PROLAPSE

Pelvic organ prolapse (POP) affects 50% of childbearing women. The pelvic organs are supported by the pelvic floor muscles (PFMs) and their intact attachments to the endopelvic facsia. POP occurs when an organ(s) slips down or herniates into the vaginal walls. Milder forms of prolapse are visible on vaginal examination and prolapse is more severe when the organ bulges out of the vaginal entrance.

Types

  • Anterior vaginal wall where the bladder and/or urethra slip down into the front vaginal wall.
  • Posterior vaginal wall where the rectum or small intestine slip down into the back vaginal wall.
  • Utero-vaginal prolapse occurs when the cervix descends vaginally.
  • Rectal prolapse occurs when the rectum is lower than the anal sphincters or the rectum telescopes internally like a tube within a tube.
  • Vault prolapse occurs (usually associated with hysterectomy) when the top of the vagina collapses down vaginally.

Causes

  • Genetic factors – women with hyper mobile joints, connective tissues disorders and Caucasian heritage have an increased prevalence of prolapse.
  • Daughters have an increased risk of prolapse when their mother had a prolapse. Ultrasound studies have found unexpectedly high rates of mild to moderate prolapse in young and/or asymptomatic women.
  • Age plays a role with some types of prolapse (but not all types). The collagen content of the PFMs is oestrogen dependent and studies show a reduction of collagen content in women with prolapse when compared with women without prolapse, regardless of their menopausal status.
  • Birth related pelvic trauma – the risk of PFM tearing (avulsion injury) is greater in women having their first baby after age 35. Damage to the pelvic floor, vagina and supports is increased when birthing interventions and poor birthing positions are used.
  • Surgery – pelvic surgery causes alteration of nerve supply and blood vessels to tissues and increased loss of collagen. Some researchers advise surgery should only be considered after the patient has trialed and failed with a pessary.
  • Lifestyle habits – straining with chronic constipation, heavy lifting, prolonged coughing and inappropriate exercise promotes prolapse.
  • Retroverted uterus – research shows that the 20% of women whose uterus tips towards the spine (instead of forward over the bladder) have a higher risk of developing more advanced utero-vaginal prolapse.

Helpful Tips

  • Eat foods rich in lysine and vitamin C to promote healthy collagen. Skin doctors describe sugar as being the ‘enemy of skin’ as it promotes wrinkles (loss of collagen).
  • Orgasm is beneficial to improve circulation and muscle tone in PFMs. Utero-vaginal prolapse may cause uncomfortable intercourse but there has been little difference reported is overall sexual function between women with and without other types of prolapse.
  • Learn pelvic floor friendly ways to exercise and prevent the risk of prolapse caused by over challenging exercise.
  • Be aware of lifting correctly (spine straight, bottom out) and limiting the weight lifted to prevent straining internal supports and promoting POP.
  • Treat allergies or a chest infection early to prevent prolonged sneezing and coughing.
  • Posture, posture, posture – keep the automatic activity of pelvic floor and core muscles switched on with ‘Tall’ posture.
  • Keep stools soft to avoid straining with bowel emptying.
  • Improve PFM strength with specific exercises and biofeedback to provide organ support during daily activity to reduce the risk of prolapse.
  • Speak with healthcare providers about trialing a pessary vaginal support as surgical repair is not always successful or suitable for some women.
  • Speak with healthcare providers about the use of vaginal moisturizers or suitability of oestrogen cream or tablets to combat dryness and loss of muscle tone.
  • Seek weight management advice to reduce abdominal/pelvic pressure on internal organs.

Prolapse is diagnosed by vaginal examination and/or ultrasound imaging to accurately determine the type of prolapse.

Read about protective habits and pelvic floor friendly exercises in Hold It Sister. New mothers will learn self-examination in Hold It Mama to determine the presence and type of prolapse or perineal damage along with specific exercise programs to restore trunk and pelvic stability post baby.