What is a vaginal prolapse?
.…I hear you ask! Vaginal prolapse is a phrase that often instills considerable fear, that’s what it is!
“I quite like my pelvic organs just where they are, thank you”!!
Officially known as ‘pelvic organ prolapse’, a vaginal prolapse is a failure/weakening in the connective tissue that supports your pelvic organs; your bladder, your bowel or your womb. Any three of your pelvic organs can prolapse/come down from their normal position and bulge into the vagina.
Vaginal prolapse is common, particularly postnatal; 50% of women will have a degree of prolapse after birth. But can also commonly become symptomatic around the menopause; again around 50% of ladies will have pelvic organ prolapse.
However despite being common, it is not normal and many things can be done to help.
Symptoms you may have?
A feeling of pressure or heaviness, a feeling of something coming down within the vagina, a feeling that there is something in your vagina, a bulgy feeling, or lower tummy pain.
But your symptoms may or may not be associated with bladder or bowel weakness. In some cases a prolapse can actually mask an underlying weak bladder, by ‘kinking; the tube somewhat. You may have difficulty emptying your bladder or bowel easily or fully. You may have discomfort or a feeling of something being in the way during sex. Or you may have no symptoms at all.
What may make it worse?
The weakened connective tissue that contributes to a prolapse can become further stretched if there is on-going poor support for your pelvic organs during activities which involve the pressure increasing in your belly (known as intra-abdominal pressure). Examples of activities involving pressure are:
Constipation or straining on the toilet
If you need to strain regularly to open your bowels this stretches any weakened tissue further and can make your prolapse worse. Constipation can actually cause a prolapse.
*It is paramount your bowels are emptying easily and regularly if you have a prolapse.*
Coughing and sneezing
These activities will raise your intra-abdominal pressure. If you have a condition that causes you to cough frequently, or maybe you have experienced a recent bad chest infection, these may cause you to develop symptoms of a prolapse. Even hay fever is posing problems to my patients (and me) at present due to repetitive sneezing.
*Very important for managing this issue are your pelvic floor muscles…..we will come back to that more later.*
Poor technique during repetitive or heavy lifting
Lifting is another activity that may cause you to strain/increase pressure in your tummy. This could be lifting your baby, the car seat (particularly awkward!), your toddler, it may be lifting/moving things in the garden. Or for many of my clients, it is lifting in the gym.
*The right type of lifting/loading can be beneficial for improving pelvic muscle control, however if your pelvic muscles are not activating correctly whilst lifting, or your diaphragm (your breathing muscle) is also not working well, then the intra-abdominal pressure caused by lifting can actually make your symptoms worse. Do not fear though – you can return to these activities with the correct advice and progression.*
Pelvic Floor Muscle Problems
If your pelvic floor muscles are not working properly, there will not be sufficient support for your pelvic organs.
For more information on this I have a VLOG discussing the pelvic floor muscles on my facebookpage: https://www.facebook.com/insideoutflintshire/videos/1091872440996004/?t=1
*The only way we can know for certain how your pelvic floor muscles are working is by doing a digital vaginal examination. This is very important when assessing, treating and starting rehabilitation for prolapse. Without it rehabilitation can be in vain*
Can my GP help?
Your GP’s priority is to rule out anything serious. Please see you GP if you are worried about a vaginal lump, or have other problems like pain, bladder irritation, bloating or altered vaginal bleeding, they may consider sending you for further tests.
Unfortunately my feedback from patients is that sometimes after a medical assessment you may be left feeling disheartened having felt there is something wrong, but then being told there isn’t. This can be because a prolapse can look ‘mild’, or may not be visible on a static assessment.
How can a Specialist Physio Help?
As part of our role as specialist pelvic health physiotherapists, we are trained to assess ladies more functionally and we have the luxury of time to assess you in more detail. We always take into account factors such as whether you have been on your feet much that day and whether the appointment is in the morning or the evening. All of these factors could influence how stretched your tissues may be at that time. The time of the month in terms of your menstrual cycle can also have an influence, as can if you have had your bowels open that day, or whether you have been to work or not. During an examination we may ask you to cough, to bear down, or even stand up during the assessment. A prolapse otherwise not visible may then become visible.
What can I do to help?
Pelvic Floor Muscles
We can fully assess your pelvic floor muscles – this is sooo important, as one of the ways you would learn to manage your intra-abdominal pressure is by activating your pelvic floor muscles in a timely and correct way. If there are any problems with your pelvic floor muscle contraction, such as weakness, poor awareness or sensation, tightness, or pain, these factors would need to be addressed prior to you regaining the necessary function to activate your muscles well enough to help with your symptoms.
Bowel and Bladder Advice
We would give advice on managing any bowel problems such as straining or constipation.
We would also screen you for any bladder problems.
We would liaise with your Dr in treating any changes in the skin of your vagina; dryness, thinning or lack of oestrogen within the tissues of the vagina can make things feel worse.
If necessary we can write to your GP regarding onward referral. Mild to moderate prolapse rarely needs a surgical opinion however. Specialised Pelvic Floor physiotherapy is recommended by NICE (The National Institute for Health and Care Excellence) as a first line treatment option. https://www.nice.org.uk/guidance/ng123
We would advise you on how to breathe and how to use your diaphragm to reduce excessive pressure in your tummy during activities or exercises. This is particularly relevant if you enjoy exercising the gym. I have successfully managed vaginal prolapse symptoms and continued to be active at the gym with some small modifications.
Other important muscles – We may advise you on how to strengthen the muscles externally around your pelvis, the gluteal (bum) muscles, adductors (groin) and abdominals (tummy) are of particular importance in helping the pelvic floor work well and training these muscles in the correct way can also help to manage pressure, reduce load and prevent worsening of your prolapse.
Pessaries are something you would insert into your vagina to support the vaginal walls, either by yourself, or by a trained medical professional. Unfortunately the consideration of the benefits of a pessary is often not at the forefront of a medical professionals mind. However we now know through research that supporting the weakened vaginal walls, whilst you are rehabilitating the muscles or recovering from surgery/having a baby/losing weight/managing you bowel problems, can actually prevent worsening and even help resolve prolapse symptoms. Some ladies with more long-term pelvic floor muscle problems use a pessary for exercise or sport and then remove it afterwards, managing their problem effectively and avoiding the need for any risky surgical procedures. I have used a pessary for exercise and know many colleagues who do the same.
Speak up for your vagina!
I am very passionate about empowering ladies to ask the right questions, not to put up with these symptoms in silence and speak up during any exercise classes or training if you feel pressure/heaviness down below.
You are your own expert; you can help to improve awareness about pelvic floor problems and the importance of pelvic floor safe exercise.
If you would like information about classes taught by instructors that are knowledgeable about the pelvic floor, please get in touch.
Alternatively, please contact me if you:
would like a confidential chat.
an assessment prior to returning to exercise.
advice after having your baby.
or just to talk through your symptoms.
Specialist Pelvic Health Physiotherapist
Email – firstname.lastname@example.org
Web – www.georginabailey.co.uk
Facebook – www.facebook.com/georginabaileyphysio