If you are going through the next stage of life as a woman, you might have felt a bulge in the vagina or had a routine smear and been told you have pelvic organ prolapse. It can be a difficult and scary time, and if you google pelvic organ prolapse some worrying images can be displayed. It is important to know that most pelvic organ prolapses are not like the ones you may see on the internet and most can be improved without surgery.
Why am I getting prolapse symptoms during menopause?
To understand why, you should probably have a basic understanding of the pelvic anatomy. Your pelvic organs include your bladder, urethra (the passage from your bladder), vagina, bowel, rectum, uterus and intestinal tract. These organs are all held in place with ligament-like tissues and supported by your pelvic floor muscles and bony pelvis. Your pelvic floor muscles span from your pubic bone at the front, to your tailbone at the back and to the sitting bones at the sides. The muscles are really important in supporting your organs, without strong pelvic floor muscles the ligaments have to do all the work. If not supported well, over time the ligaments stretch and weaken, and if they already have been injured during childbirth this can become problematic. When you start going through menopause you experience a change in hormone levels, particularly a decline in oestrogen production, which weakens the supporting tissues around the vagina further.
What is happening in my vagina?
When there is not enough support for your pelvic organs they can bulge into the vagina. A pelvic organ prolapse of the front vaginal wall often occurs when the bladder and/or urethra have lost their support mechanism and descended within the pelvis, placing pressure on the front vaginal wall and creating a bulge. If you have prolapse at the back it is commonly the rectum causing a similar problem of pressure against the back vaginal wall. It is important to know that there is nothing wrong with the organs themselves, only their support structures, and the vaginal wall is still providing some support, but it is stretched. There can also be a prolapse of the uterus, where the cervix and uterus descends into the vaginal space. If you have had a hysterectomy, the top of the vagina (known as the vault) can still drop downwards. Pelvic organ prolapses have different stages from mild to more severe, depending on how far the bulge in your vagina extends, most are mild to moderate. The severity of your symptoms is not always an indicator of the severity of the prolapse. You can have a small prolapse but feel a lump in your vagina all the time or you can have a larger prolapse and have very few symptoms. A pelvic floor physiotherapist can help you understand what stage your prolapse is at, which organs are involved, and what you can do about it.
1. Typical position of the pelvic
2. Front wall vaginal prolapse where the organs bladder has dropped into the vagina, known as a cystocele
3. Back vaginal prolapse where the rectum is dropping into the vagina, known as a rectocele
Prolapse does not always get worse and can often get better. You probably find some days are better than others and this is very common with pelvic organ prolapse. It is not too late to help improve the support for your pelvic organs by doing pelvic floor exercises. Pelvic floor exercises have very strong research showing they can improve both the symptoms and stages of pelvic organ prolapse. It is important you do your pelvic floor exercises correctly and we suggest you see a pelvic floor physiotherapist to guide you. Future blogs will discuss some other tips for pelvic organ prolapse and explore some other symptoms around menopause that physiotherapy can help with – so keep your eyes on this space.
There is strong evidence to support the role of a pelvic floor physiotherapist with additional training in women’s and pelvic health to treat a number of conditions across all life stages – from more commonly known pelvic health issues affecting women such as incontinence and prolapse, to pelvic and sexual pain concerns and also for helping children and adolescents with bed wetting or other bladder/bowel control concerns.
We hope the information in this blog has been useful and should always be considered in conjunction with an individual assessment with your physiotherapist and/or other health care provider skilled in the area such as a GP or gynaecologist.
We would love to help you manage your concerns and get you back achieving your goals worry –free!