What is prolapse? 

PhysioDynamics  offers answers to the following questions you may ask.

What is prolapse?

The pelvic floor consists of a sheet of muscles, tissue and ligaments that supports the organs filling your pelvic cavity: bladder, uterus, colon and small intestine. If these supporting tissues stretch or weaken, some of the internal organs may sink lower in the body. Prolapse occurs when an organ collapses or slips out of position. The collapsed organ appears as a soft bulge of tissue that protrudes through the vaginal opening. While this bulge may not be noticeable in mild cases, in moderate and severe ones it can be uncomfortable, although rarely painful.

Types of prolapse and typical symptoms:

• Prolapsed bladder (cystocele): may lead to urinary frequency, urgency, retention, and incontinence. This can make emptying your bladder difficult, and lead to bladder infections.
• Prolapsed uterus (uterocele): may lead to a feeling of fullness or pressure in your pelvis (like sitting on a small ball), low back pain, and painful sexual intercourse.
• Prolapsed rectum (rectocele): makes bowel movements difficult to the point that it becomes necessary to push on the inside of your vagina to empty your bowel.
• Prolapsed small bowel portion (enterocele): a pulling sensation in your pelvis and backache when standing, relieved when you lie down.

What Causes Prolapse?

Many factors can cause prolapse including genetics; repeated increased pressure in the abdomen (typically caused by chronic cough, straining withconstipation, or heavy weight lifting); childbirth; nerve damage; aging; pelvic surgeries or trauma; obesity; hormones; and medications. Caucasian women are more commonly affected than African Americans or Asians.

When to See a Physician

If you notice a prominent bulge of tissue protruding from the vagina, or have difficulty urinating or defecating, surgery may be necessary. While the benefits of this type of surgery can last for many years, there is a possible risk of recurrence. Women who do not elect surgery or are poor candidates for it may opt to wear a supportive device called a pessary in the vaginal canal which can be used temporarily or permanently. However, in cases of severe prolapse, a pessary may not work.

When to See a Physical Therapist

For women with mild or moderate prolapse, non-surgical treatments (such as using a pessary) along with lifestyle changes and Kegel exercises are often effective. You can strengthen your pelvic muscles by performing Kegel exercises which help the pelvic diaphragm to provide support. A Kegel exercise program is most successful when taught by a physical therapist and followed up with regular visits to check the progress of your muscle strength.

PhysioDynamics' Approach to Treatment

We can teach you how to isolate and exercise your pelvic muscles as well as go about your daily activities without putting extra stress on the prolapsed area. We may provide bladder and bowel re-training, such as learning how not to strain, or suggest ways to protect the pelvic floor during activities that increase abdominal pressure. We can also treat any related musculo-skeletal issues and recommend core strengthening exercises, weight control and fitness training. In addition to providing a comprehensive home exercise program, we may use biofeedback and electrical stimulation technologies to help you achieve better control. If you are recovering from prolapse surgery, we can help you heal faster and teach you prevention techniques that reduce the chance of recurrence.

Pelvic Health

To maintain a healthy pelvic floor:

• Lose weight
• Prevent constipation
• Treat a chronic cough
• Quit smoking
• Avoid heavy lifting
• Perform Kegel exercises (below)

Kegel Exercises

Kegel exercises are designed to strengthen your pelvic floor muscles and can help prevent prolapse or stop an existing condition from getting worse.However, they cannot cure prolapse. Before doing the exercises described below, make sure that the prolapsed organ is pushed up well into the vagina. These subtle internal exercises are most effective when they become habitual. Woven into the activities of daily life, these motions can be performed every time you urinate, laugh, cough, sneeze, blow your nose, lift something or change position. They can be done anywhere, anytime, even in public while walking, climbing steps, or running!

A good way to perform Kegel exercises (if you have not yet been tested by a physical therapist to make sure that you are doing them properly) is by visualization. Visualization prepares the muscles to act.  While doing the exercises visualize:

• “Stopping the flow of urine”
• “Closing off the vagina and lifting up a marble inside”
• “Stopping yourself from passing gas"

Do it quickly repeating it 5-10 times. Then do it slowly holding the contraction for 5-7 seconds, relaxing for 10 seconds and repeating it for 5-10 times. Do them often during the day or at least 2 times a day. Before and while doing any activity visualize “closing off the vagina”, this increases the tension in those muscle and provide extra support to your prolapse and in your perineum.

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