I see it all the time. Women who are taken by surprise with organ prolapse after childbirth, hysterectomies and during menopause. Marathon runners and high level athletes are also caught by surprise when they start to feel pressure or something like a ball inside their pelvis. At our healing center we see women with this condition all time and we treat pelvic organ prolapse with physical therapy very successfully. I want to share our expertise and education with you so that you can empower yourself with knowledge and arm yourself with successful tips to fight back.
By the time new moms come to my pelvic rehab center, Renew Physical Therapy, for help, they are depressed, angry and in a state of disbelief. These feelings are not just experienced by new moms but by many other women who also experience prolapse and have not been properly informed about their condition. Women often wonder how this did happen to me? I often hear, “I wish I had known”, or “Why doesn’t anyone tell you that this is big risk factor of organ prolapse associated with childbirth, female surgeries and impact exercises?” Most importantly, women tell me they wished they had known so they could have taken action and to prevented it. Pregnant women in general usually express frustration because they wish they had known how to minimize or prevent it during pregnancy. Pregnancy and childbirth are big risk factors for prolapse organs. The stats are sobering, 50% of childbearing women will experience some degree of prolapse. Prolapses are rated in 4 grades with the worst being grade 4 in which the organs come out of the vagina. As a physical therapist I see this more than I want to and it is quite disturbing for the patient.
It is important to understand the functions of the pelvic floor muscles and their importance in the prevention of pelvic organ prolapse. When I think of the pelvic floor muscles (PFM) I think about the letter “S”. The PFM have 4 primary functions: Stabilization, organ Support, Sphincteric action and Sexual function. When the PFM are not functioning optimally or are weakened, scarred or too tight the repercussions span many systems. The core and abdominal muscles, along with pelvic alignment also play a part in organ prolapse. The female organs that can prolapse are the bladder (Cystocele), rectum (Rectocele), and uterus (Uterine Prolpase). When these organs are not supported properly by the PFMs and other systems they can fall into the pelvis. The vagina itself can also collapse and that is called Vaginal Vault Prolapse.
Although pelvic organ prolapse is not life threatening it is a “game changer” where women are not the same as before and they have to “adapt” to this new form of being”. This new adaptation and not being able to do what they once did can cause disharmony and depression leaving women to feel changed forever. I am here to tell you it’s not that bleak and that there are things you can do to help yourself and these things are not difficult and can be incorporated into your busy lifestyle. Also by knowing the risk factors for organ prolapse you can start to make changes immediately to limit your risk factors. Below I will cover organ prolapse risk factors, symptoms and tips to prevent this condition.
Know the Risk Factors Associated with Pelvic Organ Prolapse
First let’s cover risk factors associated with pelvic organ prolapse. Risk factors and causes run the gamet but there are some things that we must pay attention to not only after the baby comes but during pregnancy as well. High level athletes and women going through the menopause change should pay attention to these risk factors as well.
Risk factors for Organ Prolapse:
• Diastasis Recti Abdominal (DRA) separation and poor core strength.
• Poor posture especially anterior tilt pelvis. This posture adds excessive pressure to the anterior wall of the pelvis where the bladder and uterus live.
• Impact exercises when you symptomatic or leaking or in the immediate post-partum period
• Abdominal surgeries, Caesarian births
• Assistive birth: forceps, vacuum or a combination
• Episiotomies or perineal tears
• Constipation and chronic pushing with defecation or urination
• Prolonged second state more than two hours but could be less
• Breath Holding during second stage of labor and directive pushing
• Coccyx injuries or broken coccyx during birth
• Chronic breath holding
• Incontinence during pregnancy or in the post-partum period
• Heavy lifting or lifting young child
• Excessive abdominal crunches performed with breath holding and PFM bearing down
• Tight pelvic floor muscles or PFM that are in spasms
• Pelvic mal-alignment especially sacral posterior torsions
• Herniated disc and low back pain
• Symphysis Pubic Dysfunction
• Chronic coughing
• Hormonal changes especially a decrease in estrogen
• Multiple pregnancies
Symptoms of Organ Prolapse
• Sensation of a having a ball in the vagina
• Pressure in the pelvis
• Heaviness in the pelvic area
• A falling out of the feeling in the pelvis
• Rubbing against the underwear contributing to irritation of the vulva-vaginal area
• Incontinence fecal or urinary
• Gas incontinence or air escaping from the vagina
• Sexual dysfunction
• Sexual pain
• Abdominal pain
• Low back pain
• Sacral-iliac pain
• Feeling like the pelvis is unstable
• Pain with Kegel exercises
• Inability to feel complete sensation in the vagina
• Sexual Dysfunction
• Problems with orgasms
Tips To Prevent and or Improve Female Organ Prolapse:
• Your Core Matters: See our Video Library and Download The Core Series and Diastasis Abdominis Testing and Correction”
Strengthen your deep abdominal muscle called Transverse Abdominal muscles. It is critical to start training this muscle in pregnancy and immediately after childbirth. If you have access to pelvic floor physiotherapy it is always best to go and see the expert. Pelvic floor therapist can show you how to correctly and safely strengthen the deep core muscles and other related muscles that can help reduce symptom of organ prolapse. Also take a look at my Core Series Video. This video takes you through corrective exercises for DRA and progresses you through 8 different core exercises that will ensure a strong and powerful abdominals muscles.
• Close The Abdominal Gap: Diastasis Abdominis Recti Separation See our Video Library and Download Core Series and Diastasis Abdominis Testing and Correction
Correct your abdominal separation before starting a regular core program. Diastasis recti separation responds well to manual therapy and you will need to see an experience women’s health specialist. Many times exercise along will not close the gap but you will have tremendous success with the video core exercises.
• To Kegel or Not to Kegel There is a great chapter in my book Ending Female Pain called “To Kegel or Not to Kegel.”
Simply drawing up and contracting your vaginal muscles and performing kegels until you are blue in the face will not improve your organ prolapse or your symptoms. There is a delicate balance here where you need to find the proper PFM contraction (Kegel) and proper relaxation (Reverse Kegel). This ratio is best determine with intra-vaginal evaluation of the PFMs which is performed by a women’s health physical therapist. For pregnant patients external palpations of the PFMs or external Biofeedback can be used and we do this at our center but can also do a scape session.
• Direct Massage Your Vaginal Pelvic Floor Tension See Ending Female Pain Chapter 11 and Ending Pain In Pregnancy Chapter 9
Massage your PFM. PFM can be tight or experience tears and resultant scar tissue after childbirth or pelvic surgeries. PFM that are compromised cannot be strengthen to their full capacity because the PFM cannot contract maximally so just strengthening with kegels will not prevent or improve organ prolapse symptoms.
Perineal massage during pregnancy can help prevent tears during childbirth. Three types of massages are explained in Ending Pain In Pregnancy. PFM scar massage and releasing tightness in the PFM are also explained in detail in Ending female Pain. .
• Align Your Pelvis See Ending Pain In Pregnancy Chapter 5.
Proper pelvic Alignment is critical for proper PFM function. The PFM live in the pelvis as well as the bladder, uterus and rectum. If the house of these organs is not in the best position then it makes sense that the organs are not being supported optimally. Ending Pain In Pregnancy highlights pelvic alignment exercises.
• Belt yourself See Ending Pain In Pregnancy Chapter___. Pregnancy and post-partum belts help to decrease pelvic pressure by supporting your organs and help to support weakened abdominals muscles in pregnancy and in the post-partum period. It is important to note that you must still do your core and pelvic exercises.
• Childbirth Tips (See Ending Pain In Pregnancy)
Avoid breath holding during childbirth and compromising labor positions. Listen to your body and avoid directive pushing.
• Try a Vaginal Steam Come to see us at our center for this women’s therapy that helps to tone the organs. It is a gentle herb steam that gentle flows upwards into the pelvis to create a toning effect.
• Get Help Early Consider a Pessary Until the PFMs Get Strong: See an Experienced and Knowledgeable MD, Nurse Practitioner or Midwife Consider getting fit for a Pessary especially in the early post-partum period. Pessaary fitting is an art form and several fittings might have to be performed. I am not saying you use this as a long term solution but research shows that in the early post-partum a pessary can help period until PFM are get stronger. You can support the organs in the right place with a pessary. For women with grades 3 or 4 organ prolapse a pessary can provide tremendous relief, improve symptoms, decrease the need for surgeries and improve life function. Every women still benefits from pelvic floor rehabilitation so a pessary is NEVER a substitute for proper pelvic floor care.
Treat Pelvic Organ Prolapse with Physical Therapy
• Hire a Women’s Health Pelvic Floor Physiotherapist or Get an In-Person or Skype Session with Renew Physical Therapy: At Renew Physical Therapy we are experts in organ prolapse rehabilitation and will gladly see you for a visit. Skype Sessions are also available for those who are out of town. For those who need a little extra help I would recommend both Ending Pain In Pregnancy and Ending Female Pain. I have also established a video library where you can download Core Abdominals Series with Diastasis Recti program that is intelligent and targeted for prolapse organ condition. Do not hesitate to call us for a consultation at 212-213-4660 or email us at [email protected]