This blog will give you some basic information about prolapse and helpful guidelines to follow that may help to reduce some of the symptoms.
In the medical world it is described as “A condition when one or more of the pelvic organs drop from their usual position. It may involve the bladder, bowel or uterus.”
The best way to visualise this is to push your tongue firmly into the side of your cheek and feel the bulge that you’ve made.
A bladder or bowel prolapse produces a very similar type of ‘bulge’ in the wall of your vagina. You may be able to see this yourself at the entrance to your vagina if you take a mirror and have a look. It’s often more noticeable if you cough. Your GP or practice nurse can assess the degree and type of prolapse more accurately by using a speculum.
Really very common indeed! It’s closely associated with childbirth and increasing age but it isn’t something that just happens to older women. Studies show that women in their twenties can present with symptoms.
A massive 40% of women over the age of 50 years have some degree of prolapse of which they may not even be aware!
There are many different symptoms associated with prolapse. It’s very much a silent epidemic with very few women seeking help and advice. Considering the effect it can have on quality of life it’s amazing that the subject doesn’t have a higher profile in the press.
Specific symptoms can give an indication of the type of prolapse you may have;
– You may be able to remember an episode when there was a sudden ‘feeling of something coming down’ or that you noticed a lump or bulge suddenly appear in your vagina. The sensation that a tampon has not been fully inserted is commonly reported.
– Your sex life may be affected and women describe vaginal laxity, reduced sensation and sometimes even vaginal wind. Full penetration may be difficult as there often feels to be a ‘block’. Very commonly women avoid sex as they are self-conscious and say they ‘look different down below’. Not surprisingly all these symptoms can lead onto negative body image and reduced levels of arousal.
– What about your bowel? Do you ever the have the sensation of ‘not completely emptying’. Women often have to support the pelvic floor area to be able to fully empty their bowel. It can be a struggle to control wind and there can be a strong sense of urgency associated with bowel movements.
Women often have a laugh together about the occasional urine leaks on coughing or sneezing. Prolapse problems however are much harder to talk about. Many of the symptoms are so personal and intimate we wouldn’t dream of discussing them with our close friends or even our partners!
A questionnaire commonly used in a clinical setting scores symptoms by asking how often you experience;
A feeling of something coming down from or in your vagina
An uncomfortable feeling in the vagina, which is worse when standing
A heavyness or dragging in the lower tummy
A heavyness/dragging in the low back
A need to push to empty your bladder
A feeling that you bladder has not completely emptied
This score can be used to rate the ‘bothersomeness’ of your symptoms and is a useful tool enabling us to measure any improvement after physiotherapy
– Family link. Unfortunately there is a ‘like mother like daughter’ element with a strong link present between family members.
– Childbirth. Often the 1st vaginal delivery stretches the vaginal tissues and associated ligaments. Subsequent deliveries don’t necessarily make the situation worse until you have your 4th baby. Interestingly having a caesarean section doesn’t necessarily protect you from prolapse. It would appear just being pregnant can be a risk!
– Obesity. Recent evidence shows being over weight is a significant factor in the risk of developing a prolapse. If you have a prolapse then carrying extra weight around is very likely to make it worse.
– Constipation. It makes sense that if you strain at stool on a regular basis you’re going to put extra pressure on your pelvic floor. Excessive straining can have the same stretching effect on the connective tissues and nerves that make up your pelvic floor as bringing baby into the world! This pushing often called a ‘valsalva movement ‘ will increase the downward force on a prolpase
– Heavy lifting at work
– Chronic cough
After that long list of symptoms let’s focus on some good news- To start with we don’t all need to rush off to line ourselves up for surgery!
Prolapse is not always a progressive condition; symptoms can fluctuate and don’t always get worse with age.
Your pelvic floor muscles have a really important role in reducing symptoms. They need to be strong, co-ordinated and able to work with other muscle groups around your pelvis when you stand, move around, cough or lift anything.
Imagine your pelvic floor is like a trampoline with 3 small holes in the base . If your trampoline is firm and toned it will form a good solid base. When you place some small objects onto this trampoline they are going to be supported and won’t bulge down through the holes.
Compare this to a weak thin trampoline – again with the same 3 holes. This type of base is not supportive and cannot move and tighten in response to pressure. The holes will widen and whatever objects are placed on the trampoline are more likely to be pushed down and bulge out.
Your pelvic floor muscles are very like the trampoline base. Effective exercises can build up a solid reactive supportive pelvic floor trampoline!
So although we cannot make your prolapse disappear the evidence shows we can help to reduce your symptoms by improving your pelvic floor strength and encouraging you to take on board lifestyle changes that can reduce the load on your pelvic floor.
2. Under the guidance of a health care professional investigate using electrical stimulation
or biofeedback devices to enable you to rehabilitate weak pelvic floor muscles.
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3. Think about your weight and if you are carrying any extra pounds around make a decision to take up low impact exercise to burn off some calories.
4. Avoid constipation and straining when you have a bowel movement. Eat a balanced diet with adequate fibre content (11-30g a day) and aim for a stool type 4 ( soft, formed and easy to pass) Stay hydrated by drinking around 2 litres of fluid a day
5. If you experience the sensation of incomplete emptying support the pelvic floor area when having a bowel movement. This is a technique commonly used and is called ‘splinting’. It involves applying pressure to either side of the vagina or back passage to assist the passage of stool.
The Femmeze is a device that many women who have a weak back vaginal wall find very helpful. By inserting it gently into your vagina it will give support to the back vaginal wall encouraging better evacuation of stool from the rectum.
6. Avoid repetitive heavy lifting. Think about adapting your activities in simple ways such as using smaller bags when shopping.
For many women it’s best to start with the conservative management described in this blog. Other women find using a pessary helps alleviate symptoms. Your GP, nurse practitioner or gynaecologist can advise and measure for the appropriate device.
Surgery is sometimes indicated. Any time and effort put into pelvic floor rehabilitation prior to surgery is never wasted. In fact many gynaecologists recommend physiotherapy beforehand with the aim of getting your muscles as strong as possible.
The take away message is if you feel that you’re experiencing any prolapse symptoms seek help and advice.
Jane Appleyard Chartered PhysiotherapistThe information on this website is written to give general information and does not in any way replace advice from your G.P. or qualified health care professional. If you have any specific concerns about your health you should seek an individual consultation with your G.P. for diagnosis and advice.