Pelvic Organ Prolapse Relief: Your Comprehensive Guide
People with pelvic organ prolapse are often faced with troubling symptoms, including heaviness in the pelvic area and a sensation of a bulge present in the vagina or rectum. These feelings interfere with daily life and can be a reason why many choose to avoid physical activities they used to enjoy.
Thankfully, there are many great options to help reduce these bothersome symptoms and improve quality of life, including pessaries, external support garments, and pelvic floor therapy. In this post, Dr. Margo Kwiatkowski PT, DPT, CSCS, PCES breaks down some of these options and explains how different types of support can help.
What is Pelvic Organ Prolapse (POP)?
Pelvic organ prolapse (POP) is a condition where pelvic organs, such as the bladder, uterus, or rectum, bulge into the vaginal wall due to weakened pelvic floor muscles. This can result from childbirth, menopause, obesity, or heavy lifting. Common symptoms can include pressure, incontinence, and discomfort.
How Do Changes in Anatomy Lead to Common Prolapse Symptoms?
The anatomical changes that occur with pelvic organ prolapse are typically the cause of symptoms. If the bladder or urethra have shifted into the opening of the vagina (cystourethrocele), this can contribute to urinary incontinence or even urinary retention. In the case of a rectocele (rectum shifting into the vagina), someone might experience constipation or fecal and gas incontinence. Both of these conditions, along with uterine prolapse, can create the sensation of a bulge being present in the vagina.
How Pessaries Can Help with Pelvic Organ Prolapse
In the case of a cystocele (bladder prolapse) or uterine prolapse, many people find using a pessary extremely helpful in mitigating their POP symptoms. A pessary is a device worn inside the vagina that provides physical support to the pelvic organs.
Pessaries come in a variety of shapes and sizes to better address a person’s unique anatomy. Typically, pessaries are fit and managed by a physician such as a urogynecologist or gynecologist. In some cases, a physical therapist can provide this service if they have had additional training. Once the correct size and style have been identified, the patient can typically manage insertion and removal on their own with ease, and pessaries can be a good option for those seeking non-surgical solutions.
Pessaries not only reduce the feelings of a bulge and heaviness, but can also address urinary incontinence and difficulty with proper bladder and bowel emptying. They can physically push the organs closer to their anatomically normal position, thereby improving the path of the urethra and the rectum.
Rectocele prolapse can be more difficult to fit properly for a pessary, as they can be below the position that a pessary would sit in the vaginal canal. In this case, the person may benefit more from an external support garment.
The Impact of Childbirth on Perineal Health and How Support Garments Can Help
POP is sometimes accompanied by muscular trauma to the pelvic floor. Muscle trauma is a common occurrence in childbirth and includes perineal tears and levator ani avulsions.
A perineal tear is one that affects the tissue between the vagina and the anus. The severity of the tear is graded on a scale from one to four, depending on which tissues the tear affected. Most perineal tears are sutured properly by an OB GYN or midwife present at the birth. Some people experience what is called a “missed” perineal laceration, which occurs when the severity of the tear is mis-identified. Missed tears, third and fourth degree tears, and multiple perineal tears can be the cause of something called perineal insufficiency.
Perineal insufficiency is a term used to describe the lack of supportive muscle and connective tissue between the vagina and the anus. Without these strong structures in place, the pelvic floor cannot work optimally to support the pelvic organs, especially the rectum.
A decrease in muscular and fascial support can be addressed with the right external support garment. The underwear from Hem Support Wear provides gentle yet firm support right on the perineum. Reinforcing the pelvic muscles with a garment can reduce heaviness and pain.
Many people with prolapse experience worsening symptoms at the end of the day due to gravity’s influence on the organs along with fatigued pelvic floor muscles. Perineal support allows the muscles to take a break and not overwork.
Levator Ani Avulsions and Their Impact on the Pelvic Floor
Another muscle trauma that can occur during childbirth is a levator ani avulsion. An avulsion happens when the pelvic floor muscle fails to adequately stretch and instead tears at or near the pubic bone. Some of these tears spontaneously improve within the first year postpartum while others remain. People with avulsions often complain of tension, pain, worsening prolapse symptoms, pelvic floor weakness, difficulty wearing tampons, and loss of sensation during intercourse.
This type of muscle damage increases the likelihood that other, intact pelvic floor muscles will be overactive. Hem Support Wear underwear provides the right amount of compression so that the muscles can relax throughout the day rather than be overworked and painful.
Pelvic floor dysfunction can also exist without any tissue trauma. The muscles in the pelvis can lose their ability to coordinate strong contractions and adequate relaxations. For this reason, supportive garments are helpful for any person with bothersome pelvic symptoms.
The Benefits of Pelvic Floor Physical Therapy
Another excellent option for pelvic floor muscle support is pelvic floor therapy. As awareness of this option increases, there are more and more practitioners around the world. Both physical therapists and occupational therapists can be trained to provide this type of therapy. These practitioners are able to examine the pelvic floor muscles and prescribe treatment strategies to help improve strength and function.
An examination by a pelvic floor therapist usually consists of an external assessment of the vulva and pelvic floor muscles followed by an internal assessment. During the internal exam, the patient is asked to contract and relax the pelvic muscles, hold for a duration of time, cough and bear down. The therapist can also assess the vaginal walls and uterus for movement indicating possible prolapse. In addition to evaluating the pelvic floor muscles, a good therapist will also look at the patient’s abdominals, hips, posture, and breathing, among other things.
After determining the needs of the patient’s unique body, the therapist will create a treatment plan to improve the patient's muscle strength and coordination. In doing so, many people experience an improvement in their prolapse symptoms. Pelvic floor therapy can also address a variety of bowel and bladder symptoms, including urinary and fecal incontinence, constipation, pain, and much more.
Recovering from pelvic organ prolapse is a marathon, not a sprint. While true anatomical resolution is a rarity, symptom resolution is attainable for most. Tools like pelvic floor therapy, Hem Support Wear’s garments, and pessaries can be used to improve a person’s quality of life and help them return to their desired physical activities.
About Dr. Margo Kwiatkowski, PT, DPT, CSCS, PCES
Margo Kwiatkowski is the founder of P4Moms Physical Therapy. She is a pelvic floor and orthopedic physical therapist based in Ventura, California. She had made it her life mission to educate about prolapse after experiencing the diagnosis after the birth of her first child.
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**Medical Disclaimer: This post is intended to provide information and resources only. This post or any of the information contained within should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your qualified healthcare provider with any questions you may have regarding your healthcare, conditions, and recommended treatment.