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The In's And Out's of Prolapse

It is estimated that 40% of women have some degree of pelvic organ prolapse, and is expected to increase with the aging population. Prolapse is more common with women who have given birth with rates up to 65% after multiple childbirths. But it does also occur in those who haven’t. Often times the initial symptoms of prolapse are extremely scary and seem to appear “out of nowhere.” Many women fear the worst - that organs are going to completely fall out. Most of this fear can be alleviated with an education and understanding of prolapse.

What is a pelvic organ prolapse? It is the descent of one or more organs, from the pelvis into, or in more severe cases out of the vaginal canal. The organs of the pelvic floor have several different support systems: ligamentous, fascia and pelvic floor muscles. The organs are tethered in the pelvis via ligaments. There is also a fascia layer around the organs that acts almost as glue to adhere them to each other. The final support system is the pelvic floor muscles that create support under the organs.

Prolapse can occur to any organ in the pelvis; uterus, rectum, small bowel or most commonly the bladder. When it is diagnosed, the practitioner will stage its severity with a grading system. Grade 1 is a smaller prolapse that remains higher inside the canal. A Grade 2 prolapse comes further down the canal to the opening. Stage 2 and 3 are prolapses that are out of the canal at different degrees. Depending on the support system that is creating the prolapse (ligamentous, fascia or muscle), pelvic floor PT can help to reduce the prolapse by up to 1 grade.




(Image used with permission from Pelvic Guru®, LLC www.pelvicglobal.com)


Symptoms of pelvic floor prolapse are most commonly reported as a pressure or heaviness in the vaginal canal, similar to a tampon that is falling out or not completely inserted. When assessed with a mirror, you may see a bulge at the opening of vagina. Other symptoms can include low back and abdominal pain. Often times, women will feel the symptoms worsening later in the day or with increased activity. This is because gravity and varying movement patterns effect the force through the pelvis. The more that you are upright or straining with activity, the more force is created. When we rest at night, the force is reduced and the prolapse can return to its resting position. This is also where Pelvic Floor PT can play a role in movement patterns and pressure management during activities, and postures to reduce symptoms.


There are many conservative treatment options for pelvic organ prolapse, including pelvic floor PT. Pelvic floor therapist will address breathing patterns and pressure management in abdominals to help reduce downward strain or force. Reviewing proper lifting mechanics and activity modifications will also reduce downward strain. They will identify muscle imbalances and coordination in hip girdle, core and pelvic floor to improve symptoms and help to support pelvic organs. Pelvic floor PT will also help to manage constipation to decrease additional strain to reduce symptoms during voiding. They will teach techniques for splinting, double voiding and provide education on other options such as pessaries.

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