What is Prolapse and What do we do about it?

The word “prolapse” tends to scare a lot of people, especially postpartum moms. Mostly because of stories they have heard from friends or family, or from searching on the internet (which is usually not a good idea). 

So I am here to break this down so it doesn’t seem so scary, and give you hope for the future. 

The medical definition of prolapse refers to the descent or dropping of organs from their normal position within the body. In the context of pelvic organ prolapse (POP), it specifically refers to the descent of pelvic organs such as the bladder, uterus, or rectum into or out of the vaginal canal due to weakened or damaged support structures (ligaments, muscles, and connective tissues) of the pelvic floor. This descent can vary in severity and is often classified based on the specific organs involved and the extent of the descent.

There are several types of pelvic organ prolapse (POP), depending on which pelvic organs are affected. The main types of prolapse (in case you hear your doc use these terms) include:

1. Cystocele (Anterior Prolapse):

   This occurs when the bladder bulges into the front wall of the vagina. It is often associated with symptoms such as urinary frequency, urgency, and incomplete bladder emptying.

2. Rectocele (Posterior Prolapse):

   This occurs when the rectum bulges into the back wall of the vagina. It can lead to symptoms such as difficulty with bowel movements, constipation, and a sensation of vaginal fullness or pressure.

3. Uterine Prolapse:

   This occurs when the uterus descends downward into the vaginal canal. It can cause sensations of pelvic pressure or heaviness, back pain, and difficulty inserting tampons.

4. Vaginal Vault Prolapse:

   This type of prolapse can occur after a hysterectomy, where the top of the vagina descends down into the vaginal canal.

5. Enterocele:

   This is a less common type of prolapse where the small intestine pushes into the upper wall of the vagina.

6. Apical Prolapse (or Vault Prolapse):

   This involves descent of the top part of the vagina (where the cervix used to be) into the vaginal canal.

It is important to note that when you see tissues in the vaginal canal – that is not your actual organs coming out. It is just the organ pushing on the vaginal walls. 

The specific type of prolapse experienced by an individual can vary based on factors such as childbirth history, age, hormonal changes, and overall pelvic floor muscle health. Each type of prolapse can present with its own set of symptoms and may require different treatment approaches, most likely including pelvic floor therapy.

So WHO is more likely to experience prolapse? 

Several factors can increase the risk of developing pelvic organ prolapse (POP). These include:

1. Pregnancy and Childbirth:

   The process of pregnancy and vaginal childbirth can weaken the pelvic floor muscles and supportive tissues, leading to an increased risk of prolapse, particularly if there were complications during delivery such as prolonged labor or use of forceps.

2. Age:

   The risk of prolapse tends to increase with age, as the tissues supporting the pelvic organs naturally weaken over time.

3. Menopause:

   Estrogen levels decrease during menopause, which can lead to thinning and weakening of the pelvic floor muscles and tissues, making prolapse more likely.

4. Obesity:

   Excess body weight can put increased pressure on the pelvic organs and pelvic floor muscles, contributing to prolapse.

5. Chronic Constipation and Straining:

   Regularly straining during bowel movements due to chronic constipation can weaken the pelvic floor muscles and increase the risk of prolapse.

6. Heavy Lifting or Intense Physical Activity:

Activities that involve repeated heavy lifting or high-impact exercises can strain the pelvic floor muscles and contribute to prolapse – BUT this is usually caused by POOR bracing habits, like bearing down or pushing out into your belly when lifting. Lifting heavy can be GOOD for your pelvic floor (your muscles need to be LOADED to get stronger) as long as you have good core bracing strategies. 

7. Connective Tissue Disorders:

   Certain genetic or connective tissue disorders that affect the strength and integrity of connective tissues can predispose individuals to pelvic organ prolapse.

8. Chronic Coughing or Respiratory Conditions:

   Chronic conditions that lead to frequent coughing (e.g., chronic bronchitis) can increase intra-abdominal pressure and contribute to pelvic floor dysfunction and prolapse.

9. Previous Pelvic Surgeries:
   
   

    Surgeries in the pelvic area, particularly those involving the uterus (hysterectomy), can alter pelvic anatomy and increase the risk of prolapse in the future.

Understanding these risk factors can help individuals take preventive measures and seek appropriate care to minimize the risk of developing pelvic organ prolapse.

So HOW do we know the extent of your prolapse? 

POP is often graded based on the extent of descent of the pelvic organs into the vaginal canal. The grading system helps healthcare providers assess the severity of prolapse and determine appropriate treatment strategies. The most commonly used grading system for POP is the Baden-Walker Halfway System, which categorizes prolapse into different stages (0 to IV). Here are the grades of prolapse along with their definitions:

1. Stage 0 (No prolapse):

   In stage 0, there is no prolapse observed. All pelvic organs are in their normal anatomical positions, and there is no descent into the vaginal canal.

2. Stage I (Mild prolapse):

   Stage I prolapse involves descent of the pelvic organ(s) into the upper two-thirds of the vagina. The descent is minimal and may not be noticeable unless the healthcare provider is specifically looking for it. Symptoms may be mild or absent.

3. Stage II (Moderate prolapse):

Stage II prolapse indicates descent of the pelvic organ(s) to the level of the vaginal opening, but they do not protrude outside the vaginal opening. This level of prolapse may cause noticeable symptoms such as pelvic pressure, a feeling of heaviness, or discomfort.

4. Stage III (Severe prolapse):

   Stage III prolapse involves descent of the pelvic organ(s) outside the vaginal opening during straining or bearing down (Valsalva maneuver). The organs may not protrude spontaneously but can be pushed out with minimal effort. Symptoms are usually more pronounced and can include a bulge sensation, urinary or bowel symptoms, and discomfort.

5. Stage IV (Complete prolapse):

   Stage IV prolapse is the most severe and involves complete descent of the pelvic organ(s) outside the vaginal opening at all times. The organs are easily visible and may cause significant symptoms affecting daily activities, such as difficulty with urination, bowel movements, or sexual intercourse.

It’s important to note that the symptoms experienced by an individual with prolapse may not always correlate directly with the grade of prolapse. Some individuals with mild prolapse (Stage I or II) may experience significant symptoms, while others with more severe prolapse (Stage III or IV) may have few symptoms or be asymptomatic. 

Treatment recommendations are based not only on the grade of prolapse but also on individual symptoms, overall health, and personal preferences.

If you suspect you have pelvic organ prolapse or are experiencing symptoms suggestive of prolapse, it’s essential to consult with a healthcare provider, such as a pelvic floor therapist and gynecologist, for proper evaluation and personalized treatment recommendations.

It’s not uncommon for some mild prolapse symptoms to improve or resolve on their own after pregnancy and childbirth, especially if the prolapse is mild and the pelvic floor muscles regain strength over time. However, the extent of improvement can vary widely depending on individual factors such as the severity of the prolapse, overall pelvic floor health, postpartum recovery, and lifestyle habits.

It can be considered normal for you to feel some symptoms early postpartum, but ideally they resolve on their own. If they persist after 6-8 weeks, getting assessed would be recommended. 

Here are some reasons why prolapse symptoms might improve after pregnancy:

• Natural Healing and Recovery: The body has remarkable healing abilities, and the pelvic floor muscles may regain strength and tone gradually after childbirth, which can help support the pelvic organs better and alleviate mild prolapse symptoms.
• Postpartum Pelvic Floor Rehabilitation: Engaging in postpartum pelvic floor exercises under the guidance of a pelvic floor therapist can help strengthen weakened pelvic floor muscles, improving support for the pelvic organs and reducing symptoms of prolapse.
• Hormonal Changes: Hormonal fluctuations after childbirth, particularly the gradual return of estrogen levels, can also contribute to tissue healing and regeneration in the pelvic area, which may aid in symptom improvement.
• Reduction in Intra-abdominal Pressure: As the uterus shrinks back to its normal size postpartum and the abdominal muscles regain tone, the intra-abdominal pressure that contributes to prolapse can decrease, leading to symptom relief.

However, it’s essential to note that not all prolapse symptoms will resolve spontaneously. Factors such as the severity of the prolapse, persistent pelvic floor muscle weakness, ongoing lifestyle habits (such as chronic bearing down or chronic constipation), and subsequent pregnancies can influence the likelihood of symptom improvement or persistence.

If you experience prolapse symptoms during or after pregnancy, it’s crucial to seek evaluation and guidance from a healthcare provider, especially a pelvic floor therapist or gynecologist specializing in pelvic floor disorders. They can provide tailored advice for YOU and what your body is needing. 

Pelvic floor therapy (can be PT/OT who has specialized training) can play a crucial role in helping women with POP safely return to active and physically demanding activities, including running, jumping, lifting heavy weights, and participating in CrossFit or other high-intensity exercises. Here are several ways pelvic floor therapy can support women in getting back to these activities:

1. Assessment and Individualized Treatment Plan: 

A pelvic floor therapist will conduct a comprehensive assessment to evaluate the severity of prolapse, pelvic floor muscle strength, coordination, and overall pelvic health. Based on this assessment, they will develop an individualized treatment plan tailored to the specific needs and goals of the individual.

2. Pelvic Floor Muscle Strengthening:

Pelvic floor therapists specialize in teaching proper pelvic floor muscle exercises (not always kegels) to strengthen the pelvic floor and improve support for the pelvic organs. Strengthening these muscles can help alleviate symptoms of prolapse and enhance pelvic stability during activities.

3. Education on Proper Body Mechanics:

Pelvic floor therapists educate individuals on proper body mechanics and techniques to minimize intra-abdominal pressure and strain on the pelvic floor during activities such as lifting weights, running, or jumping. Learning to engage the core muscles effectively and maintain optimal alignment can reduce the risk of prolapse symptoms.

One way that can help manage intra abdominal pressure and reduce risk of prolapse is by mastering your BREATH mechanics, especially when working out or lifting heavy. 

Learning how to breathe effectively during lifting and other activities is crucial for managing intra-abdominal pressure and supporting pelvic floor health, particularly for individuals with POP or pelvic floor dysfunction. Proper breathing techniques can help minimize strain on the pelvic floor muscles and reduce the risk of exacerbating prolapse symptoms.

Here’s an outline of effective breathing strategies and their impact on the pelvic floor:

1. Diaphragmatic Breathing:

   Diaphragmatic breathing, also known as 360 breathing, involves engaging the diaphragm to expand the lower lungs and abdomen, ribs, and pelvic floor. This type of breathing promotes relaxation of the pelvic floor muscles and helps manage intra-abdominal pressure more effectively.This is a great way to build awareness of your pelvic floor muscles and making sure you can RELAX and LENGTHEN them. 

HOW TO DO IT: 

Sit in a comfortable position. Inhale deeply through your nose, allowing your abdomen, ribcage, and pelvic floor to expand outward (like filling a balloon). Exhale slowly and fully through your mouth, allowing your abdomen to naturally deflate.

2. Avoid Breath-Holding:

   Holding your breath (Valsalva maneuver) during lifting or exertion increases intra-abdominal pressure significantly and can strain the pelvic floor muscles. Avoid this (while you are still managing symptoms) by maintaining a steady breathing pattern throughout the activity.

3. Coordination with Movement:

   Coordinate your breath with the movement during lifting:

• Inhale before you begin the movement to prepare and engage the core.
• Exhale during the exertion phase (e.g., lifting a weight, standing up), which helps stabilize the core and manage intra-abdominal pressure.
• Inhale again as you lower the weight or return to the starting position.

4. Engage Transverse Abdominis (TA) and Pelvic Floor Muscles:

   Activating the deep core muscles, including the transverse abdominis (TA) and pelvic floor, can further support the pelvic organs and reduce strain on the pelvic floor during lifting.

A lot of times the issue is more with coordination of your pelvic floor muscles, so not everyone needs to be doing a kegel all the time with movement. Your pelvic floor therapist can help guide you through this and know what is best for you. 

5. Maintain Neutral Spine Alignment:

   Keep your spine in a neutral alignment during lifting to optimize pelvic floor support. Avoid excessive arching or rounding of the lower back, which can affect pelvic floor mechanics. Obviously there are movements where this is not possible or optimal, but it can be a good start for basic movements like a squat, deadlift, overhead press. 

6. Focus on Controlled Exhalation:

   Emphasize a slow and controlled exhalation during the most challenging phase of the movement (e.g., lifting, lowering). This helps manage intra-abdominal pressure and reduces the load on the pelvic floor.

Proper breathing techniques not only optimize pelvic floor function during lifting but also promote overall core stability, enhance exercise performance, and reduce the risk of injury. If you’re unsure about implementing these techniques or have specific concerns related to prolapse symptoms, consult with a pelvic floor therapist for personalized guidance and support. They can assess your individual needs, provide tailored recommendations, and help you safely incorporate effective breathing strategies into your daily routine and exercise regimen.

4. Behavioral Modifications: 

Therapists provide guidance on lifestyle modifications and behavioral changes that can support pelvic floor health, such as managing constipation, optimizing bladder habits, and avoiding activities that exacerbate prolapse symptoms.

5. Progressive Exercise Program: 

Pelvic floor therapists design progressive exercise programs that gradually introduce activities and movements, ensuring a safe and controlled progression back to higher-intensity exercises like running, jumping, or CrossFit. This approach allows individuals to build strength and endurance while minimizing the risk of pelvic floor dysfunction.

6. Addressing Psychological and Emotional Factors:

Dealing with pelvic organ prolapse can have emotional and psychological implications. Pelvic floor therapists provide support and counseling to address concerns related to body image, fear of movement, or anxiety about returning to physical activities.

7. Collaboration with Other Healthcare Providers: 

Pelvic floor therapists collaborate with gynecologists, urogynecologists, and other healthcare providers to ensure comprehensive care and address any medical interventions or surgical considerations if necessary.

By combining these approaches, pelvic floor therapy empowers women to regain confidence in their bodies, manage prolapse symptoms effectively, and safely return to an active lifestyle that includes running, jumping, lifting weights, and engaging in high-intensity exercises. The key is personalized care, education, and a gradual, progressive approach to rebuilding pelvic floor strength and function. If you’re considering returning to these activities after prolapse, consulting with a pelvic floor therapist can provide invaluable guidance and support on your journey toward optimal pelvic health and physical well-being.

But WHO is the right PT for me? 

At Life In Motion PT, we operate as an out of network clinic. Operating a cash-based physical therapy practice offers unique advantages and allows you to provide a higher quality of care compared to traditional in-network clinics. Here are several benefits of going to an out-of-network (cash-based) physical therapy clinic and why we always recommend these first: 

1. Individualized Treatment Plans:

Cash-based clinics often prioritize quality of care over volume of patients. This allows for more personalized and individualized treatment plans tailored to each patient’s specific needs, goals, and preferences. Therapists can spend more time with patients, conducting thorough assessments and developing comprehensive treatment strategies.

2. Longer Treatment Sessions:

Unlike in-network clinics that may be constrained by insurance-driven visit limits, cash-based practices typically offer longer treatment sessions. This extended time allows therapists to address multiple aspects of a patient’s condition, provide hands-on therapy, and ensure thorough education and guidance.

3. High-Quality Hands-On Therapy:

Cash-based physical therapy clinics emphasize hands-on manual therapy techniques, which can be more effective in promoting recovery and addressing musculoskeletal issues. Therapists have the freedom to allocate sufficient time for manual therapy interventions, such as joint mobilizations, soft tissue techniques, and specialized exercises.

4. No Third-Party Interference: 

By operating outside insurance networks, cash-based clinics avoid the administrative burden and restrictions imposed by insurance companies. This allows therapists to focus solely on patient care without concerns about pre-authorizations, claim denials, or treatment limitations.

5. Enhanced Focus on Patient Education:

Cash-based therapists prioritize patient education and empowerment. They have the time to thoroughly explain diagnoses, treatment plans, and self-management strategies, fostering better patient understanding and compliance with home exercises and lifestyle modifications – so you don’t have to depend on us forever! 

6. Flexible Scheduling and Availability:

Cash-based practices often offer flexible scheduling options, including extended hours and same-day appointments. This flexibility allows patients to receive timely care and ongoing support throughout their rehabilitation journey.

7. Continuity of Care and Long-Term Relationships:

Building a cash-based practice fosters strong relationships between therapists and patients. Therapists can follow patients throughout their recovery process, track progress over time, and provide ongoing support to optimize outcomes and prevent future injuries.

8. Focus on Wellness and Prevention:

Cash-based clinics emphasize holistic approaches to health and wellness, promoting preventive strategies and lifestyle modifications to optimize overall physical function and well-being beyond immediate rehabilitation needs.

Overall, choosing an out-of-network (cash-based) physical therapy clinic can offer a higher quality of care characterized by personalized attention, advanced treatment options, longer treatment sessions, and a patient-centered approach focused on achieving optimal outcomes and long-term wellness. 

While cash payments may require upfront investment from patients, the value gained in terms of quality care and comprehensive rehabilitation often outweighs the limitations of insurance-driven models.

Surgery is not always the answer for prolapse – conservative treatment with pelvic floor therapy can be effective! 

• To schedule with us, call 563-204-8343 or visit https://lifeinmotionphysicaltherapy.com/request-appointment/