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Can Physical Therapy Help Pelvic Organ Prolapse?

 

 

CAN PHYSICAL THERAPY HELP PELVIC ORGAN PROLAPSE?

Physical therapy can be a great first line conservative approach for pelvic organ prolapse (POP).  Let’s first talk about what POP is and some of the causes as well as treatment options, including a more in depth discussion about physical therapy.

Pelvic organ prolapse is the descent (falling) of one or more of the pelvic organs from its original position in the body in the pelvic cavity.  Three types of prolapse can occur (see illustration):  bladder (anterior vaginal wall), the rectum (posterior vaginal wall), the uterus (cervix), or the top of the vagina (vaginal vault) after hysterectomy.

An important thing to remember about prolapse is that if you notice a bulge in the vaginal canal, it is not the actual organ you are seeing but the wall of the vagina.  The organ falls and presses on the vaginal tissue which then falls towards the vaginal opening.

 

 

 

 

 

 

 

 

 

 

 

 

 

The cause of prolapse can be from a lot of factors but is primarily associated with:

  • Pregnancy and vaginal delivery, which leads to direct pelvic floor muscle and connective tissue injury
  • Increased age due to the hormone loss of estrogen which weakens vaginal support tissue
  • Hysterectomy
  • Pelvic surgery
  • Conditions associated with sustained episodes of increased intra-abdominal pressure, including obesity, chronic cough, constipation, and repeated heavy lifting.

Most women with pelvic organ prolapse are asymptomatic. Symptoms may become more bothersome as the bulge of the organ protrudes to or past the vaginal opening. In these instances it is not uncommon that a woman experiences aching in the pelvis, particularly at the end of the day, or a feeling that you are sitting on something in between your legs.

Urinary incontinence (loss of urine), particularly stress urinary incontinence, can be common in women with prolapse. Stress incontinence occurs when any kind of pressure is put on the bladder such as coughing, exercising, walking or rising from a chair.

 

Treatment options include for prolapse:

  • Pelvic floor physical therapy.   A pelvic health physical therapist will do an evaluation to determine an individualized treatment plan for you.  Evaluation includes posture and strength (especially in the hips and core). A an internal vaginal evaluation can also be performed to assess the level of prolapse as well as the strength of the pelvic floor muscles.  Treatment can include specific strengthening exercises for hips and core, lifestyle modifications to manage prolapse, pelvic floor muscle rehabilitation, and treatment of chronic constipation.

 

  • Vaginal pessaries are soft removable device that goes inside the vagina to help support the vaginal tissues displaced by the prolapsed organ. You gynecologist should evaluate you and fit you with a pessary to decide which one best suits you.  (See illustration below on examples of pessaries and how they are positioned in the vagina).

 

 

 

 

 

 

 

 

 

  • Surgery. Available surgical options for prolapse are reconstructive pelvic surgery with or without mesh augmentation.

Please call our clinic to speak with a pelvic health specialist if you have any questions about prolapse or any other pelvic health conditions. (847)550-9784.