Prolapse, medically known as pelvic organ prolapse (POP), occurs when one or more pelvic organs drop from their normal position and press against or descend into the vaginal canal. This condition happens due to a weakening or stretching of the muscles and connective tissues supporting the pelvic organs, often leading to discomfort and other symptoms. While prolapse is more common in women who have experienced childbirth or menopause, it can affect women of all ages.
Pelvic physiotherapy has emerged as a highly effective non-surgical intervention to manage and improve prolapse symptoms.
Understanding Prolapse: Causes and Risk Factors
Prolapse occurs when the pelvic floor, a group of muscles and connective tissues, is weakened or damaged. The primary causes and risk factors include:
- Childbirth: Vaginal deliveries, particularly those involving large babies or instrumental assistance, can strain the pelvic floor.
- Ageing and Menopause: Reduced oestrogen levels during menopause can weaken pelvic tissues.
- Chronic Straining: Persistent coughing, constipation, or heavy lifting can place undue pressure on the pelvic area.
- Obesity: Excess weight increases pressure on the pelvic organs.
- Surgery: Previous pelvic surgeries, such as hysterectomies, can disrupt the pelvic support structures.
- Genetics: A predisposition to weaker connective tissues may increase risk.
Types of Prolapse
There are several types of prolapse, each affecting different pelvic organs:
- Cystocele (Bladder Prolapse): The bladder bulges into the vaginal wall.
- Rectocele (Rectal Prolapse): The rectum pushes into the vaginal wall.
- Uterine Prolapse: The uterus descends into the vaginal canal.
- Enterocele (Small Bowel Prolapse): The small intestine presses into the vaginal wall.
- Vaginal Vault Prolapse: Occurs post-hysterectomy when the top of the vagina sags downward.
Symptoms of Prolapse
Symptoms vary depending on the type and severity of the prolapse but may include:
- A sensation of heaviness or dragging in the pelvic area.
- A visible bulge or lump in the vaginal opening.
- Discomfort during intercourse.
- Difficulty emptying the bladder or bowels fully.
- Frequent urinary tract infections (UTIs).
- Lower backache.
While these symptoms can range from mild to severe, seeking professional advice to manage the condition effectively is important.
How Can Pelvic Physiotherapy Help?
Pelvic physiotherapy is a specialised form of physiotherapy designed to restore pelvic floor strength and function. It is a non-invasive, evidence-based approach that can significantly improve symptoms of prolapse and enhance quality of life.
- Pelvic Floor Muscle Training (PFMT)
The cornerstone of pelvic physiotherapy is pelvic floor muscle training. This involves targeted exercises, often referred to as Kegels, to strengthen the muscles supporting the pelvic organs. A physiotherapist will assess your pelvic floor strength and guide you in performing the exercises correctly. Benefits include:
- Improved pelvic floor strength and endurance.
- Reduced prolapse symptoms.
- Prevention of further progression.
- Biofeedback
Biofeedback uses specialised equipment to help you understand and optimise your pelvic floor muscle contractions. This technique ensures you are activating the correct muscles and provides real-time feedback, enhancing the effectiveness of your training.
- Lifestyle and Posture Advice
Pelvic physiotherapists provide guidance on lifestyle adjustments to reduce strain on the pelvic floor. These may include:
- Proper lifting techniques.
- Avoiding chronic straining from constipation or coughing.
- Weight management advice.
Good posture is also emphasised to ensure optimal pelvic alignment and reduce pressure on the pelvic organs.
- Bladder and Bowel Training
Pelvic physiotherapy includes bladder and bowel retraining for individuals experiencing urinary or bowel issues. Techniques focus on improving control, avoiding urgency, and ensuring complete emptying.
- Pessary Fitting and Support
In some cases, physiotherapists may recommend the use of a vaginal pessary, a device that provides support to the prolapsed organ. While not a permanent solution, it can alleviate symptoms and improve quality of life.
Benefits of Pelvic Physiotherapy
Pelvic physiotherapy offers numerous benefits for managing prolapse:
- Non-invasive treatment option.
- Improved pelvic floor strength and functionality.
- Reduced need for surgical intervention.
- Enhanced confidence and quality of life.
When to Seek Professional Help
If you suspect you have a prolapse or experience persistent pelvic discomfort, it’s essential to seek professional advice. Early intervention can prevent further progression and ensure effective management. A pelvic physiotherapist will conduct a thorough assessment, tailor a treatment plan to your needs, and monitor your progress.
Preventing Prolapse
While not all cases of prolapse can be prevented, the following measures can reduce risk:
- Perform regular pelvic floor exercises, especially during and after pregnancy.
- Avoid heavy lifting and chronic straining.
- Maintain a healthy weight to reduce abdominal pressure.
- Seek treatment for chronic coughs or constipation.
Final Thoughts
Prolapse is a common yet manageable condition that can significantly impact daily life if left untreated. Pelvic physiotherapy provides a safe, effective pathway to recovery, empowering individuals to regain control and improve their well-being. Whether through tailored exercises, lifestyle advice, or additional support, pelvic physiotherapy is valuable for those experiencing prolapse.
