Pelvic Organ Prolapse: “My Insides are Falling Out.”

“My vagina has broken.”

“There is bulge in my vagina.”

“I can feel something coming down.”

“My insides are falling out.”

These are the words spoken to me by women presenting with Pelvic Organ Prolapse otherwise known as POP - which is an appropriate acronym because for many that is how it feels, like something has gone “pop” in the vagina. It now it feels different, and heavy and uncomfortable, which can lead to a lot of worry. For others it is gradual, slowly getting worse over time. It may start as a dull ache in the back or a general ache in the pelvis which can get annoying. Sometimes it becomes hard to empty your bowels or feel like something is blocking your wee getting out or that sex can leave you with an achy feeling. This may lead women to think “is this it now? Will it get worse?”

The vagina is a tube with the cervix and the womb at the top of the tube, the bladder at the front and the bowel at the back. The organs in your pelvis don’t just float around they are anchored in place by supportive structures - muscles, ligaments and connective tissue. The highest level of support holds up the top of the vagina and the womb. Think suspension cables on a bridge – the cables are long ligaments that connect the top of the vagina and the womb to the pelvis, keeping everything supported from above. A failure of these cables (actual name uterosacral and cardinal ligaments) means the top of the vagina can drop down- this is called a uterine or apical prolapse (you can still experience the dropping down of the top part of the vagina even if your womb has been removed known as a vaginal vault prolapse).

The middle level of support consists of a trampoline like layer of connective tissue that stretches from the one side of the pelvic wall to the other. When this trampoline loses its tension and becomes more like a hammock (for example after being stretched during childbirth) the bladder can bulge into the vagina from the front (called a cystocoele or an anterior wall prolapse) or the bowel can bulge into the vagina from the back (called a rectocele or a posterior wall prolapse).

The base level of support closest to your skin is your pelvic floor. The pelvic floor is a group of muscles shaped like a basket that supports your pelvic organs from below and controls all your openings as well as providing muscular support to pelvis (along with muscles in your abdomen and back). When these muscles become weak you can experience bladder and/or bowel leakage also. Often more than one level of support will be affected but different levels lacking support will result different symptoms. Lifestyle factors can also affect prolapse such as high impact exercise (like CrossFit and heavy weights), hormonal changes (like the drop in estrogen during menopause), chronic constipation and straining, heavy lifting in daily life such as caring for young children), and chronic coughs.

The good news is that POP can be treated. POP is not a modern problem luckily, we have progressed with treatment options over time…. the go-to remedy for over 3,000 years was half a wine-soaked pomegranate inserted in the vagina to hold the pelvic organs in place!

These were the earliest support devices or pessaries. We still use pessaries but now they come in the form a comfortable silicone ring, cube or disc inserted into the vagina to provide support which for many can provide great relief from symptoms. A great start is seeing your GP, gynaecologist or Pelvic Health Physiotherapist to talk about treatment options. Pelvic Health Physios can also assess and address the lifestyle factors that may be contributing to your POP. Ensuring the foundation of support, your pelvic floor is strong and functional is a great starting point. For some women with POP surgery, can provide a good solution but even when this is the plan pelvic floor prehab before your surgery and rehab following can ensure the best long-term outcomes for symptom relief.

Want to make sure your pelvic floor is ready for whatever life has in store?

Call 8239 2811 and make an appointment.