or neck in neutral position. Hold for up to one minute. This can be done several times a day and also in a standing position.
If you have myofascial pelvic pain, limitations in hip mobility or have tried the above recommendations without resolution of symptoms, seeking the help of a women's health physical therapist who specializes in the treatment of organ prolapse is recommended. Restoring hip range of motion is important, in addition to addressing deficits in core muscle function. If the obturator internus muscle is tight or has trigger points, it can drag down the organs, like an anchor. Addressing the hip and entire pelvic girdle is essential for proper support of the pelvic organs. Specialized physical therapy at Healthy Core can help, whether you already have prolapse or are at risk.
Disclaimer: the exercises in this blog are not meant to replace individual medical advice or treatment.