What is a Pelvic Organ Prolapse (POP)?
A prolapse is when the supporting ligaments and muscles in the pelvis have weakened. This leads to one or more of the pelvic organs – bladder, uterus/womb or rectum falling downwards.
You may feel it is a bit uncomfortable, feel a heaviness or dragging sensation in your vagina or find sex painful.
Types of prolapses
There are different types of POP’s. The main forms of prolapse are:
- Bladder / Cystocele – this is when the bladder protrudes through into the vagina
- Rectocele – when the rectum pushes through/bulges into the vagina
- Uterine – where the uterus descends down to the vagina
- Vaginal Vault – this is when the vagina descends from its position – more common with women who have had a hysterectomy.
I like this diagram too:
Different grades of prolapses
There are also different degrees/levels of prolapse.
- Stage 1 / 1st degree – often a women doesn’t know she has a prolapse until she is examined
- Stage 2 / 2nd degree – may feel a slight dragging/heavy feeling in the vagina. Sex can be uncomfortable.
- Stage 3 / 3rd degree – more obvious symptoms and sometimes slightly visible when looking at the vagina
- Stage 4 / 4th degree – this will be very uncomfortable and will be very obvious, with this stage being much more visible
What to do if you suspect you have a prolapse
Firstly, please don’t panic and think your whole world has fallen in. It is upsetting to think you may have a prolapse, but there is help and there is a lot that can be done.
The 1st thing to do is to book in to see your GP. Always ask your GP practice who is the best Women’s Health GP in the practice. She or he may then examine you internally to see how everything feels.
They may then refer you to see a Women’s Health Physio (WHP). You probably don’t need to see a gynaecologist, certainly not at the start. A women’s health physio is a specialist on all pelvic floor matters. They will examine you and then advise on the best things for you.
IF you have private health insurance then you may want to be seen quicker. There are some excellent WHP at private clinics, physio or osteopath clinics here in Bristol and in most cities/towns. I am always happy to enquire for you so get in touch. I have some excellent & lovely WHP here in Bristol I can always suggest.
What you can start doing immediately
Whilst waiting to see a WHP or even your GP. You can start thinking more about your body, how you breath, whether you hold you breath and also start doing more regular ‘kegals’.
The muscles in the pelvic bowel are just like other muscles – they need to be worked & with a full range of movement. What I mean by that is that they need to be engaged & ‘activated’ as well as relaxed and lengthened. So the easiest thing to start doing is very gently – close the orifices (hold a fart & a wee!!) whilst exhaling.
When I ask someone to do a pelvic lift 99% the time they do it holding the breath. So when you do a ‘pelvic floor exercise’ just try not to hold the breath, sigh out, exhale, sing, hum or whistle. This will prevent causing ‘intra-abdominal pressure’ which pushes down on the pelvic floor.
Until you have seen a WHP, I would stop all types of sit ups. If you are a new mum, try and roll over to the side to get up, use your hands to push you up and again avoid holding the breath.
The same goes for getting up from a chair, pushing or pulling something heavy – avoid holding the breath, engage the pelvic floor and exhale just before the pressure.
Finally, if you have a cough or cold this can be very hard on the pelvic floor & a prolapse. The more you can try and do a pelvic floor close and lift just before you do cough/sneeze it can offer some support.
Ok, so as I said above, a prolapse occurs when the muscles and ligaments in the pelvis weaken and can’t hold the pelvic organs in place. I always like this diagram. Its like a boat in harbour, sitting on top of the water due to the strong lines that hold them in place. However, when they weaken or loosen off the boat may drop lower in the water.
Other blogs about the pelvic floor are here: https://www.vickihill.co.uk/pelvic-health/