Pelvic Organ Prolapse

Here at PROmotion, Pelvic Organ Prolapse is a condition our Pelvic Health Physiotherapists see on a daily basis. Liz Pavlovich has a special interest in this area and has recently completed additional training in prolapse management.

Pelvic Organ Prolapse is a condition whereby the pelvic organs become lowered in the pelvis, causing bothersome symptoms to the woman. It may be the uterus, bladder, bowel or cuff (top of the vagina in people who have had a hysterectomy). This article will help answer some of your questions about what it is, how to prevent it and best management strategies.

Imagine a marble resting on a straight line; it will remain still and happily resting up on the surface. Now imagine the marble’s flat surface has sagged a bit and it is no longer flat; the marble will roll to a different place. If we put it on the back of the surface it will roll forwards and if we put it towards the front, it will roll backwards. This is what happens to the pelvic organs if their supporting connective tissue and muscles become stretched or weak. The bladder or uterus may roll back or the bowel forwards.

The sensation a woman will feel when this happens is varied. The five most common symptoms are; vaginal bulge, pelvic or perineal pressure, the need for splinting when going to the toilet, lower back ache, or bleeding/ discharge/ infection. She may not feel anything at the beginning of the day, by the end of the day when gravity and daily life has been putting loads on the pelvic support structures, they will become more elongated and fatigued, thus the sensation of prolapse may only appear at the end of the day. Some women only have symptoms around the time of their period or ovulation as this is a time of lowered estrogen hormone. This may also be the case for a woman who has never had any prolapse symptoms and then reaches menopause where she starts feeling a prolapse or a sensation of a scratchy bulge.

To prevent prolapse from occurring or worsening there are certain things you can focus on. These include keeping your bowels healthy to avoid constant and heavy straining. Maintaining a healthy weight is also very important in minimizing the chance of progression of pelvic organ prolapse. Keeping up with your pelvic floor muscle training exercises and using a bracing strategy known as ‘The Knack’ before you lift anything heavy. For those people with respiratory issues regular coughing and sneezing should be best managed in conjunction with your physio and doctor.

As with all pelvic health conditions, a thorough examination is required to assess and discuss your condition. We ensure a woman feels safe and supported in her assessment as this can be sensitive or embarrassing for some people to discuss. Our management strategy will be a combination of increasing the upwards support of the organs, a “lift” from below and reducing the downward pressure on the organs. We always talk about your exercise or activity goals and find a way to ensure you feel ready to take on your day with confidence.

Liz Pavlovich, Women’s and Men’s Continence and Pelvic Health Physiotherapist, is part of our Pelvic Health Team providing you with expert prolapse management. Both Liz and Anna White are trained to fit pessary devices which may assist with management of prolapse. You will need to book a ‘Woman’s Health Initial Assessment’, to book click here or call 9284 4405.