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Physiotherapy for pressure down there?

    Yes, you read that correctly. We’re going to jump right into it! Let’s talk about pelvic organ prolapses.

    If there is one thing that I’ve noticed in practice… it can be extremely difficult to talk about your pelvic organ prolapse. I can completely understand why. Although it may feel like your bladder could just “fall out”, this is certainly not the case. Today, we’re going to shed some light on some of the misconceptions about pelvic organ prolapses, provide some information about evidence-based management strategies, and hopefully let you see that a prolapse is not a life sentence.

    What is a pelvic organ prolapse?

    A pelvic organ prolapse is the descent of one or more of the pelvic organs from their normal position in the pelvic cavity, most commonly through the vaginal canal. This can be your bladder, urethra, uterus, and/or rectum. This may be surprising, but prolapses are quite common among women with 40% of postmenopausal women having a prolapse, regardless of having a hysterectomy . But no one really talks about it. So it can feel isolating when you feel that you are the only one experiencing these symptoms. Now, I should mention that not everyone with a prolapse on examination is symptomatic, this will depend on the severity of the prolapse, your activity levels, medical and family history.

    What causes a prolapse?

    So… this is where things get a little tricky. Vaginal birth continues to be a significant risk factor, especially if you had multiple births or your babies were bigger than the average. But there are women you have multiple vaginal births with no signs of a prolapse, so there must be other factors that affect your risk. And the latest research tells us that genetics can play a big role! There are specific genes that can affect the elasticity and strength of the pelvic floor. What is currently hypothesized is that pregnancy and vaginal birth may not directly cause a prolapse in women with a genetic predisposition, but rather can further increase your risk of developing a prolapse. We also know that reduced sex hormone levels, age, obesity, and constipation are risk factors for prolapse.

    What can you do to fix this?

    There’s lots that can be done! And surgery may not be necessary to address your symptoms. The first-line of management for prolapse is actually pelvic floor muscle training! Research has shown that this type of training can significantly reduce your symptoms for mild to moderate forms of prolapse. For optimal success, you will also need to address some of your other risk factors like constipation and weight gain. Now, I know what you’re thinking. How are you supposed to exercise if you feel like your bladder is bulging out? There are actually many strategies you and your pelvic health physiotherapist can discuss to help reduce your symptoms when you exercise and choose which exercises are appropriate for you right now and work up to your exercise or fitness goals. What about constipation? I’ll save this one for later as it deserves its own blog post.

    Need more immediate relief?

    We all know that it can take some time to feel the effects from exercise. One strategy to help reduce your symptoms while still engaging in your pelvic floor muscle training is a pessary, which is a device that can be inserted vaginally to support your organs. These devices can be inserted as needed or can be indwelling. This is an option you can discuss with your family physician or gynaecologist. So, why would you do pelvic floor exercises if you can just use a pessary? Well, the research shows us that a pessary is not anymore beneficial than pelvic floor muscle training. But if you require immediate relief of your symptoms or do not want to go the surgical route, a pessary may be a great option for you! But don’t forget about your pelvic floor muscles, they still play an important role supporting your pelvic organs, as well as sexual and digestive function.

    Myth busting time

    Let’s address some misconceptions that have been floating around on the internet. The most common question I get in my practice is “Will my prolapse be worse if I have sex?” No, you may need to engage in different positions to make intercourse more comfortable, but it is completely safe. However, research shows us that women are less likely to be intimate as a result of body image concerns. So, if this is truly a concern for you, bring this up to your medical professional and discuss options to address your worries and concerns.

    The next misconception is a comment that I get frequently. “I had a c-section, so there’s no way I will have issues with leakage or prolapse.” Although this was believed by many practitioners not too long ago, the latest research tells us that a cesarean may not be as protective against pelvic floor disorders as we previously thought. Specifically, there are similar rates of prolapse with those who had spontaneous vaginal delivery and a c-section while in active labour. However, elective c-sections can result in fewer prolapses.

    This information is for educational purposes only. Please speak with your OBGYN/midwife about what options are best for you.

    Now, if reading this made you a little nervous about pregnancy, child birth, intercourse or engaging in physical activity. Don’t be! Prolapses are very common and there are many ways to manage it. There is no need to stop your life because of this. Book an appointment with your local pelvic health physiotherapist and see what works best for you!

    Until next time,