What to Do If You Have Pelvic Organ Prolapse
Pelvic organ prolapse occurs when weakness in the pelvic floor muscles or supporting ligaments causes the vaginal wall to bulge inward. Several pelvic organs can be involved, and the condition is categorized by both type and stage depending on where the weakness is and how far the prolapse has progressed.
Common symptoms include a feeling of heaviness or pressure in the vagina, which often worsen after physical activity or extended time on your feet. Pelvic floor physical therapy is typically one of the first treatment options recommended, as it can address muscle weakness and provide tools for managing symptoms.
Not all prolapse stems from muscle weakness, and some cases are rooted in ligamentous laxity that conservative care cannot fully resolve. Understanding that difference is central to deciding whether pelvic floor physical therapy, lifestyle changes, or surgical intervention is the right path forward.
Pelvic organ prolapse can sound scary if you don’t know what it is. But having a better understanding of what is happening to your body after diagnosis can ease your mind. I always say, knowledge is power!
What Pelvic Organ Prolapse Actually Is
Pelvic organ prolapse happens when there is weakness in the supporting structures of the vaginal wall including ligament laxity and/or muscle weakness.
Prolapse can happen at different areas of the vaginal wall based on the source of weakness. That weakness causes the vaginal wall to bulge into the vagina at different degrees.
Types of vaginal prolapse:
Uterine prolapse is when the uterus lowers into the vaginal canal
Vaginal vault prolapse can happen to people who have had a hysterectomy and the top of the vaginal canal collapses down into itself because there is no longer a uterus there.
Cystocele is when the bladder pushes on the anterior vaginal wall causing a bulge in the anterior wall of the vagina. This can also be called anterior wall prolapse.
Rectocele is when the rectum pushes on the posterior wall of the vagina causing a bulge in the anterior wall of the vagina. This can also be called posterior wall prolapse.
Enterocele is when the intestines push on the vaginal wall causing a bulge on either side of the vaginal wall. This is a more rare form of prolapse.
Stages of prolapse:
Stage 1- when the bulge of the organ pushes down but is still within the vagina
Stage 2- when the bulge of the organ pushes down to the vaginal opening
Stage 3- when the bulge of the organ pushes down partially outside of the vagina
Stage 4- when a large part or whole organ is pushed outside of the vagina
What Causes Prolapse
The major structures that are affected with prolapse are the pelvic floor muscles and the pelvic supporting ligaments. The ligaments can become elongated or stretched from childbirth and are unable to effectively support the pelvic organs (and other organs stacked on top of those) effectively.
The cardinal and uterosacral ligaments allow for suspension of the bladder and uterus in the anatomical position.
Unfortunately, these connective tissue ligaments do not shrink back to their original size after stretching so that can cause laxity allowing more movement of the uterus and/or bladder, which in turn can cause it to move into the vaginal wall causing that bulge.
When the pelvic floor muscles are weak around the vaginal wall that can also cause bulging of structures such as the rectum, intestines, uterus, or bladder into the vagina.
Weakness can be caused secondarily to increased pressure at the pelvic floor. Activities that increase pressure at the pelvic floor include holding your breath while exercising, and straining and/or pushing to go to the bathroom.
Symptoms of Pelvic Organ Prolapse You Might Notice
Common symptoms you may experience if you have pelvic organ prolapse include heaviness and/or pressure in the vagina.
It can feel like you are sitting on a golf ball. Symptoms can be worse after increased activity, being on your feet a lot, or after going to the bathroom.
Pelvic organ prolapse can also occur during pregnancy because of the changes happening to your body.
I know that these symptoms can affect your quality of life. Just know that there are treatment options for you!
How Prolapse is Diagnosed
The gold standard for diagnosing prolapse is imaging such as a CT or MRI to truly be sure of which organ is prolapsed. But a vaginal exam can be performed to determine if you have anterior or posterior vaginal wall prolapse using a gloved finger or speculum.
Lifestyle Changes that Can Help
Eliminating pushing or straining when going to the bathroom can help with prolapse symptoms and reduce the risk of making the prolapse worse. And avoiding holding your breath when working out or lifting things can help reduce the strain on the pelvic floor that can contribute to prolapse.
What to Expect From Pelvic Floor PT
The focus of pelvic floor PT for treatment of pelvic organ prolapse will be to determine if there is a pelvic floor weakness component to the root cause of your prolapse.
If there is, you will work on pelvic floor strengthening techniques and learning breathing mechanics to reduce pressure on the pelvic floor. Please know this is so much more than Kegel exercises.
Your pelvic floor PT will also give you tools to manage your symptoms of heaviness, such as positioning to reduce the pressure at your prolapse, proper bathroom mechanics, and maybe even vaginal splinting techniques to help with going to the bathroom.
When Surgery is and is Not the Answer
Pelvic floor physical therapy can help you strengthen your pelvic floor, but it cannot change the integrity of your supporting pelvic ligaments that I mentioned earlier. And that's exactly why we have other treatment options.
So if you have a strong pelvic floor, and your prolapse is caused by ligamentous laxity you are likely a candidate for surgery.
A pelvic floor physical therapist can examine you for presence and stage of prolapse, as well as your pelvic floor strength and conservative treatment can start by addressing that. Conservative treatment is always a good start, because it won’t make things worse.
If your pelvic floor PT feels that your prolapse is not due to pelvic floor weakness, they can refer you back to your doctor for imaging to determine the cause of prolapse and surgical options.
Where to Find Pelvic Floor Therapy for Prolapse in Meredith, NH
If you are experiencing heaviness or pressure in your vagina that you think could be a prolapse, schedule a discovery call to learn more about working with me! I service the Lakes Region of New Hampshire out of my clinic in Meredith.
Book a discovery call or an evaluation to get started. I would love to be a part of your pelvic health journey!
My office is conveniently located in downtown Meredith, and I offer individualized pelvic therapy for women who want to stay healthy and active without leaking.
Next on your reading list:
**The information provided on this blog is intended for general wellness education purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physical therapist, physician, or other qualified health provider with any questions you may have regarding a medical condition