Patients most commonly associate prolapse with the womb (uterus) but it can also affect the bladder, rectum and bowel.
Pelvic Organ Prolapse
A Mummy MOT is recommended from 6 – 8 weeks postpartum.
It is essentially the slipping down of one or more of the pelvic organs. There are many types and combinations and symptoms can range in severity, but of course it is prudent to act on any symptoms as soon as possible to avoid the situation worsening.
Types:
- Uterine/Cervical prolapse (Womb)
- Anterior Vaginal Wall Prolapse (Bladder)
- Posterior Vaginal Wall Prolapse (Rectum)
- Vaginal Vault Prolapse (Cervix after hysterectomy)
- Enterocele Prolapse (Intestine)
Signs & Symptoms
Symptoms can vary with time of day, activities, gravity, where the woman is in her cycle or if she is post-menopausal. In general, prolapse is more noticeable later in the day, if the woman is constipated and straining to have a bowel movement, after long periods of standing or vigorous exercise and in the run up to her period.
The common signs are:
- A lump or bulge in the vaginal region, noticeable when sitting or wiping after the bathroom.
- Pressure in the lower pelvis, in between legs or thighs.
- Lower abdominal pain or lower back pain
- Bleeding, discharge or vaginal infection
- Needing to support the perineum or splint the vaginal wall with a finger to have a bowel movement.
- Issues with passing urine: Hesitancy to get the stream started, slow or stop/start flow, straining, increased frequency & urgency or not feeling fully empty after a void.
- Difficulty passing a bowel motion: straining, incomplete emptying, urgency or soiling
- Pain with intercourse, difficulty with penetration or inserting tampons.
Management
There are a variety of graded treatment options for prolapse issues and all are clearly discussed with the patient at their appointment.
As always there is no one size fits all cure for these symptoms. As you can see from the list they are varied and can be related to other conditions too. In order to evaluate which organs are prolapsing a vaginal assessment is required. This will guide the diagnosis and management plan for the patient. This may seem daunting but rest assured that this is carried out in a professional and expert manner to make the patient feel relaxed and comfortable. Only specialist women’s pelvic health physiotherapists are trained in this assessment technique.
There are a variety of graded treatment options for prolapse issues and all are clearly discussed with the patient at their appointment. Suitability for each may vary and liaison with the patients GP, gynaecologist and pharmacist is key. Treatment can include simply monitoring periodically, lifestyle modifications, pelvic floor exercises, pessary insertion, topical hormone treatment, right through to surgical intervention.
At Anatomy Physiotherapy we provide a specialist pessary fitting service. This is a conservative management option that can be life changing for women, if deemed suitable for it. It is important to note that patients can self-refer to the clinic if this is something they wish to explore. Like with the vaginal assessment, Suzanne has completed extra postgraduate training in the measuring and fitting of pessaries as she can see the value they hold in the management of pelvic organ prolapse and certain types of incontinence.