Pelvic Organ Prolapse – a physiotherapy perspective
Pelvic organ prolapse is extremely common, affecting 41–50 percent of women (Barber and Maher, 2013). For many, it may not cause symptoms, but for others it can be quite debilitating, affecting daily activities, recreation and sport. For some it affects intimacy and sexual function. However, despite the fact that it is so common, there is a huge lack of awareness about what a prolapse is. Women don’t know how to prevent it happening and they don’t know where to go to get help if they do have symptoms.
Childbirth, age and menopause are all risk factors for prolapse (Tineke et al, 2007). As women age, and then experience hormone changes at menopause, the chances of getting a prolapse increase. But it’s not just a condition that affects older women. As a pelvic health physiotherapist, I also see young women who present with prolapse following childbirth. For some this may become an issue straight away, for others it may not be until several months, or even years, after the baby is born.
A vaginal prolapse occurs when the bladder, bowel or uterus are no longer held in place. The bladder or bowel can slip down and cause the vaginal wall to bulge inwards, or the uterus can slip down in the vaginal canal.
We can’t help the stretching that happens during a vaginal delivery, and we certainly can’t stop the ageing process, or prevent ourselves reaching menopause. But we can limit the amount of stress and strain on the pelvic floor over our lives, by modifying daily activities.
Being careful with heavy lifting, contracting the pelvic floor when coughing and sneezing, watching your weight, and avoiding constipation or straining will all help (Miedel et al, 2009). Learning how to strengthen the pelvic floor and use it in a functional way will also be of benefit, as the pelvic floor provides support for the pelvic organs. Women with prolapse can get rid of their symptoms with pelvic floor training.
It is important that women restore their pelvic floor function as best they can after vaginal birth before embarking on an exercise programme, to help prevent prolapse occurring. This is particularly important for women who may want to do higher level exercise, running or high impact sports.
If you’re not sure how to isolate and strengthen your pelvic floor, get in touch with a local pelvic health physiotherapist. They have extra skills and training to help women with pelvic floor problems, including prolapse. The aim is to help women achieve their exercise and lifestyle goals – be it lifting children, walking, running, climbing etc. Every woman should be able to participate in the activities they enjoy, and not be limited by any form of pelvic floor dysfunction, including prolapse.
It disappoints me that there are so many women with this condition, yet there is such a lack of awareness about it. Often women don’t seek help – they don’t know where to go, and many don’t even know that help is available. Pelvic floor problems cause shame and embarrassment, are not talked about and women end up suffering in silence.
I am so pleased that Anja is highlighting prolapse issues by creating this website, including the story of her personal experience, and those of others. Real stories by New Zealand women will enable others to see that they are not alone, and that they can get help.