June is Pelvic Organ Prolapse Awareness Month. Pelvic Organ Prolapse (or POP) is a common condition affecting 1 in 2 women worldwide. It can be be scary, embarrassing and debilitating. Many women I see who have been diagnosed with a POP, or have a sense they have one, stop doing many things in their daily life, including exercise and hobbies they love (gardening, etc) for fear of making the prolapse worse.
What is POP?
POP is when one or more organs ( bladder, uterus or rectum) shift out of their normal positions into the vaginal canal due to connective tissue laxity and a weakening of the pelvic floor muscles.
What Causes POP?
Vaginal childbirth and menopause are the two leading causes of pelvic organ prolapse. Chronic coughing, heavy lifting, abdominal surgeries and chronic constipation can also be factors, as well as your genes. If you have hyper-mobility (i.e. “double jointed”, Ehlers Danlos Syndrome).
What are the Symptoms of POP?
Some women experience no symptoms at all, however symptoms can be subtle or seem unrelated to your pelvic floor. POP symptoms can include:
A feeling of heaviness or pressure in the vagina that worsens throughout the day
Feeling different “down there”
- Feeling like you are “sitting on a golf ball”
Extra tissue in the vaginal opening
Unable to insert or keep a tampon in place
Needing to use a finger to splint near or in the vagina during a bowel movement
- Low Back Pain
What is the Treatment for POP?
After a search online or a visit with an gynecologist, many women think their only option is surgery. In the majority of cases, this is just not true. There are different degrees of POP, and many can be treated with pelvic floor physical therapy. Research supports pelvic floor physical therapy for successful treatment for POP and is more than just kegels. A physical therapist will educate you on safe movements, guide you on doing the activities you love without fear of making your POP worse, and help to coordinate your pelvic floor with the rest of your body, especially with functional movement patterns (correct lifting techniques).
In some cases, surgery is recommended, but that doesn’t mean you shouldn’t consider physical therapy to prepare you and your pelvic floor before surgery and then rehab after surgery. A third of women who have surgery for POP, will have multiple surgeries. This is due in part to not addressing the root cause of the POP: weakness, breath holding, poor movement strategies, constipation. If you just suspend the prolapsed organ(s) without addressing the behaviors, the success of the surgery will be compromised.
Knowledge is Power
If you suspect you may have POP, get assessed. See you gynecologist, midwife or pelvic floor PT. Once you know what organ is prolapsed and to what degree, you can make a plan going forward. Seek more information or a second opinion if the plan doesn’t sit well with you. There is hope and you can live a full and active life with POP!