Pelvic organ prolapse is a condition in which the pelvic organs( uterus, bladder, and/or rectum), descend or bulge into the vaginal canal. This happens when the muscles and tissues that support the pelvic organs weaken or stretch.
Symptoms:
•Feeling of fullness or pressure in the pelvis,
•a bulge or protrusion from the vaginal opening,
•pain or discomfort during sexual intercours or in general
•constipation
•urinary leaking, or difficulty emptying bladder, can be accompanied by bladder urgency and frequency.
🔸There are several risk factors for pelvic organ prolapse, including age, menopause, childbirth, obesity, chronic constipation, and trauma to the pelvic floor muscles, chronic coughing for very long time.
Treatment:
❗️ Many patients are referred to surgery directly by their medical providers without giving any other options of conservative care including pelvic floor physical therapy or pessary. I think this is a disservice to the patients and failure of medical system. Imagine if you were only offered cesarean as a birthing option! I know apples and oranges but you get my point.
🔸Sadly the guidelines for pelvic organ prolapse have not done a good job with outlining conservative options in details which can literally be life saving and life altering for patients. The only thing they mention about pelvic floor physical therapy is "Pelvic floor exercise " commonly knows as kegels.
🔸It is worth noting that not everyone will benefit from kegels from the get go. Not everyone knows how to do kegels from the get go. Many patients suffer from constipation or pelvic pain and urgency freuquency as secondary symptoms of prolapse and for these patients, kegels actually make symptoms worse.
So here is a step by step approach to prolapse:
Evaluation by a pelvic floor therapist who has experience treating prolapse . I am not trying to pat my back here neither doing a self promotion. Pelvic floor PT has shown grade A evidence for the treatment of prolapse or any other kind of pelvic floor disorder for that matter. Please note that pelvic floor PT does not only mean kegels and hooking up to biofeedback for 30 mins. That is not pelvic floor PT. It's much more than that.
2. Lifestyle changes:
• avoiding straining during bowel or bladder emptying
• foods that are not constipating
• improving posture so that it doesn't put pressure on pelvic floor
•not clenching gluts, pelvic floor or abdomen constantly
•trying to maintain healthy weight
•activity pacing means not doing things past the point of disomcort or symptoms aggravation
3. Support garments or pessary
They help to support the pelvic floor until you strength and learn to work on posture and movement modifications. They also help to avoid stretching the ligaments past the point of their elastic limit. This depends on the severity and factors like comfort, daily movement habits, age, other underlying conditions.
4. Surgery
Surgery done when all other conservative management has failed can be a blessing! It can greatly improve quality of life.
•Surgery for prolapse might involve using mesh. It's important to ask what kind of surgery would it be. FDI has banned the use of mesh for transvaginal mesh but transabdominal is approved. https://www.fda.gov/medical-devices/urogynecologic-surgical-mesh-implants/pelvic-organ-prolapse-pop-surgical-mesh-considerations-and-recommendations
•Ask provider for the recovery time and other factors, and the rate of success for surgery.
Lastly, there is a lot of fear and scare around prolapse. There is a lot of information online but not is accurate and so consider the above things and best the best and informed decision.
