Whether you’ve just had your first child or you’ve had many, let’s face it, it can be pretty unnerving to suddenly feel a bulge or heaviness in your vagina. I often hear, “It feels like a tampon is coming out all the time”.
Fear not, you may be experiencing something called Pelvic Organ Prolapse (POP). This happens when the muscles, ligaments and tissues of the pelvic floor become too weak and elongated to properly support your pelvic organs. Eventually these organs can press or descend into the vaginal canal.
The 3 most common types of POP are:
- Uterine Prolapse - when the uterus descends down into the vagina
- Cystocele - when the bladder presses against the vaginal canal
- Rectocele - when the rectum presses against the vaginal canal
There are varying degrees of severity of prolapse that range from just pressing in a little bit in less severe cases, to protruding out of the vaginal opening in more severe cases.
POP is commonly seen among women who have given birth. In fact, some degree of prolapse is seen in about 50% of child bearing women. Again, not to worry. This condition is not life threatening but can have a huge effect on your quality of life. There's a lot you can do to help!
Still not sure if what you’re feeling is a prolapse? Here are some other common symptoms of POP:
- Feeling of vaginal or lower abdominal heaviness or pressure
- Vaginal itching or burning
- Urinary incontinence (leaking), increased frequency, or incomplete emptying
- Constipation, straining to pass stool, or incomplete emptying
- Inability to hold gas or stool
- Discomfort or pain with sexual intercourse
The risk of POP increases with delivery of a larger baby (8+ pounds). It also increases with the number of vaginal deliveries. Other things to keep in mind that may increase your risk of POP include aging, menopause, smoking and chronic diseases, especially those that cause chronic coughing due to the repeated increase in intra-abdominal pressure.
Treatment for POP starts with conservative measures such as lifestyle changes and pelvic floor muscle training (PFMT) guided by a physical therapist. PFMT has been shown to diminish prolapse symptoms and their severity.
This is where a pelvic health physical therapist comes in. We can help distinguish what kind of prolapse you have (if not already done by your MD) and then design a treatment program specific to your body, lifestyle and goals.
Treatment programs are case dependent for a whole slew of reasons. The type of POP is important for retraining since we can use gravity and various body positions to assist the organ in returning to its rightful position while we strengthen.
It is also important to consider what is going on concerning the pelvic floor. For example, if you have a weak, elongated pelvic floor with difficulty activating the musculature to even start doing an effective Kegel contraction, you would benefit from biofeedback and steadily progressive, guided exercise specific to the direction of POP. Whereas, someone with seemingly similar symptoms may, in fact, have some parts of the pelvic floor that are weak and elongated, but some muscles that are tight and have trigger points. This person would benefit from first downtraining the pelvic floor to release the trigger points and to restore healthy tissue integrity, followed by uptraining work to regain strength. This may be you if you have tried strengthening exercises (Kegels) but find that your symptoms stay the same or actually worsen.
It is also important to check in with your pelvic health physical therapist to ensure you are performing Kegels correctly. Oftentimes, when someone is having trouble with the mind-body connection, they may think they're contracting, but in fact they're doing the reverse and bulging (as you would do while passing gas or stool). You can check this by using a mirror while doing your Kegels. You should see a closing and gentle drawing-in of the pelvic floor. If you see no movement or a bulge, you are not getting an effective contraction. A qualified PT can help you with this.
As we talk about strengthening and retraining the pelvic floor, it is important to remember that the pelvic floor comprises only a quarter of our deep core. In order for our bodies to fully recover and function optimally, the whole core must be working together as a unit, including the diaphragm, transverse abdominus (deep abdomen) and multifidi (spinal stabilizers). When these muscles function properly, they control the abdominal pressure and promote safe and effective transfer of load from your limbs through your core during physical activities. So, to reiterate, if you have a prolapse, the coordination within your core as a whole is probably dysfunctional, putting you at increased risk for other musculoskeletal injuries.
Retraining starts with a comprehensive assessment. We will examine the alignment of your body, including posture, pelvic alignment, and how your spine and ribs are at rest and during movement. We will look at your breath and how you utilize your diaphragm and core, and how you stabilize your body during activity. And, of course, we will assess your ability to relax the pelvic floor muscles as well as your ability to contract them with endurance and strength. The training program should be tailored to you and your daily activities, whether that be standing, running, lifting a toddler, or pressing a heavy barbell.
Other treatment options available include the use of a mechanical device, such as a pessary, which is inserted into the vagina to give additional support for holding organs in place. This is fitted and administered in your doctor’s office. In severe cases, surgery may be recommended to hold the organs in place. It is important to talk about the pros and cons of surgery with your doctor. It has also been shown that PFMT post surgery can improve pelvic floor strength and decrease urinary symptoms. So, ladies who have already had or are planning on having surgery to correct a severe grade POP, pelvic floor physical therapy applies to you, too! After surgery, it is important to retrain your pelvic floor how to function again so that you get the most benefit out of the surgical procedure.
Check out our Pelvic Health page to learn more about this topic.
Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.
Fonti Y. Giordano R. Cacciatore A. Romano M. La Rosa B. Post partum pelvic floor changes.Department of Obstetrics and Gynecology of S. Bambino Hospital. University of Catania, Italy.
Hagen S. Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2011;12: CD003882.
Rortveir G. Hannestad Y. Association between mode of delivery and pelvic floor dysfunction. Tidsskr Nor Laegeforen. 2014 Oct 14;134(19):1848-52. doi: 10.4045/tidsskr.13.0860. eCollection 2014 Oct 14.