Prolapse
I was unsure whether to put a section in specifically on prolapse as, obviously, not all incontinence is related to a pelvic organ prolapse and not everyone who has a prolapse will have incontinence. Then after an internal debate with myself I thought that, yes, it was worthwhile!
If you know you have a prolapse then you will already have had an examination by your GP and presumably are on a healthcare pathway to resolve the situation therefore this section is more for information than anything else but hopefully you will learn something from it.
All the pelvic floor recruitment and activation exercises in the presentation section will be of benefit. Then, once you have worked with these, I sincerely hope that you feel stronger and have more confidence in the ability of the muscles to start providing some support to the pelvic organs.
So basically a prolapse is the pelvic floor organs descending due to the muscles, ligaments and fascia being unable to provide support. This can be due to weak or damaged tissue or too much fascial tension pulling on particular structures and thus altering the integrity of the pelvic floor to do its job. There are several potential reasons for this and you will find a more complete list in the presentation however here are some directly connected to increasing the chances of a prolapse :
- Vaginal childbirth (number and size of babies can increase risk)
- Menopause
- Chronic cough
- Obesity
- Lipoedema
- Age
- Heavy lifting (children, work or sport)
- Medical conditions (such as Hypermobility, Ehers-Danos Syndrome or Marfan Syndrome)
- Chronic constipation
- Surgery
These are the types of prolapse. For those with a vagina you can get all of these, for those with a penis it will be a rectal prolapse.
CYSTOCELE
Bladder moves down into anterior (front) wall of the vagina
RECTOCELE
Herniation or bulge at the anterior (front) wall of the rectum and the lower portion of the bowel moves down into the posterior (back) wall of the vagina
UTERINE/WOMB
Uterus and cervix move down into the vagina
ENTEROCELE
Vaginal hernia whereby a section of the small bowel moves into the space between the back of the vagina and the front of the rectum. Following hysterectomy there can be a situation whereby the small bowel can move into the space behind the bladder and in front of the vagina
RECTAL
Lower part of the bowel or rectum moves downwards towards the anus
There is a rating system for prolapse
STAGE 1
No awareness as no symptoms are showing. A routine pelvic examination by your GP for another reason may be the first indication that it has happened.
STAGE 2
As Stage 1, there may be no symptoms. However, some people will experience a dragging or heavy sensation. It could also manifest as lower back or abdominal discomfort. Possibly pain during intercourse.
STAGE 3
Symptoms from stage 2 plus there may be some physical changes which start to become apparent. There may be a small bulge within the vagina which can be felt. Some continence issues begin – urgency or stress incontinence – and there can be pelvic pain. For rectal prolapse this could include constipation or bowel leakage.
STAGE 4
Symptoms from stage 3 plus there may be additional pain and organs visibly protruding.
If the prolapse is not too advanced it can be made more manageable or even resolve with conservative treatment such as :
- Weight loss/weight maintenance if possible
- Avoiding heavy lifting
- Avoiding constipation or treating it quickly
- Pelvic floor re-training
What is available from health service
Medication – oestrogen may be introduced to improve the hormone level as too little oestrogen can weaken the muscles of the pelvic floor as well as contributing to vaginal dryness. This can be taken orally or as a vaginal cream. Oestrogen is not suitable for everyone and this would obviously be discussed with your GP.
Physiotherapy – will use the exercises we are already looking at here to enhance the ability of the pelvic floor to support the organs. May also use biofeedback devices which monitor and analysis the strength of the muscle contractions to assist in finding the correct way to perform the exercises.
Pessaries – silicone or plastic device which is placed inside the vagina to give support to organs.
Surgery – to secure connective tissue between structures to provide support for the organs. The type of prolapse will determine the surgery required. Weakened tissue is not “fixed” by this procedure but it does improve the tissue bulge. Another repair may be required in the future if lifestyle and exercise changes are not implemented.