The world’s leading experts have recommended treatments provided by pelvic health physiotherapists for incontinence, prolapse and pelvic pain. Read on to find out which treatments are available for your Pelvic Organ Prolapse.
Pelvic Floor Muscle Training
Pelvic floor muscle training also has the highest level of benefit according to experts at reducing symptoms in women with prolapse.
PFMT generally will not reduce the stage of prolapse (the physical position of the prolapse), but there is evidence that this training can lead to changes in muscle thickness and vaginal dimensions which may account for some of the symptom improvement. We also know that these exercises, when delivered by a trained pelvic physiotherapist are likely to prevent and improve prolapse symptoms in the longer term.
Lifestyle advice
You are at greater risk of developing POP if you are:
- Overweight, obese (body max index over 25)
- Regularly lifting heavy weights at the gym or work
- Straining when you use your bowels- such as with constipation
- Coughing or sneezing often, which may be due to smoking, or respiratory disorders like asthma or hayfever
Physiotherapists along with your GP and/or other health professional will be able to help you work out the likelihood of these factors influencing your prolapse symptoms and help you come up with a plan of action as to what you may be able to do about it. Pelvic physiotherapists have skills in analysing your posture, even your posture on the toilet! And will be able to help you be more effective in this area without overloading the muscles and supports of the pelvic organs.
For example, it can be helpful to understand that in a normal upright sitting position the rectum is naturally ‘kinked’ which helps to maintain bowel control. In a squatting position the angle is opened to allow easier passage of stool. If you are experiencing constipation or straining, try the following tips to improve your posture while emptying your bowel:
- Lean forward at the hips with your elbows resting on your thighs.
- Keep the spine in a neutral position.
- Ensure knees are higher than the hips – use a foot stool to assist.
- Relax your breathing, do not strain or hold your breath.
- Soften your pelvic floor and tummy muscles, let your abdomen bulge out.
Overweight and obesity
The prevalence of pelvic floor disorders increases with the degree of being overweight or obese. If you are overweight or obese you are four times more likely to have urinary incontinence and two times more likely to have difficulty controlling bowels. This is thought to be due to a number of reasons including:
- Obesity-related comorbidities
- Diabetic neuropathy
- Intervertebral disc herniation
- Chronic increase in intra-abdominal pressure which puts downwards strain on the pelvic organs and pelvic floor
- Damage to pelvic muscles and supports
- Nerve damage (including from diabetes, back injury) and disruption of signals to the pelvic organs and pelvic floor
Weight is a modifiable factor, so weight reduction (surgical and non‐surgical) may be an effective treatment for the management of pelvic floor disorders and this has been shown to be true for urinary incontinence. Some studies suggest even a small amount of weight loss (such as 5%) can have a significant impact on bladder leakage. If you are having difficulty losing weight, offsetting the downwards pressure with pelvic floor training supervised by a physiotherapist trained in pelvic floor muscle rehabilitation may be a good starting point for you.
Medications for treating Pelvic Organ Prolapse
Vaginal Oestrogen
In women with genitourinary symptoms of menopause (GSM) or have symptoms of vaginal atrophy (tissue thinning), topical vaginal oestrogen may help improve symptoms associated with pelvic organ prolapse. As oestrogen levels decline after the menopause, the blood vessels, connective tissue, skin and muscle weaken, lose elasticity and this may contribute to the development and symptoms of prolapse. In post menopausal women using support pessaries, it is often a requirement to use topical vaginal oestrogen to maintain tissue health.
Vaginal support pessary
A vaginal support pessary is a flexible medical device that sits within the vagina and provides support to the pelvic organs. It is a non-surgical way to successfully relieve the symptoms of pelvic organ prolapse for many women. We know that pessary with pelvic floor muscle training is just as effective as pelvic floor muscle training alone.
There are many benefits of using a vaginal support pessary:
- It is an affordable, non-surgical option for immediate to long term symptom relief
- It allows you to trial what better pelvic organ support feels like for you and any immediate side effects can easily be adjusted or reversed, unlike surgery.
- It does not preclude you from having future surgery, however surgery may limit your ability to use a pessary in the future.
- It requires no time off work or home duties, and can allow you to continue higher impact or intensity exercise if this is your preference.
- You can be taught how to fit and remove it yourself.
There are some risks associated with pessary use that can be minimised with correct care and follow-up:
- The pessary can cause pressure areas in the vagina – the risk of this occurring can be reduced if the pessary is removed to give the vaginal tissues a rest, at a frequency directed by your physiotherapist. Some women will be advised to use oestrogen cream in the vagina to reduce vaginal irritation and risk of pressure-areas developing.
- Some women do notice more vaginal discharge, this can be normal. However it is important to be aware of signs of vaginal infection or irritation such as any vaginal blood, odorous or abnormal discharge. These signs require timely medical follow up.
- Some women may experience difficulty emptying their bladder or bowel, or general pelvic discomfort and may require modified use or re-sizing of the pessary. If you are ever unable to empty your bladder and bowel, you must remove the pessary and alert your physiotherapist to arrange a timely review.
- Occasionally, a pessary can unmask stress urinary incontinence. This occurs as the pessary elevates the bladder and may unkink the urethra (tube from the bladder), allowing urine to leak with increases in pressure in the abdomen (e.g. cough, sneeze). This will only occur if stress urinary incontinence already existed but was being prevented by the prolapse. It is completely reversible and another pessary may be more appropriate for you.
Surgery for treating Pelvic Organ Prolapse
If your prolapse is bothering you, a surgical repair may be offered to you. Your surgeon will recommend the most appropriate surgical treatment for you based on a number of factors including your age, general health, previous surgical history and the severity of prolapse. The two main categories of surgery are reconstruction, where the aim is to restore your pelvic organs to their natural position, or vaginal closure surgery, if for example you no longer wish to be sexually active, or there are too many risks performing a reconstruction.
There are many different surgeries and approaches available, with the most common types outlined below:
Summary
There is strong evidence to support the role of physiotherapists 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!
