Making Sense Of Women's Health

Managing Prolapse: What Every Woman Needs to Know

Roberta Bass Season 1 Episode 10

In this episode, Roberta delves into pelvic organ prolapse, exploring its causes, symptoms, and ways to manage it effectively. Whether you're postpartum, menopausal, or dealing with chronic constipation, understanding prolapse and how to improve your pelvic health is crucial. Roberta shares practical advice on pelvic floor exercises, diet adjustments, and other lifestyle changes to manage prolapse symptoms and improve quality of life.

Key Takeaways:

  • Understanding Prolapse: What it is and the different types (cystocele, uterine, rectocele, and vault prolapse).
  • Common Causes: Pregnancy, menopause, constipation, and heavy lifting.
  • Symptoms to Look Out For: Heaviness, bulging, difficulty emptying your bladder or bowels.
  • Management Techniques: Pelvic floor exercises, avoiding heavy lifting, managing constipation, and seeking professional help when necessary.
  • Treatment Options: Pessaries, physiotherapy, and when surgery might be required.

Resources Mentioned:

Join the Conversation:
Continue the discussion in our podcast group: Making Sense of Women’s Health Podcast Community.

Call to Action:
If prolapse symptoms are affecting your life, contact Roberta for a personalised consultation. Visit her website for more information on how physiotherapy can help.

www.thriveandshinewomenswellness.co.uk

Supporting Women's Health Transitions with Education, Physiotherapy, Mentoring, Pilates, and Hypnosis.

Hello and welcome back to Making Sense of Women's Health.
I am Roberta Bass, and I am your host. I am also a women's health physiotherapist, amongst other things, and one of the topics I love talking about is pelvic health. You may have caught my previous episode where I gave you a bit of an overview about pelvic health. One of the ladies in my class was like, "All these things to look forward to," which gave her a bit of a shock. But that doesn't mean you're going to experience all those things.

One of the things I did mention on that podcast was a prolapse—a pelvic organ prolapse to be precise. We're going to dive a little bit deeper into that topic today.

So let's start by talking about what a prolapse is. A pelvic organ prolapse is when the walls of the vagina bulge in, or they can bulge externally, meaning they can be seen outside the body. You can also have a uterine prolapse, where the cervix and the uterus drop down into the vagina. There are different types of prolapses. Along with a uterine prolapse, we can get a front wall prolapse, which is often called an anterior prolapse or cystocele. This is where the bladder (not the whole bladder, but part of it) bulges into the vaginal wall.

People often think that if they've got a bladder prolapse, the whole bladder is coming out, but that’s not the case. A bladder does not fall out. What happens is the organ pushes against the vaginal wall, and you get a bulge because the walls aren't strong enough to support it. This bulge can stay inside but descend downward, or it can come below the entrance of the vagina.

A back wall or posterior prolapse, also known as a rectocele, is when the rectum pushes forwards into the vaginal wall, causing a slight bulging. Again, it can stay inside or bulge out of the entrance. So you've got three different types of prolapses: cystocele, uterine prolapse, or rectocele. You may have one of them, or you could have all of them. Alternatively, you might have a vault prolapse if you've had a hysterectomy and your uterus has been removed.

Why do we get prolapses?
There are various reasons why we might develop a prolapse. One major factor is having a baby. Babies cause many issues throughout their lives, even when they grow up! But when we deliver, particularly vaginally, we are more susceptible to prolapse because everything has been stretched. Even if you've had a C-section and didn’t deliver vaginally, you can still get a prolapse. Just being pregnant and carrying the weight of the baby puts pressure on the pelvic floor and all those structures. And if you went into labor and started pushing, even if you didn’t deliver vaginally, you might still experience a prolapse later on.

You might not have any problems at all after delivery, but they could arise when you hit menopause. I spoke about menopause and all the lovely symptoms we get during that stage. One of those is a lack of oestrogen, which acts like scaffolding for the vagina. When we don't have enough oestrogen, the vaginal walls become laxer, making them more likely to bulge and cause a prolapse. So the classic times we might see a prolapse are after having a baby or during post-menopause.

However, I've treated women who haven’t had a baby and aren’t menopausal, but they have had chronic constipation. This is another major cause of prolapse. If you've struggled to empty your bowels and you're constantly straining, that pressure stretches the pelvic structures, potentially leading to prolapse. So the main risk factors are pregnancy, constipation, and menopause.

Other factors that can worsen or potentially cause a prolapse include being overweight. Similar to pregnancy, the added weight stretches all of the pelvic structures, making everything a little laxer. Heavy lifting is another contributing factor. If you're a weightlifter and not using proper form, or if your job involves a lot of heavy lifting, that downward pressure could cause a prolapse.

Symptoms of a prolapse
One common symptom is a feeling of heaviness, or you might feel or see a bulge. Sometimes, using a mirror, you can see it more clearly, particularly when emptying your bowels. You may struggle to fully empty your bladder or bowels, depending on whether the front or back wall is affected. For example, you might go for a wee, and then a few minutes later, find that you can go again. With a rectocele, you may not fully empty your bowels because the rectum can get caught in a pocket formed by the prolapse. So, even though the rectum should be at a right angle when you sit correctly on the toilet, the prolapse may cause things to get stuck.

You might also experience discomfort during intercourse, as the prolapse creates a bulge in the vagina, making penetration difficult.

How do we improve a prolapse?
There are several things you can do to manage or improve a prolapse. One thing to consider is whether you have a chronic cough, especially if you’re a smoker. Stopping smoking is crucial—not only for general health but also because smoking affects tissue healing and can worsen a prolapse due to constant coughing. Other factors to address are weight loss and avoiding heavy lifting. Lifting correctly and managing pressure within your abdomen is essential.

If you do lift regularly, make sure you're lifting in a way that reduces pressure on the prolapse. It's important to get an assessment, as the severity and type of prolapse will determine the specific guidance. Reducing how much you're lifting or dividing up heavier loads could help. If you're exercising, especially weight training, it might be worth looking into supportive products. A company called EVB Sports has designed shorts and leggings with built-in support to help people exercise with prolapse or incontinence. These products may provide the extra support needed to continue exercising.

Pelvic floor exercises
Strengthening the pelvic floor is key to managing prolapse, but it’s important to ensure that your pelvic floor muscles are functioning correctly. If they’re weak, they need to be strengthened. If they’re overactive, they need to fully relax before being strengthened. I recommend an assessment by a pelvic health physio to ensure you're doing the exercises correctly. Pelvic floor exercises involve starting at the back passage, as if you're stopping wind, and then drawing the contraction forward. Aim to hold for up to 10 seconds, ensuring full relaxation between each contraction.

In addition to pelvic floor exercises, improving your overall core strength is important. This will help offload pressure from the pelvic floor and support the prolapse. Make sure you're exercising in the right way for your body and prolapse type. If you notice an increase in heaviness or bulging during certain exercises, it might be time to stop and reassess.

When to seek help
If you’re struggling with prolapse symptoms, I recommend seeing a women's health physiotherapist. Around 70-80% of women with mild to moderate prolapse improve with physiotherapy. In more severe cases, a pessary might be recommended to support the prolapse internally, allowing you to engage in physiotherapy and lifestyle changes. Surgery is an option for more severe prolapses, but there is a high failure rate if the underlying causes, like constipation or lifting, are not addressed.

If you're experiencing symptoms like heaviness, bulging, difficulty emptying your bladder or bowel, or discomfort during intercourse, it could indicate a prolapse. Hopefully, some of the tips I’ve shared today will help you manage it, but if the prolapse is affecting your day-to-day life, I encourage you to seek a professional assessment.

Conclusion
I hope you found today’s episode informative. If you have any questions or want to continue the conversation, you can join my podcast group—details will be in the show notes. You can also check out my website for information on all the services I offer. Until next time, take care!