Pelvic Organ Prolapse: Now What?

One of the biggest fears many of my patients have is whether they have pelvic organ prolapse or not. Spoiler alert: Prolapse is not something to be afraid of! Your life is not over. You will still thrive.

Pelvic organ prolapse is the downward shift of pelvic organs. The most common organs to shift downward are the bladder, bowels, or uterus. Don't worry, your organs aren't going to literally fall out of your body! Prolapse is graded on a 4 point scale with 1 being minimal prolapse and 4 being severe. It can be screened for during a pelvic floor exam by your doctor or a pelvic floor physical therapist.

What causes prolapse?

• Pregnancy: even women that have a C-section can get prolapse, the weight of carrying the baby can push the pelvic organs downward.

• Labor and Delivery: prolapse can be caused by the downward force of delivering a baby vaginally

• Weight Gain: the weight of abdominal fat can shift the pelvic organs

• Chronic Constipation: the constant bearing down to poop can lead to the downward shift of pelvic organs.

• Decreased Estrogen Levels: this can lead to more instability in the tissues of the pelvic region leading to prolapse

• Heavy Weightlifting: this can be caused from holding the breath during heavy lifts, leading to increased pelvic pressure

There can be other causes and sometimes it can be hard to know the cause.

Special note: A lot of people live with some level of prolapse (some studies say up to 50% of people have prolapse). Often it never bothers them, and they never even know they have it.

When is it time to get help?

• If you experience feelings of pelvic region heaviness or bogginess

• If you have difficulty getting all of your urine or poop out

• If you feel self-conscious about changes to this area

• If you feel tissue in your vaginal or rectal region

• If you are leaking urine or gas

• If you have pelvic pain

• If you have a strong urge to urinate

• If you get frequent UTIs

• If you urinate more than 8 times per day

• Any other pelvic health changes

Will it go away if I do kegels everyday?

Kegels SOMETIMES help with prolapse. However, the most effective way to heal prolapse is to get individualized care. Sometimes prolapse can actually be worsened by pelvic floor tension. In this case, doing kegels can actually make the prolapse worse. As another example, you can do all the kegels in the world, but if you are constipated every day, it is going to be quite difficult to get rid of prolapse.

It is important to work with a pelvic floor physical therapist in order to get to the root cause of the prolapse for lasting relief. Pelvic floor physical therapy has shown to be an effective way to treat and manage prolapse. Pelvic floor physical therapists can recommend healthy diet and lifestyle choices to help manage prolapse. In most cases, pelvic floor physical therapy should be the first line of defense before surgery is considered. In most cases, surgery can be avoided.

Author: Dr. Maddy Roth, pelvic floor physical therapist

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