PELVIC HEALTH CARE
Pelvic organ prolapse (POP) is the downward displacement of the pelvic organs (bladder, bowel or uterus) resulting in movement towards the vaginal canal or a herniation through the vagina or anal opening. POP is common, with research demonstrating 40-50% of women over 50 have some degree of prolapse.
The pelvic organs are normally held high within the pelvic cavity by two support systems:
‘Pelvic Floor Muscles’ – a sling of muscle which lies between the tailbone and pubic bone creating a sling of support for our pelvic organs. Sometimes these muscles can become weak or damaged which may lead to a reduction in support for the pelvic organs which rest above them.
Connective Tissue System:
‘Endopelvic fascia’ – a network of connective tissue which provides support to the walls of the vagina. This fascia can become stretched or torn, reducing support of the pelvic organs.
If one or both, of the support systems for our organs become compromised, for example after childbirth, during pregnancy or following high levels of abdominal strain. Women will often report a lump or bulge at the vaginal entrance, especially after heavy exercise, long periods of time on feet, or following straining to defecate.
In many cases the POP can be asymptomistc and only seen on pelvic examination.
The symptoms of POP can vary for each individual and can be dependent on which organ is shifting. Some symptoms which women often describe include:
Pressure, heaviness or discomfort in the vaginal or pelvic area (often made worse by long periods of standing, exercise or lifting)
Low back ache
Change in control of bladder or bowel, including urgency or frequency
Slow urine stream or initiation of urine flow
Incomplete emptying of bowel or difficulty with evacuation
Discomfort during intercourse
Types of Pelvic Organ Prolapse
Anterior vaginal wall compartment – A dropping of the bladder towards the vaginal entrance.
Central compartment – A dropping of the uterus and cervix towards the vaginal entrance.
Posterior vagina wall compartment – A dropping of the rectum towards the vaginal entrance.
Physiotherapy can be highly effective in reducing the symptoms and stag of POP, especially in mild to moderate cases. We know from the research that when a structured program by a womens health Physiotherapist is undertaken that an improvement of POP by one stage, symptoms reduction and a 50% increase in pelvic floor muscle bulk occurs.
In our assessment we will be aiming to identify where the POP is originating from, the severity, the level of lack of support (Pelvic floor, connective tissue or both) and any other contributing factors.
In moderate to severe prolapse it is likely that damage has not only occurred to the muscles but also the connective tissue which provides support to the organs.
A treatment program at WIF will usually include:
Optimising breathing patterns
Assessing and retraining abdominal muscle recruitment
Pelvic floor strengthening
Lifting and movement reduction
Pessary insertion in our Pessary Clinic
Referral for surgical consult in some more severe non responding cases may be necessary