What is pelvic organ prolapse and how do I know if I have it?
Pelvic organ prolapse (POP) is the descent or tissue laxity of the front (bladder), back (rectum), or top (cervical) aspect of the vaginal wall. With less support from connective tissue and muscles of the pelvis, the bladder, uterus, or rectum can press on the vaginal wall contributing to increased pelvic pressure or bulge sensation. The exact prevalence of POP in the United States is unknown, but an estimated 40% of women who have given birth will have evidence of POP upon physical exam.
Many women (around 80%) who have prolapse will be asymptomatic (Durnea et al. 2014). This is important to note because if someone is asymptomatic, they may not know they have prolapse and not necessarily require treatment. However, if someone is habitually putting excessive pressure on the pelvic floor with straining on the toilet, chronic coughing, or heavy lifting AND doesn’t have the abdominal and pelvic floor strength or coordination to counteract the increased pressure, they could make the condition worse over time.
Risk factors for prolapse include: vaginal childbirth, increased BMI, age (decreased tissue support as estrogen decreases with postmenopausal changes) and excessive increased intra-abdominal pressure from chronic constipation, or coughing etc. (Vergeldt et al. 2015).
So how do you know if you have POP? Common symptoms include:
Feeling or seeing a bulge of something coming out of the vagina or rectum
Feeling pressure, fullness or aching in the pelvis
Pressure in the vagina or pelvis that gets worse with standing, jumping, or coughing
Difficulty starting or emptying a bowel movement completely
Difficulty starting urination or emptying the bladder completely
Pain/dragging sensation with intercourse
Difficulty inserting a tampon or feeling like something is pushing it out
Despite the focus placed on pelvic floor strength as a treatment for prolapse, the main issue is poor control of increased intra-abdominal pressure. A lack of support from pelvic floor muscles is only one aspect. Increased pressure from above from breath holding, excessive abdominal tension, chronic coughing or constipation can all contribute significantly to prolapse. Make sure you are working with a physical therapist who will assess, not only your pelvic floor strength and coordination, but also how you use your abdominal muscles and how you control your abdominal pressure.
To better understand increased intra-abdominal pressure and to see if you are able to manage the pressure, try coughing. When we cough our pelvic floor muscles and abdominals should gently contract to support our pelvic floor and abdomen as opposed to pressing out or down. This helps send increased intra-abdominal pressure up (not down on the pelvic floor). To self-assess your body’s coordination and support, try coughing or clearing your throat. Notice if your abdomen draws in (good pressure control) or if you feel pressure down and out (sign that you might want to work on coordination and strength with a pelvic floor PT).
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