Conservative management of Pelvic Organ Prolapse

What is Pelvic Organ Prolapse?

A pelvic organ prolapse is a systematic descent of a pelvic organ (uterus, cervix, bladder) pushing on the walls of your vagina and/or anus and is observed in 50% of postpartum woman (1,2). Descent of a pelvic organ may occur under various conditions such as laxity of ligaments holding the organ in position, and/or weakness of the pelvic floor musculature. There are various types of prolapse depending on the organ involved. In some cases a woman may present with more than one organ prolapse.

Types of pelvic organ prolapse

1. Cystocele: Bladder prolapse
2. Rectocele: Rectum prolapse
3. Vaginal vault prolapse: Vaginal walls prolapse
4. Uterine prolapse: Uterus prolapse
5. Urethrocele: Urethra (tube that disposes urine) prolapse

Common Symptoms

• Feeling of heaviness
• Increased sensation of the need to urinate
• Constipation
• Difficulty/discomfort with intercourse
• Seeing the uterus/cervix outside of the vagina

Risk factors

A pelvic organ prolapse may result from various conditions.  As a woman ages and progresses through menopause changes in hormone levels, primarily estrogen, increase risk. Childbirth is also a precipitating factor.  Other factors including obesity, constipation, pelvic organ cancers and surgical removal of the uterus may also lead to in a pelvic organ prolapse (2).

What I can do to manage my prolapse at home?

The goal for home management is to reduce the amount of downward pressure or intra abdominal pressure on the organs (1).

Strategies include:

• Correct lifting techniques/lift lighter weights
• Avoiding high impact activities such as running or jumping
• Managing constipation and avoid straining with a bowel movement
• Maintaining weight at a healthy BMI
• Avoid/reducing bladder irritants such as caffeine /citrus fruit

What a physiotherapist can do to help?

A prolapse occurs when the ligaments and musculature surrounding the organ become weak. A physical therapist will help clients strengthening the pelvic floor musculature to essentially lift and support the organ that has begun to descend.
Furthermore, a physical therapist can help to re-educate pelvic floor musculature to naturally coordinate during times of increased intra-abdominal pressure such as coughing, sneezing, and sitting up from a chair (1,2).

Practical tips:

• Practice diaphragmatic breathing
• Urinate regularly
• Eat a balanced diet
• Use a foot stool when having a bowel movement to reduce stress on tissues

Physiotherapy Treatment in Burnaby, B.C.

Blog written by Heather Baker, physiotherapist at Absolute PhysioCare & Sports Rehab in Burnaby BC. She has completed additional coursework in pelvic health and is an advocate for physiotherapy treatment of incontinence.
If you are experiencing any of these symptoms, or have any questions regarding women’s health, feel free to book an appointment at Absolute Physio Care. Call us at 604-558-2273 or get in touch with us online.
References

1. Hagen, S., and Stark, D. (2011). Conservative prevention and management of pelvic organ prolapse in woman: The Cochrane Library.

2. Hagen, S., and Thakar, R. (2015). Conservative management of pelvic organ prolapse: Obstetrics, Gynaecology & Reproductive Medicine, 25(25), 91-95.