What the heck is a prolapse and what can you do about it?
What the heck is a prolapse?
A prolapse is when an organ starts to come out of your body.
SAY WHAT?!?!?!?
That is right. Your organs sit nicely close together in your body. When the tissue between them gets weakened, they can start to fall “out of place”. Your organs consist of multiple body parts. However, the ones that typically prolapse are the uterus, rectum, or bladder. Usually they prolapse into your vagina, but sometimes the rectum prolapses out of your anus (or the hole you poop out of).
Think of the tissue holding up your organs as a piece of really tight elastic. That elastic has some movement and play, but once it gets stretched out, it does not have the same properties it once did and it stays stretched.
What can cause your tissue to get weak?
Usually child birth, the postpartum period, and/or menopause can cause the tissues to get weak.
During pregnancy you have relaxin (a hormone) in your body. That hormone’s purpose is to loosen your ligaments so that your pelvis can open up to allow a human being to pass through. Sometimes that hormone also causes the ligaments holding up your organs to stretch. If they have added pressure while they are in the stretched position (straining to have a bowel movement, lifting your toddler, running) then they might stay in that stretched position causing a prolapse.
As your hormones change during menopause, the tissues can get weak causing the organs to not be as “snug” against each other. This can cause prolapse.
What are some typical things that can “stretch” the tissues?
If you had to push for a long time or push really hard because you were told that “You need to get your baby out of you right now or we’ll go into the operating room,” you might be at greater risk of having a prolapse. If you usually strain to have a bowel movement or strained during the first few weeks postpartum, you might be at greater risk of having a prolapse. If you returned to activities or exercise too soon after having a baby, you might be at greater risk of having a prolapse. If you didn’t have pelvic floor PT after having a baby and then you went through menopause, you might be at greater risk of having a prolapse.
So what if you did some of those things and you know you have a prolapse?
If you know you have a prolapse, I strongly suggest not to google it. Contrary to what Dr. Google might tell you, you cannot die from having a prolapse, you can reverse a prolapse to some degree, and surgery is not your only answer.
Yes, some people need surgery, but I would exhaust all of your options before you turn to the knife (or these days, the robot). Pelvic floor PT can improve your prolapse by a full degree and the change can be permanent. Using a pessary is another great option if your prolapse symptoms are getting in the way of you doing your daily activities and enjoying life the way you want.
What is a pessary?
A pessary is like an orthotic for the vagina. They come in all different sizes and shapes. You go to a gynecologist who will “fit” you for one. They will then make one for you based on your own anatomy. You insert it into your vagina and you can leave it in as long as you want (although it is usually recommended to take it out once a month to clean). You can take it in and out as you please. Some people are very happy and satisfied with their pessary, while other people try them and do not like them.
There are various degrees of prolapse?
Yes! Prolapse is graded by how much the organ comes down. We usually grade the ones that push into the vaginal walls. When the bladder pushes into the front wall of the vagina, it is called a cystocele. When the rectum pushes into the back of the vagina, it is called a rectocele. When the uterus comes down into the vagina, it is called a uterine prolapse. When an organ starts to push into the walls of the vagina it is graded as grade I. When it pushes into the wall and then comes down a little bit, it is grade II. When it pushes into the wall and you can see it at the opening of the vagina, it is grade III. And when it pushes into the wall and starts to come out of the vaginal opening it is grade IV.
A grade IV prolapse is a good time to get a surgical consultation. Any of the other grades can be treated with pelvic floor physical therapy and/or a pessary.
Can pelvic floor PT really help?
Pelvic floor PT can help by making sure your organs are in their most optimal position. Once your organs are where they are “supposed to be” you can do exercises to help strengthen your muscles to keep them there. Since a prolapse is caused by weakening of the tissue around the organs, if you strengthen your muscles, that will help keep your organs “in place”.
