What are the symptoms of Prolapse and how to treat it?

Pelvic organ prolapse is often categorized as a condition affecting older people. However, due to the variable factors that contribute to developing prolapse, it can be noted among younger people as well. Based on symptoms reported, pelvic organ prolapse has a prevalence of about 3 to 6%. This prevalence increases drastically, to about 50%, when a vaginal examination is performed to investigate the underlying cause for a person’s physical complaints. 

Since there’s a significant variation in the symptoms reported for pelvic organ prolapse, it’s truly important to understand how your pelvic floor functions so that you are aware of when your pelvic floor is healthy and when it’s experiencing problems. The “good” news? Pelvic floor prolapse is treatable, with minimal intervention when detected early. In the case of prolapse, early detection is key! 

What is a pelvic prolapse?

In simple terms, a prolapse of any of the pelvic organs occurs when they slip from their normal position within the pelvis.

The pelvic floor is a support system for your pelvic organs that also assists the function of external and internal passages of the pelvic floor. The bladder, uterus, vagina, and rectum are the primary structures that rely on a strong pelvic floor.

With pelvic organ prolapse, one or more of the organs have started to sink from their position within the pelvis. This is primarily due to a weak or injured pelvic floor. 

How do you get a pelvic prolapse?

There are several ways in which one can develop pelvic prolapse.

Age is a primary risk factor for developing pelvic prolapse.  Studies have indicated that pelvic organ prolapse is often observed in people above 45 years of age. With age, the degree of prolapse and symptoms also increase as the pelvic floor further weakens. This makes surgical intervention a likely possibility for the management of prolapse with age. 

Following age, childbirth is another common cause for prolapse. During childbirth immense pressure is placed on the pelvic floor through stretching of the pelvic fascia. Additionally, the length of pregnancy also adds strain to the pelvic floor. During delivery, experiencing trauma or the requirement of external interventions to facilitate delivery, can further weaken the pelvic floor. Having multiple vaginal deliveries is a contributor to prolapse.

Conditions such as having a chronic cough or recurrent constipation are increasing the pressure you apply on your pelvic floor. Over time this weakens the pelvic floor making the organs susceptible to prolapse. Which is why treating underlying causes of constipation, or kicking the smoking habit to the curb, become cornerstones of lifestyle changes required to manage pelvic organ prolapse. 

Another cause linked to prolapse is obesity. Being significantly obese adds pressure to the pelvic floor. With time this added pressure can weaken the pelvic floor. Coupling this with constipation or other possible conditions associated with obesity, escalates the chances of developing pelvic organ prolapse if you're obese.

Surgical procedures that involve the pelvic floor, such as a hysterectomy, are also potential risk factors as well.

How do I know if I have a prolapse?

Signs and symptoms of a pelvic organ prolapse can vary from one person to the next. The reasons are that both the organ involved as well as the degree of the prolapse can differ. 

For most, it isn’t until the vagina, uterus, bladder, or rectum descend significantly into the pelvic floor that they begin to experience symptoms. In fact, mild prolapses might go on for years without presenting any significant signs.

Signs you should get checked for pelvic organ prolapse include:

  • An unusual feeling of fullness in your vagina or pelvic floor
  • You feel a bulge or protrusion within your vagina
  • A nagging backache, especially when you stand
  • A discomfort or struggle during penetrative sex
  • Urine that leaks between bathroom breaks
  • Increased frequency to pee
  • Struggle with proper bowel movements

As we mentioned, the symptoms experienced with prolapse can vary depending on the organ that is involved. This means that a prolapsed urinary bladder will result in symptoms relating to your passage of urine, and so on.

Most of the symptoms will observe a notable decline throughout the night since there’s less pressure being applied to the pelvic floor. However, as the day progresses, with pelvic organ prolapse, you will notice increasing discomfort.

How is a prolapse treated?

If you’re currently experiencing one or more of the symptoms that are listed for pelvic organ prolapse consider visiting your primary care physician.

During your doctor visit be sure to explain all the symptoms you are experiencing. Your doctor will conduct a routine pelvic exam during your visit to confirm the presence of pelvic organ prolapse and guide you in the next steps towards treating it.

One of the foremost ways to manage pelvic organ prolapse is through physical therapy and lifestyle changes. Pelvic muscle therapy, such as performing Kegel exercises, will be conducted during a physical therapy session. These small but mighty exercises will gradually improve pelvic floor muscle strength over time. 

A vaginal pessary, which is a silicone support device, might be placed inside your vagina for small prolapses. Studies show that vaginal pessaries can provide  significant relief along with Kegel exercises for those experiencing prolapse symptoms.

Surgical methods are reserved for prolapses that cannot be treated through less invasive techniques. In cases where initial non-invasive methods fail, surgery is considered as well. Most surgical procedures aim to strengthen the weakened pelvic floor and put the prolapsed organ back into its position.

In the case of severe uterine prolapse, a hysterectomy can be considered only if the desire to not have any children or significant discomfort is relayed to the surgeon.

Can I prevent a prolapse?

We know that the information in this article may seem scary, but don’t worry, there are many things you can do to prevent prolapse from ever happening, starting with maintaining a strong pelvic floor. Be sure to visit your physiotherapist and perform your Kegel exercises correctly to maintain a strong pelvic floor. Below are some factors that can add strain to your pelvic floor, further weakening it. AKA, things to avoid!

Being overweight or obese can increase the pressure placed on your pelvic floor, weakening it over time. Which makes maintaining a healthy weight essential. Meet with your doctor to discuss your healthy weight and the appropriate and effective ways that you can meet this weight.

Chronic coughing and constipation were earlier cited as possible risk factors that can weaken the pelvic floor. This means managing these conditions by taking care of their underlying cause can help minimize the strain on your pelvic floor.

While general exercise can also help with maintaining a healthy pelvic floor, consider safer methods while lifting heavyweights. Be sure to correctly train your muscle groups and try to avoid putting excess pressure on your pelvic floor.

Finally, practice your Kegel exercises regularly! It’s the simplest method to strengthen your pelvic floor and decrease your risk of prolapse.

Article written by
Michelle Frank, Medical Doctor
Director: Health & Wellness at Naima


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