Pelvic Organ Prolapse Management And Fitting Of Support Pessaries
What Is Prolapse?
Prolapse is a term that describes a common condition where the bladder, bowel or uterus protrudes into the vagina. This can cause the symptoms such as vaginal heaviness or dragging, the sensation of a lump or bulge into the vagina, constipation, difficulty emptying the bladder or bowel, or problems with sexual intercourse.
How Common Is It?
Pelvic organ prolapse is common in women who have had a baby with 50% of women who have had a vaginal delivery experiencing some degree of prolapse. Prolapse is more common with the increasing number of vaginal deliveries and the delivery of larger babies. There are also some genetic factors involved, and it is more common for you to have a prolapse if your mother or sister has one. The symptoms of prolapse are not always related to the degree of prolapse. Some women are very bothered by a small degree of prolapse, and some women are unaware they have a prolapse until they are told by their doctor and are never bothered by their prolapse.
✖ If you have prolapse it is only going to get worse
✖ You just have to live with a prolapse
✖ I am too old to do anything about it
✖ Surgery is the only successful treatment for prolapse
✖ Pelvic floor exercises won’t work for someone like me
✖ Exercise makes prolapse worse
✔ Age is no barrier to improvement
✔ The sooner you seek help the better
✔ Prolapse can be reduced by seeing a pelvic health physiotherapist
✔ Exercise can help prolapse symptoms if performed correctly
✔ Research shows that 6 months of pelvic floor exercises can reduce symptoms of prolapse
Risk factors for prolapse include childbirth, menopause, aging, constipation, being overweight, chronic coughing, heavy lifting, high impact exercise or previous gynecological surgery.
Assessment of Pelvic Organ Prolapse
At Body Logic Physiotherapy our Pelvic Health physiotherapists have completed postgraduate advanced training in the treatment of pelvic organ prolapse.
To understand your problem, it is important to understand the factors that cause your prolapse symptoms and the impact that this has on your life. Our physiotherapists will take a thorough history, screen for factors that could be influencing your problem and establish your goals for treatment.
Following this we will conduct a comprehensive assessment of your condition including assessment of your ability to perform correct pelvic floor muscle contractions.
Assessment of the pelvic floor muscles can be done fully clothed using real-time ultrasound. For a more comprehensive assessment of pelvic floor muscles and pelvic organ prolapse a direct assessment can be performed via a vaginal assessment. This method is recommended for an accurate assessment of the type of prolapse (bladder, bowel or uterus) and degree (1st, 2nd, 3rd degree) of prolapse. The method of assessing your pelvic floor muscles is always your choice and will be thoroughly explained and based on your consent.
Following the assessment, we will explain to you in simple terms the factors that may be impacting on your prolapse symptoms and design a collaborative treatment plan to help you achieve your goals.
Treatment of Prolapse
There is strong evidence that physiotherapy management should be first line therapy for pelvic organ prolapse before surgery is considered. Physiotherapy management includes pelvic floor and abdominal muscle training, and bladder or bowel habit retraining. We can work with you to personalise a program that addresses lifestyle factors such as regular physical activity, sleep, diet and stress management.
Pelvic floor muscle training is an important part of any management program for the management of prolapse. Research has shown that pelvic floor exercises are difficult to perform correctly with up to one third of people performing exercises incorrectly and could be worsening their prolapse and incontinence symptoms.
We recommend a progressive specific pelvic floor and abdominal exercise program and generalised graduated fitness program starting with low impact exercise and building up to increased impact as the muscles strengthen.
Incorporating your pelvic floor exercises into functional daily tasks is an essential as part of a self-management plan and is the key to controlling your symptoms in the long term.
Research has shown that improvements can occur in 3 months, but often a pelvic floor muscle program needs to be continued for 6 months to gain changes in prolapse symptoms.
Your physiotherapist is skilled in non-surgical management of prolapse and will identify additional factors that may need to be modified to optimise improvements and ensure they are maintained. We also work with your doctor if additional care is needed.
Vaginal Support Pessaries
At Body Logic Physiotherapy we have physiotherapists with special training in the assessment and fitting of vaginal support pessaries. A support pessary may assist in the management of prolapse. A ring or cube pessary can be fitted to support the pelvic organs internally and reduce symptoms of prolapse and facilitate pelvic floor muscle training. Support pessaries may be helpful in allowing women with prolapse to be more active and return to activities of daily living and sport (such as running and gym work) without putting further stress on the pelvic organs.
Vaginal support pessaries do not suit all people but may be an option in managing prolapse in conjunction with a pelvic floor muscle-training program. You need to discuss if this is a suitable option for you. We also work with your doctor to care for you if you chose this option.
For any further information around Pelvic Prolapse, or for any other information, get in touch with our friendly team today.