Pelvic Organ Prolapse

So You have a Pelvic Organ Prolapse…Now What?

What is a pelvic organ prolapse?

A pelvic organ prolapse occurs when a pelvic organ in your body such as your bladder, uterus, or bowel drops lower than its anatomical position into the vagina or rectum. Common terms used are cystocele (bladder prolapse), rectocele (rectal prolapse), and enterocele (small bowel prolapse).

What are symptoms of a pelvic organ prolapse?

Patient will come to physical therapy with the diagnosis of pelvic organ prolapse with various complaints such as of pressure in the vaginal or rectal area, feelings of incomplete bladder emptying (needing to double void), feeling like a bowel movement is blocked with needing to splint, and pain in the pelvis and low back. Depending on the severity of the prolapse, patients may see the prolapse outside of their vagina or rectum. Often patients will feel better in gravity reduced positions than they do with prolonged standing. Even having a smaller level 1 defect can cause symptoms of lumbosacral back pain. If the prolapse is severe, you may actually see the affected pelvic organ coming out of your vagina or rectum.

What caused me to get a pelvic organ prolapse?

Pelvic organ prolapse has a variety of causes ranging from childbirth, weak pelvic floor muscles, poor coordination of pelvic floor muscles with activity, post pelvic surgical procedure issues, and even poor exercise habits such as improper breathing techniques with weightlifting that cause a spike in intra- abdominal pressure that increases stress on the pelvic organs.

How can conservative care help a pelvic organ prolapse?

Pessaries can be inserted into the vagina or rectum to help support the pelvic organs, especially during times of exercise. Physical therapy has been proven in the research to improve pelvic organ prolapse symptoms, especially in milder cases. Pelvic floor physical therapists can teach appropriate pelvic floor muscle exercises to improve the coordination and strength of the pelvic floor muscles to support the pelvic organs more efficiently. Pelvic floor physical therapists also can teach you lifestyle modifications to avoid excessive intra-abdominal such as proper lifting mechanics with breath coordination, and postural habits throughout the day. Exercise modifications can be provided to prevent worsening strain on the prolapse and keep you active. Additional strengthening exercises are often provided for the lumbopelvic complex to address any orthopedic considerations causing stress to the pelvic floor muscles.

If I have had a surgical repair to my pelvic organ prolapse, can physical therapy help me?

Any surgery to the body is going to have an effect on the surgical site and the surrounding areas. Often, surgery fixes the problem of the prolapse, but it is still important to address why you got the prolapse in the first place to prevent it from reoccurring and additional problems down the road. There are many surgical options available for repairing a pelvic organ prolapse such as an anterior wall repair or rectopexy, and physical therapy can help post- surgery to optimize your outcomes.