Pelvic Organ Prolapse occurs when the front or back vaginal wall or the uterus is applying pressure down onto/into the vaginal canal so the vaginal tissue descends to, or more severely past, the vaginal opening. Clients often report feeling pressure at the vagina, a heaviness or bulge in this area, and sometimes difficulty with bladder or bowel emptying. Lying down usually helps decrease these symptoms and prolapse is not directly associated with pain. Prolapse symptoms can occur due to a combination of an increase in abdominal pressure (ie chronic cough, vaginal child birth), decreased connective tissue support through the organs (as a result of chronic abdominal pressure or tissue changes due to child birth or hormone changes), poor pelvic floor muscle support and sensitivity in the vaginal tissues.

Mythbuster: pelvic organ prolapse does not ONLY occur in older women, although risk increases with age, and pessaries can be used at any age to help relieve symptoms

Types of Prolapses:

• Anterior wall prolapse – previously referred to as cystocele or bladder prolapse; when there is stretch in the front vaginal wall and the weight of the bladder pushes it down towards the vaginal entrance

• Posterior wall prolapse – previously referred to as rectocele; when the bowels are pushing down on the back vaginal wall

• Uterine or cervical prolapse: when there is stretch in the ligaments that support the cervix high at the end of the vaginal canal, so the cervix (tip of the uterus) moves down towards the vaginal opening

• Vaginal Vault prolapse: Prolapse of the top of the vagina after a hysterectomy

• Enterocele: Prolapse of the intestine pushing on the back (or less commonly the front) vaginal wall

How Pelvic Floor Physiotherapy can help:

• assess abdominal pressure regulation through muscle pattern and posture

• assess pelvic floor response and support and recommend appropriate exercises

• assess connective tissue laxity/stretch

• recommend and be fitted with a pessary to help relieve symptoms 

• consider tissue sensitivity and overall body awareness 

What you can do now:

• address constipation and decrease straining/pushing with bowel movements

• address stress levels – our body automatically holds tension through the abdomen, ribs, shoulders and pelvic floor muscles with stress, which can influence the sensation of prolapse at the vaginal opening

• try exhaling with movement/lifting – breathing out tends to decrease abdominal pressure and signals the pelvic floor muscles to activate. This doesn’t work for everyone but feel free to try it out!

• offload/rest as needed through the day – lying down may help decrease symptoms temporarily, but keep in mind that pessaries and pelvic floor muscle training are meant to help you find symptom relief without feeling the need to lie down all the time.  

​Is prolapse something you are concerned about? Let’s find out what is going on and work towards a solution together!