Supporting Wellness: Understanding and Managing Pelvic Organ Prolapse
Continuing with the theme of pregnancy and postpartum, we thought it would be appropriate if we talked about Pelvic Organ Prolapse. Prior to giving birth, many people don’t know that they can experience symptoms of heaviness in their vagina, a “dragging” sensation vaginally, or feeling/seeing a physical bulge in the vaginal canal. If these things happen, we can imagine it can be quite alarming if you didn’t know it existed. The good news is that we can help minimize the symptoms of POP.
What is normal anatomy vs. prolapse.
The vagina is more than just a passageway; it's like a room with walls. Nearby are the bladder, rectum, and uterus. Think of them as marbles on a table in a neat row—that's how it should be. But imagine those marbles on a less sturdy surface, like a loose sling. They start to sink toward the middle and into the vagina. With pelvic organ prolapse, the supporting tissues—the fascia, ligaments, and maybe even the pelvic floor muscles (which act like the sling)—are a bit relaxed, allowing the organs to “prolapse” into the vagina.
While this can be alarming to some, just know that it is not your organs that are problematic. It is the structure, which is the pelvic floor muscles, pelvic fascia and ligaments, holding them in place that needs help supporting the organs. Therefore, it is our job to improve the supportive structures to help hold the organs in place.
Furthermore, just because someone has an anatomical prolapse does not mean that they technically have a symptomatic prolapse. Recent studies have proven that only 24% of females with an average age of 42.7 (they tested a total of 1004 females) had a prolapse of stage zero. Is it right to call 76% of females abnormal? With more stats, out of 165 females with an average age of 20, 40% of them had a stage 1 anatomical prolapse. Therefore, clinicians thought, “Is it right to call stage 1 prolapse abnormal? Especially when they’re asymptomatic?” This leads us to state that we are now looking for a stage 2 prolapse that is also symptomatic.
So what does pelvic PT do? In all honesty, much of the research out there is looking at pelvic muscle training alone, meaning they are only looking at the pelvic floor muscles and not the whole body. Here at The Pelvic Model, we are doing more than just addressing the pelvic floor muscles by lengthening them, doing PFM strengthening exercises, and working on control. We are also looking at how the patient handles pressure put on the pelvic floor, addressing the pelvic girdle, and the whole core. Our postures during movement and exercises matter, and we inform our patients how to exercise with good form to ensure good pressure management and decrease the risk of progressing your prolapse. We know that pelvic floor muscle strength is important, but looking at the core and the pelvic girdle is important as well. All of these structures work within the same system: your body. Treating all of it can improve pelvic organ prolapse symptoms. Further, we look all the way up into the thoracic spine to further address the body’s pressure systems. There are many minute details that pelvic PT can help with to manage prolapse symptoms.
Furthermore, we also assess the need for a pessary if necessary. A pessary is a device put vaginally to provide additional support for your pelvic organs to keep them from prolapsing. This is another conservative treatment we can do prior to even discussing surgery.
In conclusion, understanding pelvic organ prolapse involves recognizing the intricate support system within the body. While the concept may seem daunting, it's essential to remember that prolapse doesn't signify a fault in the organs themselves but rather in the supporting structures. By addressing these support mechanisms through various interventions, including pelvic physical therapy and the consideration of supportive devices like pessaries, individuals can effectively manage prolapse symptoms and improve their quality of life. With continued research and a holistic approach to treatment, we can offer comprehensive support to those affected by pelvic organ prolapse.
