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Pelvic Organ Prolapse – Feeling of “insides”falling out

Updated: Apr 15, 2023


What is pelvic Organ Prolapse?

Pelvic organ prolapse (POP) is the dropping of the pelvic organs caused by the loss of normal support of the vagina. It might occur due to weakness or damage to the normal support of the pelvic floor. The pelvic floor holds up the pelvic organs, including the vagina, cervix, uterus, bladder, urethra, intestines and rectum. If the supportive tissue of the pelvic floor (including muscles and connective tissue) become weakened, stretched, or are torn, the pelvic organs may drop down. Women may feel or see a bulge coming out beyond the opening of their vagina.


RISK for POP?

•Childbirth injuries

•Vaccum or forceps delivery

•Prolonged pushing phase during delivery

•Menopause

•Pelvic floor injuries

•chronic coughing

•Chronic constipation or straining

•Obesity

•Improper Mechanics with Heavy exercises

•Genetics


Symptoms of POP

  • A bulge near the opening of the vagina or have a pressure sensation in their pelvic region and or lower abdomen that worsens by the end of the day or during bowel movements.

  • The feeling of “sitting on a ball.”

  • Discomfort (usually pressure or fullness).

  • Bleeding from the exposed skin that rubs on pads or underwear.

  • Urinary symptoms of leakage, difficulty starting the stream of urine, frequent urinary tract infections.

  • Difficult bowel movements—the need to strain or push on or around the vagina to have a bowel movement.

  • Urinary frequency or the sensation that you are unable to empty the bladder well.

  • Lower back discomfort.

  • The need to lift up the bulging vagina or uterus to start urination.

  • Urinary leakage with intercourse.


“I feel like my insides are falling out”. This is the most common sentence used by patients when they are trying to describe what they feel. They also feel heaviness on their insides with lifting things or standing for a long time. All these feelings are symptoms of something called as Pelvic Organ Prolapse or Pelvic Organ Descent. What this means is that the pelvic organ/s(uterus, bladder or rectum) are descending in to your vaginal canal or out through vaginal opening. It does not mean that it would fall out literally, there is the vaginal wall that supports it and the organ above it. So what you would feel is you do, is the vaginal tissue.

A lot of women push it in with their fingers, some use tampons, some use a support brace, some use pessary fitted by their doctors. But most of these women ‘just live with it’. They compromise their quality of life by sacrificing the things they love or even getting basic things done.


The story that I hear and which is very common and might resonate with you is- a woman would have a feeling of heaviness either after giving birth or after years of giving birth. They would neglect it for time period but then the feeling of heaviness would keep increasing over the period of time. Every time they lift their baby or heavy grocery bags or stand for a long period of time at work or home they have discomfort. So then they would see a obgyn or a urogyn who would give them the most common option which is surgery, some patients might be offered pessary which is a much better option than surgery, duh!(if the doctor is not trained in pessary fitting you might not be given that option). From here on, it can go two ways, either the patients do their own research and find a pelvic PT or else they get surgery, and feel fine for few years and then if the symptoms come back, and have to rethink surgery, they sometimes look for other options and can then in the process find a pelvic pt.

I don’t have anything against surgery, but just as you won’t get a surgery right away if you had weak knees or a problem with your shoulder, you would try other things first, your pelvic floor should be no different.


So why do people, (yes people and not just women because men and children can have prolapse too, anyone with rectum bladder OR uterus) have prolapse? Think of your core as a coco cola can, with the diaphragm at the top, abdominal muscles in front, back muscles and pelvic floor muscles at the bottom. This is a pressure system. So when the can is open it is very easy to crush it, in this case if any of these sides are weak, the pressure will give out from somewhere in the form of prolapse or hernia or disc bulge. Pushing for long periods(more than 2 hours) during natural childbirth can put you at the risk of organ descent. Long term constipation can also lead to prolapse. Chronic coughing can also put you at risk of prolapse. Playing high impact sports for a long period with improper mechanics can put you at risk of prolapse. So now you see that fixing or suturing up just the muscles and tissues cannot cure prolapse. It has to involve training of the whole pressure system and not just pelvic floor. Even if you have to get the surgery, I strongly recommend seeing a pelvic floor physical therapist before and after surgery just like you would see a PT after a knee or shoulder surgery!


Mesh Surgery Stance:


While US is still far from the reporting the complications with Mesh surgeries, UK Canada and Australia have done well in supporting and hearing its people.


Above is the website for more accurate information.




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About Dr. Bhavti Soni 

Founder & CEO, Pelvic Health Specialist

Dr. Soni is a pelvic health expert and has been practicing pelvic physical therapy since 12 years and has been a PT since 15 years. She has extensive education in pelvic health and has been  part of expert panels, global conferences and pelvic health courses where she teaches other Pelvic PTs.  She worked in New York City with leading pelvic pain specialists for 4 years before moving to NJ in 2018 to raise a family and started her own premier Pelvic PT practice. She lives with her husband and 3 year old son.

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