Pelvic Organ Prolapse

Pelvic organ prolapse occurs when muscles and ligaments supporting the pelvic organs (bladder, bowel, and uterus) become overstretched and/or damaged.

Risk factors for prolapse include:

• Familial predisposition
• Obesity
• Hysterectomy
• Previous prolapse surgery
• Defective connective tissue
• Constipation, straining at stool
• Pregnancy
• Birthing process
•  Inappropriate exercise regime in a strength based fitness environment
•  Heavy lifting
•  Chronic cough 

These activities can cause an increase in intra abdominal pressure pushing down repetitively on the pelvic organs.
The pelvic organs slip out of place (or prolapse) into the vagina.  There are three types of prolapse:

• Bladder bulges through front wall of vagina (anterior prolapse)
• Bowel bulges through back wall of vagina (posterior prolapse)
• Uterus drops down into the vagina (superior prolapse)
• More than one organ can bulge into the vagina.

The main symptoms of pelvic organ prolapse:

• Uncomfortable feeling of bulging or heaviness in the vaginal area
• Dragging feeling in the pelvis
• Urinary and/or bowel incontinence
• Difficult to pass  urine or bowel motion
• Constipation
• Chronic pelvic pain
• Enlarged, wide, and gaping vaginal opening
• Sexual problems

New Research Shows Pelvic Organ Prolapse Surgery less Effective Than Expected

http://healthcare.utah.edu/publicaffairs/news/current/05-14-2013_pelvic_organ_prolapse.php

At Innovative Physio/Pilates we understand that signs and symptoms of a vaginal prolapse are very distressing and bothersome. Research has shown pelvic floor muscle strengthening is important to reduce the bothersome symptoms of a prolapse. Importantly if your prolapse is serious to warrant surgical correction then this pelvic floor muscle training is vital to assist in the long-term success of the prolapse surgery.

The pelvic floor muscles support the pelvic organs (bladder, uterus and bowel) spanning like a trampoline form the pubic bone in front to the coccyx behind. In women there is three openings for the bowel, vagina and urethra (wee tube). Strengthening the pelvic floor muscles causes the muscles to get thicker, sit higher in the pelvis, more responsive to lift and squeeze with coughing assisting the urethral closing and reduced the vaginal opening. It is a vital female function to have these important muscles
This statistics is fascinating and helps us understand why women start getting bothered by a vaginal prolapse.

‘43% of women bear down when believing to do a lift and squeeze of the pelvic floor muscles’.
It is challenging to get the correct motor control pattern of the pelvic floor muscles. Many women get the contraction correct initially for a second then quickly bear down as they believe they need to put effort into the contraction.

At Innovative Physio the Women’s Health Physio who have undertaken post-graduate study in Continence and Pelvic Floor Muscle Rehabilitation will initially perform a detailed assessment taking note that you are not constipated and straining to pass a stool. Correct defecation dynamics (how best to pass a stool) will be taught. We want to eliminate as much as possible any unnecessary straining that could contribute to the bothersome prolapse symptoms.

We then want to know what your belief system is of a pelvic floor muscle contraction. This is done by placing a real time ultrasound probe on the lower stomach so a clear view of the bladder is visible. Please don’t empty the bladder just before attending physio for the ultrasound session, just make sure you have some urine stored.

The physio will ask you to squeeze and lift your pelvic floor muscles and we should see the bladder elevate into the body as the floor rises. If the bladder is pushed down then the correct of the pelvic floor muscles must be learnt.

The treatment then progresses to pelvic floor muscle strengthening and this is done via internal vaginal examination.  Internal examination to assess the strength of the pelvic floor muscles and design a strength program that is unique to you is the gold standard. We make sure you are recruiting the correct deep muscles not just the superficial pelvic floor muscles. Your pelvic floor muscle strength will be graded as weak, moderate or strong and an appropriate strengthening program developed.

The functional use of the pelvic floor and whole body muscles is then treated and time is spent on learning ideal basic movement patterns associated with sitting, sit to stand, and standing, bending, squatting and walking. The use of mirrors and education of the importance of the postural stability muscles, diaphragmatic   and how they are linked to optimal pelvic floor muscle day to day function.

Many women then progress to group Pilates to maintain the function strength of the pelvic floor muscles keeping these muscles well elevated in the pelvic cavity supporting the pelvic organs.
Most of the above would be achieved in 4-6 physiotherapy sessions. Some sessions may be 60 minutes duration others 30 minutes.