Have you ever heard of pelvic organ prolapse (POP)? It sounds scary and it can feel scary when you have symptoms of POP. However, armed with truth and knowing exactly what’s going on with your body, you can heal from POP with physical therapy! Let’s first understand what POP is.
What is Pelvic Organ Prolapse (POP)?
Pelvic organ prolapse is the descent downward of one or more of the pelvic organs (bladder, uterus, or rectum) into the vaginal canal. When you have pelvic organ prolapse you could experience a number of symptoms including:
Feeling extra tissue when wiping after peeing or pooping
Feeling something more than normal between your legs in standing (or sometimes sitting!)
Feeling heaviness of the pelvic floor and maybe even a “falling out” sensation. This typically happens towards the end of the day when your pelvic floor muscles are tired and gravity has taken effect all day.
Other more ambiguous signs of prolapse can include difficulty emptying your bladder or bowels, low back pain, pelvic pain, tailbone pain, and pain with sex. You can have your pelvic floor physical therapist, midwife or OB check you for prolapse.
Pelvic floor physical therapists often check for prolapse in positions other than the classic stirrup position in a gynecologist’s office. Prolapse often occurs with gravity-dependent positions (standing and upright activities), so it’s important to check for prolapse in those dependent positions, as it may not always be apparent when lying on your back.
To measure the severity of POP, there are 4 grades of measurements according to the Baden-Walker Halfway Scoring system for pelvic organ prolapse:
0- No prolapse
1- Descent halfway to the hymen
2- Descent to the hymen
3- Descent halfway past the hymen
4- Maximal possible descent for each site
Once we have a baseline starting measurement, it’s important to recheck your measurements after some time to make sure you’re improving and PT is working!
How can pelvic floor physical therapy help heal pelvic organ prolapse?
Now that we have defined POP, what can be done about it!? Pelvic floor physical therapy can be tremendously helpful.
1 - Strengthen the pelvic floor muscles
A pelvic floor PT will teach you how to contract your pelvic floor muscles so that those muscles provide support and keep the prolapsed tissue “in” instead of letting the tissue fall “out.” Here’s a quick tutorial to understand exactly what the pelvic floor is and help you do a productive pelvic floor muscle contraction.
2 - Strengthen the muscles around the hip
Along with pelvic floor strength, hip muscle strength needs to be optimal to heal prolapse. Pelvic floor physical therapists will test your hip muscles and recommend exercises to increase hip muscle strength. The pelvic floor muscles and hip muscles are intimately connected and often work together to provide support.
3 - Intra-Abdominal Pressure Management
A pelvic floor physical therapist will assess if imbalances in intra-abdominal pressure are contributing to your prolapse. Intra-abdominal pressure could be increased if your abdominals are tightened or in a clenched holding position, or if your breathing mechanics aren’t optimal. For more about intra-abdominal pressure, take a look at this video describing piston breathing. Your PT should correct any postural dysfunctions to fix intra-abdominal pressure imbalances too.
4 - Activity Pacing
A pelvic floor PT will advise you on managing symptoms throughout your day. The physical therapy term is “activity pacing” - knowing when your symptoms are going to show up and stopping activity before the symptoms increase. For example, if you know you get prolapse heaviness when you’re standing making dinner, I would advise you to sit when making dinner. OR perhaps rest in a lying position for 30 minutes right before making dinner to hopefully prevent the prolapse symptoms.
5 - Inversions - Amazing Position for Resting
Inversions (or lying down with your pelvis at or above the level of your heart) are a fantastic way to unload your pelvic floor muscles and encourage the prolapsed organs to move superiorly upwards. Here are two of my favorite inversions: bridge position with a yoga block under your pelvis & legs up the wall yoga pose. Both are so relaxing and make your prolapse symptoms go away!
6 - Bowel Training
What does bowel training have to do with POP?! We want to make sure that #1 you’re not straining when you poop, increasing intra-abdominal pressure and increasing downward pressure out of your pelvic floor. Using a squatty potty may decrease the pressure on your pelvic floor by angling your hips and pelvis optimally when sitting on the potty. Also importantly #2 we want to make sure your poop is a soft squishy consistency so that they slide right out!
7 - External Supports
Wearing external support garments, like tight leggings or Spanx, can help relieve prolapse symptoms. Some women just happen to stumble upon this. There are also many medically developed external products designed to help with pelvic organ prolapse. I personally used a product like this when I was dealing with vaginal varicose veins and prolapse in my pregnancies and postpartum. It was literally a lifesaver!
8 - Internal Supports
A gynecologist can determine if an internal support called a pessary would benefit you if you’re experiencing prolapse symptoms. A pessary can even help while going through physical therapy to correct a prolapse. Before trying a pessary, a tampon (or Poise Impressa) or even a menstrual cup might provide enough support to keep the tissue from descending.
There are a variety of ways to treat and cure Pelvic organ prolapse! From diet to exercises to rest positions and clothing to wear, reach out to a pelvic floor PT to figure out what exactly is going on with your body to best serve you in managing your pelvic organ prolapse.