PROLAPSE: WHAT YOU NEED TO KNOW
You may of heard from your mom or your grandmother about “Fallen-bladder Syndrome” and it sounds SCARY. What is that? Will I wake up and my bladder is laying on my bed?
What they are referring to is what is called a Pelvic Organ Prolapse (POP). And for the record, no, you won’t wake up and there is an organ laying there.
POP is when the muscles, ligaments and tissues of the vaginal wall begin to lose strength and elasticity. Those structures are responsible for holding the rectum, uterus and the bladder where they should be, but with a change in tissue structure, they descend into the vaginal canal.
We’re going to stop you here for a second. If you Google Pelvic Organ Prolapse a bunch of cartoon images come up and sometimes other pictures. If you take off your filters for Google then the pictures can be even more scary. Just so you know, most of the pictures are like cow, sheep and dog vaginas and it is terrifying. This is not what you look like!
Now, many people start to notice POP when one day they feel “something is there” or they may describe that they feel a lot of pressure at the end of the day, maybe even experience pain. Some describe the feeling like there is a bulge or a ball of tissue and you may even see it. Other common symptoms include pressure or heaviness after constipation, sometimes even back pain can be associated with a POP. Furthermore, there is often urinary or bowel symptoms such as urge or incontinence.
Why does it happen? Well, childbirth, chronic coughing, constipation, menopause, surgeries, genetics, family history, increasing age and obesity can play a role in the development of prolapse. One misconception is you have to have a vaginal birth for a prolapse to develop. While it is more common, we have seen women who have not had children or had c-sections who have them. So if you feel something there or have the feeling of heaviness, and you haven’t had kids, you aren’t making it up! It could be a POP.
Can I ever participate in high impact exercise again? The answer is yes/maybe. The good thing about POP is it is a functional issue. This means that yes, although the tissues may have lost elasticity, some training and changes in muscular tone, strength, coordination and endurance can help.
Think of it a bit like a hamstring pull. The tissues got over-stretched, some maybe even torn. You feel pain when you participate in certain activities but maybe not so much in others. As the tissues heal and you learn proper mechanics and exercises, you can tolerate more and more before you feel pain or weakness. Maybe you even use some K-tape to help you out! At some point, you are back to regular activities and maybe have to stick with some modifications for a while.
Same goes for a POP. Usually, we go back to basics and give the tissue some time to heal and time for the strength of the muscles to come back. Just like a hamstring pull, we may back off of running for a little bit, or back off of the full WOD in CrossFit. During that time we work on specific exercises for the pelvic floor, core and the rest of your body to learn to tolerate these activities again. In the mean time, we may also get you fitted with a pessary. This is like K-tape or a brace for the bladder. It helps give support while you do your rehab. Then maybe you just need to wear it for activity! Pessaries are NOT just for old ladies. They can be really helpful! We will also work on other factors like constipation! This is a big one for aggrevating POP.
Soon, we start to look at the activities you want to get back into. Do you love running? CrossFit? Yoga?
We will take the components of each of those activities and try them out. We will change your form, change breathing strategies and potentially change the exercise to better suit you. From there, we start to build up tolerance. Do you get your symptoms at 4km of running? Only with double-unders in CrossFit? This is where the “maybe” comes in. We like to work just under that tolerance. So maybe there are specific activities that just aren’t great for you, or maybe you just need time. Overall, the goal is to get you back to what you love doing. We will say that it is more often than not, women can get back to their activity of choice without symtpoms!
What about surgery? If you have gone to your doc about these issues, one thing that may happen is you get a referral to see if you are a candidate for surgery. For some women, I believe that surgery is a good option but I think women need to be better informed. Most surgeries only last 10-15 years. If you don’t work on the pelvic floor muscles, they won’t just magically learn to work properly to prevent the same issues you had before surgery from happening again. Surgery doesn’t train muscles, core or breath. Those strategies need to be learned. Furthermore, some surgeries have side effects like incontinence. So maybe you don’t have the feeling of pressure but now you pee? Great. Again, I think surgeries can definitely be part of the picture, but I sure know many people who do well without surgery. In fact, in a multi-centre randomized control trial on individual pelvic floor muscle training, there were significant improvements in subjective reports by those who underwent pelvic floor physiotherapy with a POP at 1-year compared to those who did not receive pelvic floor muscle training.¹
But I have a grade 2 prolapse: my answer is alright, good to know, but let’s move on. Yes prolapse is graded 0-4. Grade 1 is a little descent, grade 2 is to the introitus, 3 is past the introitus and 4 is fully descended. Here’s the thing though: there are many women walking around with “bad” prolapses and have no symptoms, and there are people with barely a grade 1 who feel a lot of symptoms. So just because you have a certain “grade” doesn’t mean that you will have symptoms.
The biggest thing we want people to be aware of when it comes to POP is not to FEAR. Reading things online can really freak you out, but we honestly see women do much better when they aren’t scared to move. You have to move. Blood and nutrition to the pelvis is important for healing! We just have to figure out the BEST way to move for you. Sometimes that fear or stress of feeling the POP actually causes the muscles to be so tired they can’t support the POP. This then in turn doesn’t allow the muscles to function properly. Remember, muscle relaxation is always equally important to the ability to contract.
Our other piece of advice is to check yourself out. Do you notice when you cough you see some tissue come down? Again, you might not have symptoms but it might be good to know. It could be a sign that maybe you need a quick check up with a pelvic floor physio to walk you through some prevention exercises and how to go through your mode of exercise in the best way possible! In my mind prevention is key. This is even true if you do decide surgery is the way to go. Check out your local pelvic floor PT to have some exercises to work on both before and after surgery to ensure the outcomes are the best possible!
Hagen, S., Stark, D., Glazener, C., Dickson, S., Barry, S., Elders, A., … & McPherson, G. (2014). Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. The Lancet, 383(9919), 796-806.
