It is a little-known fact that as many as 40% of women will experience some form of pelvic organ prolapse (POP), and 11% will undergo surgery for prolapse or experience incontinence at some point in their lifetime.
The pelvic organs, which include the bladder, vagina, uterus, and bowel, are held in place by the pelvic floor muscles and supporting tissues such as 'fascia' and 'ligaments'. These help to join the pelvic organs to the bony side walls of the pelvis and keep them in place.
Your pelvic floor muscles also work to support the pelvic organs from underneath. If the supporting tissues, are torn or stretched, and the pelvic floor muscles are weak, then the pelvic organs may not be held in their right place.
POP occurs when one of the pelvic organs sags and may bulge or protrude into the vagina.
There are different types of POP, and it is important to have any prolapse properly assessed by a Pelvic Health Physiotherapist.
The most common symptoms of POP are:
the feeling of a lump in the vagina
vaginal heaviness or pressure
difficulty emptying the bladder or bowel
lower back pain
Not surprisingly this can cause embarrassment, anxiety, fear of going out and avoidance of exercise and social situations.
Risk Factors
About half of all women who have had a child have some degree of prolapse, but only one in five women need to seek medical help.
Prolapse can run in families. It is more likely after menopause or if you are overweight, but it can happen in young women right after having a baby.
Prolapse can also happen in women who haven’t had a baby. Causes may include coughing with a chronic lung condition, straining on the toilet e.g., with constipation, or lifting very heavy loads.
The most important thing to do is get help and the sooner the better! Most healthcare practitioners would agree that the prognosis is almost always better the sooner a person seeks help and support.
The main treatment options for women with POP are:
Lifestyle modification
Pelvic floor exercises
Pessaries
Surgery
Pelvic Floor Physiotherapy and POP
POP and incontinence have traditionally been viewed as an older woman’s problem, but this group certainly don’t make up the majority of clientele. Physiotherapists are now seeing much younger women, some soon after childbirth, as well as women in their 40s and 50s. The point is, POP is common and can affect women of all ages, including those who have not had children.
The initial assessment is an important part of the diagnostic process and is thorough. This involves exploring medical and surgical history, current prolapse symptoms and what makes them worse, pregnancy and birth outcomes, and current bladder and bowel function. Then a vaginal examination is undertaken to assess the degree of prolapse and what has prolapsed, e.g., bladder, bowel, or uterus.
A thorough assessment of the pelvic floor muscles is vital because one of their main functions is pelvic organ support. The pelvic floor muscles are hidden, so our examination needs to determine if a woman can contract the muscles correctly, the strength and endurance, and how they behave under any pressure, such as lifting or exercise. Sometimes we also use real time ultrasound, where we can see the prolapse and movement of the pelvic floor muscles.
Can Physiotherapy reduce the need for surgery?
This depends on the degree of prolapse. With mild to moderate prolapse, pelvic floor physiotherapy can help to reduce symptoms and prevent them from getting worse. If the prolapse is more severe, for example, outside the vagina, it is unlikely that muscle training alone can help. The addition of a pessary may be a successful long-term solution, but if that fails, the next option then is usually surgery.
POP is not normal!
These issues are not normal and pelvic floor dysfunction should not hold you back from having a good sex life, being active, playing with your kids and doing things you enjoy. There is a lack of information available to women about POP and it should be known that
a pessary, combined with pelvic floor physiotherapy, can improve quality of life.
Should I consider surgery for POP?
It is important to discuss the non-surgical options first, such as pelvic floor physiotherapy and the use of a pessary. Surgery should be considered when these options are unsuitable or have failed to manage symptoms. Considerations for surgery for POP may include:
How bothered a woman is by the symptoms of a prolapse bulge, i.e., ‘bother score’
The severity of the prolapse
The risks of surgery and what a woman is prepared to accept
The age of the woman and their future fertility plans
Surgical Options for POP
surgery can be approached either from the vagina, the abdomen, or a combination of both. There are numerous surgical options, and all have their pros and cons. Considerations in surgical choice include the type of prolapse, the severity of the prolapse, the desire to preserve childbearing and past medical and surgical history.
For some women, surgery may be the best option, and the benefits may last a lifetime. Conservative treatment options require persistence, ongoing care and regular review which may be difficult for some women. Others may find it challenging to look after a pessary or adhere to pelvic floor muscle exercises. When these have failed to address their symptoms, surgery may be a more suitable option, although with some risks.
Surgery for POP may involve the following risks:
Potential trauma to surrounding organs, such as the bladder, uterus and bowel
Post-operative pain with sexual intercourse
Post-operative stress incontinence
Voiding (urinating) dysfunction
As Seen on The Continence Foundation of Australia.