The Role of Physiotherapy in Managing Pelvic Organ Prolapse

Did you know that up to 50% of all women experience Pelvic Organ Prolapse (POP) in their lifetime? Often referred to as ‘prolapse’, it is a very common gynaecological condition. Whilst it is not usually life-threatening, it can significantly affect your quality of life. Typically enjoyable activities may become unpleasant causing discomfort and pain. The good news is you don't have to suffer in silence. POP is treatable, so it’s important to seek help!

What is a Pelvic Organ Prolapse?

POP is the downward movement of one or more of the pelvic organs from their normal position into the vagina. There are several types categorised by the site of descent.

These are:

• Bladder prolapse (Cystocele).

• Rectum prolapse (Rectocele).

• Uterine prolapse.

• Vaginal vault prolapse.

• Urethra prolapse (Urethrocele).

• Small bowel prolapse (Enterocele).

The pelvic organs are held and supported inside the bony pelvis by ligaments and muscles; commonly called the ‘pelvic floor’. The pelvic floor muscles help to support the pelvic organs and control the bladder and bowel to prevent incontinence. When the pelvic floor muscles or the supporting structures become weakened and stretched, it causes the vaginal walls to sink downwards leading to a prolapse.

POP can be mild, causing little or no bother at all, or it may be severe – causing many problems and badly affecting your quality of life.

What are the symptoms of prolapse?

A few common symptoms to look out for:

• The sensation like a tennis ball dropping down between your legs.

• A bulge may be felt inside or outside the vagina.

• Incomplete emptying of bladder or bowels and needing to strain.

• Incontinence.

• Frequent urination.

• Bladder or bowel urgency.

• Urinary retention (unable to urinate when the bladder is full) and/or a Urinary Tract Infection (UTI).

• Difficulty inserting tampons.

• Pain during sex, or feeling something is in the way.

• Backache or abdominal discomfort.

What are the risk factors of pelvic organ prolapse?

• Pregnancy.

• Childbirth; especially if you have had a prolonged second stage of labour, a difficult delivery, a large baby or multiple pregnancies.

• Obesity and being overweight; increase in weight puts extra strain on the supporting structures and may increase the likelihood of prolapse.

• Family History.

• Ageing and Menopause; due to hormonal changes.

• Heavy Lifting.

• Chronic Cough.

• Chronic Constipation.

• Previous Pelvic Surgery.

Female Anatomy and Types of Prolapse

Treatment/Management

Pelvic organ prolapse is not a life threatening condition and this can change with rehabilitation; not all prolapses get worse and some may improve. If you have been told that you have POP, you may have the following choices:

• Do nothing and observe the POP status at regular intervals.

• Be aware that sometimes your symptoms may feel worse whilst you are on you period, after standing for a long time or at the end of a busy day, especially when you have spent a lot of time on your feet.

• Develop good bowel and bladder habbits. Aim to drink around one and a half litres of fluid a day and incorporate fibre into your diet to help you avoid constipation.

• Consider the amount of lifting you do. If something is heavy, it will cause you to strain which can cause increased pressure on your pelvic floor. Ask for help if you do feel yourself straining to lift.

• Increase the vaginal support by improving the strength of your pelvic floor muscles.

• Weight loss has shown to prevent worsening of prolapse symptoms in overweight and obese women.

• Try vaginal pessary which can help to minimise your symptoms and may be a great option for long-term management in the right person.

• Vaginal oestrogen medication may help with some of the symptoms of POP particularly vaginal dryness and milder bladder symptoms such as urgency. Surgery may be appropriate for some women with prolapse, speak to a gynaecologist about the possibility (or option) of surgery.

Pelvic floor physiotherapy, including pelvic floor muscle training, remains a cornerstone in the conservative management of POP. Our Women’s Health Physiotherapist, Suvarna and Georgina, have special training and can complete a full and thorough assessment, look at your body as a whole, how you are moving and breathing - as well as complete a vaginal examination (if needed) with patient consent. They will also be able to provide you with advice, education and exercises to strengthen the pelvic floor muscles, improve muscle coordination, and enhance overall pelvic support. Through evidence-based practices and personalised care, physiotherapists play a pivotal in helping women regain control, confidence and overall wellbeing.

It is important to remember that everybody is different and it is important to be guided by your symptoms and seek help from a specialist if you are unsure on what to do. If you believe you may be suffering from POP and you want more information or want to book in with the team, please contact:

Suvarna at Totley on 0114 235 2727 or via email hellototley@activphysiotherapy.co.uk

Georgina at Hope on 01433 623 602 or via email hellohope@activphysiotherapy.co.uk