Pelvic Organ Prolapse: Build a Better House

Ladies, you’ve just completed the most athletic endeavor of your entire life (or really the most physically demanding experience that any human can endure): you’ve been pregnant for many months and then gave birth or had a c-section in order to finally hold your baby(ies) in your arms. Let’s just say that during that process things have stretched, moved, wiggled, accommodated, and now everything feels a little (a lot?) different. One of the more interesting (and quite frankly, alarming) things that can occur after pregnancy (particularly after childbirth) is called pelvic organ prolapse (POP).

What the heck is that? >>> The vagina, uterus, bladder, urethra, and rectum are all considered pelvic organs and they are held in place by the pelvic floor muscles as well as layers of connective tissue (fascia, ligaments, etc). Pelvic organ prolapse is defined as the descent of one or more of the pelvic organs: the bladder into the front vaginal wall (cystocele), the rectum into the back vaginal wall (rectocele), the uterus or cervix into the vaginal canal, or the apex of the vagina into the vaginal canal. Now you can see why this sounds so alarming! Many women first discover they have a prolapse when they feel vaginal bulging (“I felt this strange thing in the shower…”) and pelvic pressure (“it feels like I am sitting on an egg!”). Not all prolapses are created equal, as there are varying degrees of severity depending on the organ that is descending as well as the distance it descends.

What are the symptoms & risk factors? >>> • Palpable bulge, lump • Perception of something “falling out” • Pelvic pressure, lower back pain • Urinary incontinence • Difficulties fully emptying the bladder or rectum • Bleeding/discharge • Difficult evacuation of the rectum, splinting • Fecal incontinence • Sexual dysfunction (ie laxity, obstruction or pain/sensation change) •

Symptoms usually increase during the day with gravity-dependent positioning and are relieved with lying down. Common risk factors include vaginal childbirth, chronic constipation, obesity, occupations or workout routines entailing heavy lifting, previous hysterectomy, and advancing age & menopause.

Doesn’t sound super fun, does it?! But not to worry, as I always say, there’s help for that. Pelvic organ prolapse is quite common (and treatable), as it’s been found that as much as 50% of parous women have some variation or degree of POP.

Life doesn’t stop for POP, and so with pelvic floor PT, specific exercises, and lifestyle modifications, we can change and manage this condition. One thing we do is build a better house for those pelvic organs to live in. The pelvic floor muscles (ie, the house’s foundation) are key in supporting the pelvic organs; however, we need to consider the whole house in order to effectively reduce the symptoms associated with POP. In other words, the floor & foundation are important, but so are the walls (in this case, deeper core muscles) and the roof (the beloved abdominal diaphragm). When we use our core muscles, diaphragm, and the the whole canister, we reduce the downward pressure on the pelvic organs and pelvic floor. Usually this downward pressure stems from improper breathing (ie, holding the breath) or even over-engaging the core muscles (if you squeeze a tube of toothpaste too hard, where does the toothpaste go?). Learning how to breathe and touch base with the pelvic floor muscles are hallmarks in pelvic floor PT. Not only does diaphragmatic breathing help reduce the load on the pelvic organs, but it naturally coordinates with the pelvic floor and the deeper core muscles in order to protect what mother nature has set up for us.

Next time you lift that laundry basket, try the Blow Before You Go (BBYG) technique (this is coined from the ever-wonderful Julie Wiebe). In other words, start an exhale before you start the task at hand. It goes something like this: Inhale through the nose, allowing the belly to gentle and slowly expand. Exhale through pursed-lips (as if you’re blowing a pinwheel to make it move) and lift the laundry basket while at the same time allowing the belly to gently decompress while air gets slowly expelled from the lungs and out through the lips (if you’re able, you can contract your pelvic floor with the exhale, but this takes practice). Don’t worry if you don’t perfect it upon your first try. Coordinating the exhale with effort takes time, practice, and patience.

If you think your’re struggling with symptoms associated with pelvic organ prolapse, bring a pelvic floor PT onto your team and you won’t regret it!

Published by kacannon

Kelsea Cannon, PT, DPT, PRPC is a physical therapist and pelvic health specialist who feels passionate about helping women restore wellness and balance in their lives. Her dedication lies in merging her comprehensive orthopedic, pelvic health, and Pilates expertise to manage pregnancy-related concerns, such as pelvic & low back pain, pelvic organ prolapse, urinary incontinence, diastasis recti, c-section scars, painful intercourse, and bowel dysfunction. She promotes an interdisciplinary approach and is a believer in helping women establish their ‘dream team’ of care providers. Her main goal is to support and inspire women using an integrative approach to help them be successful in reaching their personal health and wellness goals.

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