Pelvic Organ Prolapse
Pelvic organ prolapse is a subjective disorder described as an annoying protrusion (bulge) at or near the vaginal opening, which may or may not be accompanied by perineal pressure (pressure between your vagina and anus) which is aggravated by standing, and relieved by lying down.
Some women have significant pelvic organ prolapse, but don't know it as it is often asymptomatic, and is usually not associated with pain.
Additional symptoms include urine retention and altered bowel function - sometimes this results in a feeling of being unable to fully empty your bowels.
Pelvic Organ Prolapse is a functional AND structural problem, and needs to be treated functionally as well as structurally for optimal outcomes. Many women respond to conservative strategies including postural correction, constipation management, toileting positions, and advice regarding rest positions. In mild to moderate cases, pelvic floor exercise can reverse the problems associated with prolapse. In some cases a well-fitted pessary (fitted by a gynecologist) may also be helpful. Most surgeons would agree that surgical correction of a prolapse should be the last resort - but it is certainly a good option for some women.
Symptoms of prolapse include:
- Sensation of heaviness in the vagina or rectum
- Difficulty initiating the urine flow
- Need to strain to have a bowel movement or urinate
- Discomfort during intercourse
- Sensation of everything falling down inside, and
- Constipation
Like many medical disorders, prolapse has had some changes in terminology in recent years. An anterior vaginal wall prolapse (cystocele) refers to descent of the bladder. Posterior vaginal wall prolapse (rectocele) refers to prolapse of the rectum. Urethrocele refers to prolapse of the urethra. Uterine prolapse refers to descent of the uterus. When the top of the vagina prolapses after a hysterectomy it is known as vaginal vault prolapse and can also lead to enterocele which refers to prolapse of the intestines.
You should be evaluated by your family doctor, gynecologist, or pelvic health physiotherapist if you suspect that you have a prolapse. Most prolapses can be treated conservatively through exercise, management of intra-abdominal pressure/ abdominal muscle imbalances, lifestyle modification and/or pessaries. Surgery is necessary in some cases.
