Pelvic Organ Prolapse: A Full Body & Lifestyle Approach - A Physical Therapy Perspective
Pelvic Organ Prolapse (POP) is described by the compartment of the vagina in which your pelvic organs drops. When it is the front wall of the vagina, typically the bladder, medically this is called a cystocele. When it is the back wall of the vaginal, typically with the rectum this is called a rectocele. Other types of prolapse can occur including the uterus and cervix, the small bowel can also descend into the posterior vaginal wall, this is called enterocele.
Prolapse can occur when the integrity of the pelvic floor is affected, these factors can include: pregnancy, particularly a vaginal delivery, chronic straining either due to constipation or heavy lifting, obesity, and also menopause has been associated with the development of prolapse. The lack of estrogen causes thinning of the vagina and is thought to reduce the strength of the connective tissue supporting it. You can also inquire with your referring physicians on the efficacy and benefits of laser treatment to stimulate production of collagen growth. Haylen et al (2010) describes prolapse symptoms as the the departure from normal sensation, structure or function, experienced by the woman in reference to the position of her pelvic organs. Most women with pelvic organ prolapse symptoms are asymptomatic. Those with symptoms often describes sensation of pressure/ heaviness in the vagina or a feeling of a bulge in or coming out of the vagina (Machin 2011), which can worse towards the end of the day or with prolonged weight-bearing (standing or walking).
Currently, there is a lack awareness by both healthcare providers and patients regarding risk factors associated with pelvic organ prolapse and management options. Studies have shown that only 10-20% of patients of pelvic organ prolapse seek treatment.
When patients are diagnosed with pelvic organ prolapse and are referred to a women's health physical therapist, the therapist can address different mechanical factors that are associated with pelvic organ prolapse. The therapist can examine your musculoskeletal system by examine how you stand and sit. A persistent slump posture can create an increase in intra-abdominal pressure thus exacerbating symtoms of POP, which can include pelvic pressure and heaviness. Good alignment and posture is vital to your health in a myriad of ways. The therapist can also examine how you lift and carry heavy items, examine how you position yourself on the toilet (www.squattypotty.com) as chronic straining with constipation can also cause these pelvic organ organs to descend. If you are chronically constipated, the therapist can make general dietary suggestions or refer you to a nutritionist who can help you improve your bowel movement with proper food choices and supplements. The therapist should also show you manual techniques to stimulate colon motility. If you are overweight, it's important that you engage in regular cardiovascular activities as extra weight on the abdomen can cause more pressure to the pelvic organs.
Depending on the training of the physical therapists, an osteopathic technique called visceral manipulation can also be implemented to reduce any restrictive motion and restore normal movement of the pelvic organs and surrounding viscera/connective tissue. The therapist can also bring more pelvic floor muscle awareness through biofeedback and neuromuscular re-education, so you can learn how to correctly contract your pelvic floor musculature. He or she can also educate and provide you with CORE exercises based on your level of awareness and fitness level. It is important that you stay compliant with your home exercise program and learn how to stabilize your trunk and pelvis during static and dynamic activities.
With the exception of manual therapy, which is based on the experience and expertise of the clinician, the same principles and lifestyle recommendation can be applied to those who have had pelvic surgeries. Studies have shown that 1/3 of patients who have had pelvic surgery will undergo another procedure; therefore it's important to adjust your lifestyle and treat your body as a whole rather than an isolated region to ultimately reduce your risk of undergoing surgery.
References
Boreham MK, Wai CY, Schaffer J. Pathophysiology of pelvic organ prolapse. In: Chapple CR, Zimmern PE, Brubaker L, Smith ARB, Bo K. Multidisciplinary Management of Female Pelvic Floor Disorders. Philadelphia: Churchill Livingstone Elsevier; 2006.
Aponte MM, Rosenblum N. Repair of pelvic organ prolapse: what is the goal? Curr Urol Rep. 2014; 15: 385W389.
Haylen BT, deRidder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/ International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010; 21: 5W26.
Machin SE, Mukhopadhyay S. Pelvic organ prolapse: review of the aetiology, presentation, diagnosis and management. Menopause Int. 2011; 17: 132W136.