PROLAPSE - What is this bulge out of my vagina?

Prolapse happens out of the blue -

• it may happen after you repeatedly strain with constipation
• it may happen after your baby is born and you return to lifting or the gym without first strengthening your pelvic floor/core muscles
• it may occur at menopause when you lift heavy grandchildren or develop a chest infection and cough for 4 weeks non stop
• after pelvic surgery e.g. hysterectomy

What is prolapse?

Prolapse is where the vagina, bowel or cervix bulge down into the vagina and even protrude out of the vagina.

It happens when the supporting ligaments from above are stretched too much (by constant coughing, lifting or straining) and the underlying pelvic floor muscles aren’t strong or coordinated enough to hold up the internal organs.

Researchers tell us some women when asked to tighten and lift their pelvic floor muscles, actually push down – they have the action completely reversed. These women are at a higher risk of developing prolapse which is why childfree women also get prolapse.

How would I know if I have a prolapse?

This is how many of my patients describe a prolapse – “it feels as though my insides are falling out” and one woman even thought she “had woken up with a penis”. Obviously this is a highly distressing affliction for any woman.

Prolapse is described in 3 stages -

Stage 1 is where the vaginal walls bulge internally (most common)

Stage 2 is where “a golf ball appears at the vaginal entrance”

Stage 3 is where the bladder, bowel or cervix protrude externally out of the vagina

Help – what can I do about my prolapse?

Your options are to visit your Doctor who will refer you to another Doctor specializing in prolapse for a diagnosis and treatment options. Your doctor may insert a Pessary support which holds the organs up internally which is a good non surgical option while you work on pelvic floor strengthening. Some Doctors will advise surgery immediately and while this option may suit some women, others are glad they took the time to find and strengthen their pelvic floor/core muscles first.

Research shows 30% of women who are surgically repaired, prolapse again requiring further surgery with even less chance of success.

Stage 3 prolapse (the most severe) is usually treated by surgical repair.

The benefit of visiting a Physical Therapist who has a special interest in pelvic floors is learning the correct pelvic floor exercises and being guided with strengthening exercises and life style modifications.

Many women find after strengthening their pelvic floor and core muscular control, their prolapse reverses.

Daily pelvic floor exercises then maintain this improvement along with avoiding heavy lifting and bowel straining. These women often decide not to have surgery because they can manage their prolapse with exercise and life style modifications.