Pelvic Organ Prolapse (POP); Uterine Prolapse, Symptoms, Grading, Risk Factors, Treatment

AUTHOR: DELENA CAAGBAY, BOUNCEREHAB WOMEN’S HEALTH PHYSIOTHERAPIST AT BOUNCEREHAB

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June was pelvic organ prolapse (POP) month and it is a great way to create some awareness and conversation around this condition.  POP is very common especially for women who have had a baby and are menopausal but there are many who may not know they have one [1].

 

It is estimated that 50% of women who have had a baby will have some degree of POP in their lifetime [2]. 

 

A minor prolapse can remain asymptomatic for many years so women may not be aware that some of their activities could be straining their pelvic organs and making the POP worse.

Here’s some great information by the Continence Foundation of Australia explaining what a pelvic organ prolapse is and how to manage it http://www.continence.org.au/pages/prolapse.html

 

What is a Pelvic Organ Prolapse?

A POP or uterine prolapse (UP) is a condition where the uterus, bladder and/or bowel descend or fall into the vagina [3].  This can happen when there is overstretching or damage to the supporting muscles, ligaments and connective tissue [4].

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Here’s a video going through the different types of POP: https://www.youtube.com/watch?v=42MNcDjLsfU

 

The most significant risk factor associated with POP is vaginal delivery including the use of forceps, vacuum and the size of the baby’s head.

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Some other risk factors include [5]:

  • having a chronic cough
  • being obese
  • weak pelvic floor muscles
  • work involving heavy lifting
  • high impact exercise with poor technique
  • chronic constipation or straining to empty bowels

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What are the symptoms of POP?

The most common symptoms of a POP are a feeling of ‘bulging’, ‘dragging’ or ‘heaviness’ between the legs.  Some other symptoms may include pelvic or back pain, urinary or faecal incontinence, difficulty emptying the bladder or bowel and difficulty engaging in sexual activity [6].  These symptoms can really impact a womans quality of life, reducing their ability to socialize, participate in exercise, work and can put strain on personal relationships.

 

You should never put up with these symptoms, as there are many treatment options to help you manage your prolapse”.

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What are the treatment options?

The conservative treatment options include lifestyle advice, pelvic floor muscle exercise and being fitted with a pessary.  When conservative options have failed or are not suitable then surgery can assist those with a moderate POP.

A pessary is usually made out of silicone and comes in various shapes.  The pessary is inserted into the vagina to help support the organs so they can’t fall down.  The pessary can be easily fitted and removed and you can’t feel it once it’s in place.

A women’s health physio can often size and fit one for you or you can be referred to a urogynaecologist.

 

Types of pessaries:

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Pelvic floor muscle exercise has been shown to improve POP symptoms, quality and life and can even reduce the stage of POP [2].

It is important to be sure you are doing your exercises correctly as if you have any downward pressure, this can make the POP worse.  Visiting a women’s health physio is a great way to check you are performing the exercises the right way and they can tailor a program to suit your needs.

Check out our blog : A beginners guide to pelvic floor muscle exercise

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How do we protect and prevent the onset of a POP?

 Women’s Health Physiotherapist or Continence Nurse should assess women who are planning to conceive or who are pregnant.  They can determine if you are able to correctly engage and relax your pelvic floor muscles correctly.  At this time, a tailored pelvic floor muscle exercise program can be implemented.

During pregnancy, you should have a discussion with your obstetrician about your birthing plan to ensure you have considered your options and weighed up any potential risks of POP.

Another good time to assess your pelvic floor muscles is after having a baby.

When you are getting ready to return to exercise, it is a good idea to have your pelvic floor muscles assessed.  A Women’s Health Physiotherapist can develop a personalised exercise plan to help you achieve your fitness goals in a safe way.
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There are a few simple lifestyle tips to keep a healthy pelvic floor:

 

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Where do you go if you suspect you have a POP?

If you have any pelvic symptoms it is important to let your GP or Women’s Health Physiotherapist know.  They can perform an assessment to determine if you have a POP, pelvic floor muscle weakness or if the muscles are too tight.  Some physiotherapists are able to fit a pessary for you to see if this eases your POP symptoms.

A great way to keep a check on your pelvic organs is to ask your GP to test for a POP while having your annual pap smear.  It only takes a few minutes and at the same time they can check the strength and control of your pelvic floor muscles.

While POP is common, there are many options to help manage the symptoms.  It is important you talk with you health provider to discuss the best options for you.  To find your local health provider, you can call the Continence Foundation Helpline on: 1800 33 00 66

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While POP is common, it is never normal and it’s important to ask for help!

If you have questions about your pelvic floor function, book an appointment with Delena our pelvic floor physiotherapist at bounceREHAB today!

For more details on Delena click here.

Our Mums-Dads n Bubs + Pregnancy Pilates classes have been purpose built by our Women’s Health Physiotherapist Delena and Director Physiotherapists (Matt and Paul) so they are health rebatable with your health fund following an initial Physiotherapy assessment: http://www.bouncerehab.com.au/services/clinical-pilates/

BOOK NOW with Delena: http://www2.insidetm2.com.au/bounce

Alternatlively if you have any questions  regarding a specific problem you can call us on 02 9571 7606 or email us in confidence at admin@bouncerehab.com.au

NEXT BLOG COMING SOON: Pilates and Womens Health 

 

REFERENCES

  1. Tegerstedt, G., et al., Prevalence of symptomatic pelvic organ prolapse in a Swedish population. International Urogynecology Journal, 2005. 16(6): p. 497-503.
  2. Braekken, I.H., et al., Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol, 2010. 203(2): p. 170 e1-7.
  3. Bo, K., et al., Evidence-based Physical Therapy for the Pelvic Floor. Bridging science and clinical practice. 2 ed. 2015: Elsevier.
  4. Slieker-ten Hove, M., et al., Pelvic floor muscle function in a general population of women with and without pelvic organ prolapse. International Urogynecology Journal, 2010. 21(3): p. 311-9.
  5. Gutman, R.E., et al., Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms? American Journal of Obstetrics & Gynecology, 2008. 199(6): p. 683.e1-7.
  6. Jelovsek, J.E., C. Maher, and M.D. Barber, Pelvic organ prolapse. Lancet, 2007. 369(9566): p. 1027-1038.
  7. Miller, J.M., et al., Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence. International Urogynecology Journal, 2008. 19(6): p. 773-82.