We're Talking About POP and No, It's Not About Soda...

By: Gabriela Rivera, PT, DPT, PCES

Many people have heard the word, “prolapse” being tossed around after giving birth. However, not many people know what it means. A pelvic organ prolapse affects millions of women and occurs when one or more of the pelvic organs (bladder, uterus, or rectum) drop from their normal positions and bulge into the vaginal canal.

There are 5 types of pelvic organ prolapse. The most common type of prolapse is a cystocele, which is where the bladder protrudes into the front wall of the vagina. A rectocele is when the rectum pushes into the back wall of the vagina. A uterine prolapse occurs when the uterus sags down into the vaginal canal. The last two are not as common: enterocele, or when the small intestine bulges into the vaginal wall, and a vaginal vault prolapse, which typically occurs after a hysterectomy (removal of the uterus).

You must be wondering, “why does this even happen in the first place?” Well, prolapses occur when the pelvic floor musculature is weakened and/or stretches. Many women will develop a prolapse after pregnancy and childbirth because the stress of carrying a baby and the strain of childbirth can weaken pelvic floor muscles. As women age, their risk increases due decreased collagen and muscle tone. Chronic constitution can also lead to prolapse due to constant straining during bowel movements, which weakens the pelvic floor.

The most common complaint I hear in the clinic is, “I feel heaviness in my vagina” or “it feels like something is falling out of my vagina.” Symptoms can also include a visible lump in the vaginal canal, urinary incontinence or increased urination, difficulty emptying bladder or bowels, pain or discomfort during intercourse, and vaginal bleeding or discharge. Some women are asymptomatic.

A prolapse is graded based on its position. A grade of 0 indicates the organ is in a normal position and there is no prolapse. A grade of 4 (maximum) means the organ protrudes greater than 2cm past the vaginal canal. A grade 1-2 prolapse can typically be treated conservatively with the help of a pelvic floor physical therapist. Pelvic floor therapy can help strengthen the muscles of the pelvic floor, hips, and core. We can also educate on proper breathing strategies, pressure management, and behavioral interventions to improve bladder and/or bowel function. Pessaries are removable devices that are inserted into the vagina to support the prolapsed organ, which provide symptom relief.

A prolapse more common than you think and it is often treatable. Just because you have a prolapse does not mean you have to completely change your lifestyle. You may need to modify your lifestyle while we work on breathing, pressure management, and strengthening weak muscles; but it is likely you will return to CrossFit, cycling, Pilates, etc soon!