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Pelvic Organ Prolapse

I have been getting quite a bit of questions lately regarding prolapse and whether physical therapy can help.  And or course the answer is not a simple yes or no. So I thought this would be a good topic for this blog!  Lets start with the what. 

What is prolapse? 

Simply put it happens with loss of support in the pelvis from ligaments, connective tissues (fascia) and muscles typically as we age, but can be brought on by childbirth, chronic straining (constipation), repetitive heavy lifting through work or exercise. Strain on the fascial system causes a lack of support for the organs of the pelvis: Bladder, Uterus and Rectum.

What you end up with is an organ that has descended and is pressing into the vaginal wall.  This can be completely unnoticed, or you may feel like something is falling out. You may notice you feel it when you wipe after going pee.  Many women feel heaviness in their perineum or vaginal area.  Some feel they are sitting on something.  It is generally not described as painful.  Each type of pelvic organ prolapse is pictured here.  

Bladder prolapse or Cystocele
Rectocele or rectum prolapsing into the vaginal wall (not to be confused with a rectal prolapse which is for a whole different blog!!)
Uterine Prolapse

Let’s Talk Management 

First off if you are experiencing any constipation or straining with bowel movements, this is your number one priority to fix.  This is a big no even when you don’t have prolapse, but very important factor to manage if you do have one.  Constipation issues can vary but there are some basic tips here. 

Second, if you are exercising you need to consider HOW you are exercising to determine if you are further worsening a prolapse.  Think about the abdominal cavity as a tube of toothpaste. Squeeze one end and toothpaste comes out the other.  The open end is the pelvic floor and the toothpaste represents the pelvic organs. If your exercise program causes you to brace with your  abdomen, creating breath holding, or pressure into the pelvic cavity, you are likely worsening your prolapse.

Pick the exercise in question, say a dead lift.  Are you able to breathe throughout the motion?  If you find yourself holding your breath you need to reduce the weight and try again. The same would go for most exercises. However, if you feel you may be struggling with prolapse the following are an absolute no, until you have seen a pelvic PT who can help you work back toward your exercise plan safely. This is NOT a comprehensive list, just ones that I commonly see people doing that they shouldn’t.

NO Crunches
NO Jumping Jacks
NO Jumping or running
NO Plank or side plank
NO Heavy lifting

What you can do are these.

Breathwork and pelvic floor contractions with inverted poses like supported bridge, forward fold, puppy or dolphin pose or down dog. We can easily modify these as well, but they are a good place to work on the bottom of the cannister, the pelvic floor, while giving your organs a break and allowing gravity to help in the process.
Do this daily or several times a day to reduce feelings of heaviness or strain on the system. For a video link click HERE.

If you feel you may be dealing with pelvic organ prolapse, don’t panic! A pelvic floor physical therapist can help diagnose this and help you manage it. There are many tools to manage prolapse from dietary and behavior changes, to the right set of exercises, to pessaries and surgery.

We offer a free 15 minute phone consultation to discuss your symptoms and whether or not pelvic PT is right for you. Click here to schedule your free consultation now!

Sarah is the proud co-owner of Foundational Concepts, Specialty Physical Therapy which opened in March 2013. Sarah lectures at the University of Missouri Department of PT, University of Kansas Departments of PT and Nurse Midwifery, and at Rockhurst University Department of PT. She is board certified in Women’s Health PT and holds certifications in medical therapeutic yoga, lymphedema therapy and dry needling.

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