Pelvic Organ Prolapse: What It Means and Your Treatment Options
TL;DR
Pelvic organ prolapse, including its three common types (cystocele, rectocele, and uterine), typical symptoms, and causes such as weakened tissue and repeated pressure. It outlines three options: a pessary, pelvic floor physical therapy, and surgery. It says people who have pelvic floor PT before and after surgery tend to have better outcomes.
Let’s discuss prolapse. What is prolapse? How is it caused? Is surgery the only option? If not, what are other treatment options for prolapse? Prolapse is a medical term to describe the descent of an organ typically in the vaginal canal. There are 3 main common types of prolapse:
- Cystocele: the bladder descends in the front aspect of the vaginal canal.
- Rectocele: the rectum descends in the back aspect of the vaginal canal or through the anus.
- Uterine: slips into the vaginal wall and can protrude outside the vulva.
Many people describe symptoms of a prolapse as sensations of heaviness, pressure, a bulge in the vagina, or a “tampon feels like it is falling out”. Bladder and bowel symptoms may also be associated with prolapse. A prolapse can be caused by weakened structures such as connective tissue and muscles which may be associated with hormonal changes like pregnancy and postpartum as well as menopause. However, it is mainly caused by prolonged or repetitive increase in pressure like chronic coughing or lifting heavy objects without proper support or pressure management and even chronic constipation. Prolapse has also be shown more recently to have connections with genetics.
What are some of the treatment options for prolapse?
- Pessary: a pessary is a device that is inserted (non surgically) into the vagina to provide support and relieve prolapse symptoms. It is recommended to find a medical provider who is trained to do a thorough assessment and fitting. It. May take a couple fittings to find the one that works best for you. Remember that one size does not fit all!
- Pelvic Floor Physical Therapy: a pelvic floor physical therapist will assess your posture, breathing, mechanics, pelvic floor muscle function, and other regions of the body that may be influencing the prolapse symptoms. A pelvic floor physical therapist will also address and educate on pressure management to decrease and manage prolapse. In some cases, a pessary can be used in combination with pelvic floor PT.
- Surgery: yes there is an option for surgical procedures to repair prolapse and are recommended for particular cases of prolapse. However, not all procedures are successful in the long term. There is evidence that shows people who opt for a surgical procedure have better outcomes and success rates if they went through pelvic floor PT prior to and following the procedure since they learned how to manage intra-abdominal pressure and pelvic floor muscle function.
