There are a lot of things around pregnancy and postpartum that women believe are just normal or the way that things are from now on but it’s important to realize that with the right rehab and information women can “have their life back” so to speak. Pelvic organ prolapse is one of these things for some women. It’s not something that is often talked about but I believe that it’s important for women to know what it is and that it can be managed with the proper information.
Pelvic organ prolapse is a condition in which the organs of the pelvis (most often the bladder, rectum or uterus) descend toward the opening of the vagina. This occurs due to a decrease in strength and support from the pelvic floor muscles, fascia and ligaments. This condition most often occurs during pregnancy and childbirth as the weight of a growing baby places a greater load on the muscles of the pelvic floor and its associated connective tissue. However these are not the only causes of pelvic organ prolapse, anything that increases pressure in the abdomen significantly can increase the likelihood of developing pelvic organ prolapse.
The type of prolapse is determined by the area/organ that is affected. Cystocele prolapse involves the anterior wall and is associated with bladder prolapse. Rectocele involves the posterior wall and associated with rectum prolapse. These are the most common types of pelvic organ prolapse. Some women may also experience uterine prolapse in which the uterus is descending toward the vaginal canal.
Pelvic organ prolapse is usually evaluated on a grading system, however the grade of prolapse is not indicative of symptoms one may experience. The location of descent is used to help determine the grade of the prolapse
- Grade 1 – descent is less than 1 cm above the hymen
- Grade 2 – descent is 1 cm above or below the hymen
- Grade 3 – descent is less than 1 cm below the hymen
- Grade 4 – complete eversion
To most accurately assess the prolapse the exam should be completed in a position that best demonstrates the prolapse. For some women this may be standing positions, during coughing or during exercise. It’s also important to note that the grade of a prolapse does not necessarily indicate that an individual will experience symptoms and many women are asymptomatic with some degree of pelvic organ prolapse.
Symptoms of prolapse can include;
- Feeling or seeing a bulge or lump in the perineum
- A sensation that something is “falling out” of the vagina
- Heaviness or pressure in the pelvis
- Incontinuence or difficulty with urination or defecation
- A feeling of incomplete emptying of the bladder or bowel
- Lack of sensation or painful vaginal penetration
- Difficulty retaining a tampon
If you are experiencing any of the above symptoms seek out a pelvic health physiotherapist. They can help you start on your healing journey and discuss a range of options for managing your prolapse symptoms including both exercise and non-exercise management options.
Some women will experience worse symptoms during exercise, but it is not necessary to stop exercising altogether because of it. The first step is working with a pelvic floor physiotherapist and layering that with a pre/post natal certified coach is ideal. Be sure to communicate with your trainer if you find there are certain exercises that worsen your prolapse symptoms. These exercises will vary from one person to the next which is why working with a physiotherapist and a coach is ideal but some movements that are likely to lead to increased symptoms include;
- High impact exercises (including running and jumping)
- Heavily loaded exercises that may cause bearing down
- Intense “ab” focused exercises
- Wider stance exercises (especially when loaded)
When exercising, it’s ideal to train in a variety of positions that are not all standing. These positions may include lying down, side lying, quadruped, kneeling, half-kneeling and seated. Standing positions will result in more gravity acting on the body as a whole so seated or lying positions may be more comfortable for some exercises. If you are experiencing symptoms in one position ensure your coach knows. Almost every exercise that a trainer can throw at you has some alternative. If you find that an exercise isn’t working for you or is aggravating your symptoms tell your coach. We want to check in with form but we can also change the load or the exercise altogether if need be.
Other things that can help to manage prolapse symptoms include resting when needed, ensuring we are using a ribs over pelvis position while connecting with our pelvic floor, wearing good shoes to support your feet and avoiding clenching your butt (this usually increases tension in your pelvic floor as well).
The aim is to remove the stigma and ensure that clients know that prolapse symptoms are something that many women experience. They should not feel ashamed of these symptoms and should reach out to a pelvic health physiotherapist as well as an educated coach to help manage symptoms. There are many things that can help improve your prolapse symptoms and you should not have to avoid exercise to make that happen.
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