Let’s start at the beginning and then get to the What does prolapse feel like part….I know I know…What it feels like is your main concern but knowing a bit more about the anatomy and definitions helps reduce fear about prolapse
SO…What is pelvic organ prolapse
Pelvic organ prolapse is defined by American Family Physicians as “... the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy).”
What does this mean?
In our pelvis we have a bladder + urethra, uterus/cervix + vagina, + rectum. These organs are held in place by connective tissue. When our connective tissue is either more stretchy or has small tears the organs can move a bit more than they once did.
Here is a picture with + without prolapse:
What causes the prolapse to happen?
I know we all want to know what we did that caused our prolapse. The truth is it is not your fault you have a prolapse. There are lots of reasons people will develop extra movement of their organs.
Things like:
Vaginal births, particularly ones where forceps were used to help baby exit
Chronic coughing
Chronic constipation- straining to poo over long periods of time
Having a bendy body aka hypermobility aka stretchy connective tissue
Jobs where you lift heavy things day in and day out
What types of prolapse are there?
Here are the most commonly diagnosed :
Cystocele: aka bladder prolapse. Your bladder has ability to move a bit more towards the vaginal canal
Rectocele: aka rectum shifting towards your vaginal canal
Uterine prolapse: aka your cervix/uterus descending - or vaginal cuff if you have had a hysterectomy
Enterocele: aka your intestines descending into the space between your vagina and rectum
If you look back at the picture of prolapse above you can see these labeled!
What does prolapse feel like?
Ok, finally we are to your actual question: what does prolapse feel like? The commonly reported symptoms are:
Feeling like a tampon is falling out
Feeling like things are falling down
Heaviness/pressure
Seeing or feeling a bulge that you did not notice before
Needing to “splint” or support the perineum to get poop out during a bowel movement
While these feelings are often very bothersome, prolapse typically is not dangerous.
So what do you do if you have the symptoms above?
Freak out?!!!
Go down the Google rabbit hole? …. which may tell you that you will no longer be able to do activities you love or lift more than 10 pounds for the rest of your life.
I say, let’s come up with a more positive plan.
You schedule with a provider who is trained in evaluating and treating prolapse. Who are those people?
Urogynecologist: a doctor who starts as either an OBGYN or a Urologist and then does further training in the other. They are trained in surgeries to repair prolapse.
Pelvic Floor Therapist
OBGYN/Midwives
How do we assess prolapse?
As a pelvic floor therapist, we start by listening to your symptoms of bother and education regarding prolapse. This means looking at pictures and models of the pelvic floor anatomy so you have a good understanding of your body.
We provide options for assessing your concerns and you pick what feels comfortable to you!
This might include:
GH + PB measure: genital hiatus + perineal body aka from your urethral exit to the mid anus with a centimeter stick. This measurement gives us an idea of how supportive your muscle and connective tissue is. This is all outside your body
Checking to make sure the tissues of the vulva and vagina look healthy
Assess muscles for movement, coordination, endurance, tenderness by touching the muscles through the vaginal wall (we might check this laying and/or in standing)
See how much the walls of the vagina are able to move when you bear down to see which parts are causing your symptoms. This typically is done with a half speculum or finger
Repeat in standing but add things like lifting a weight or a child to see what changes
Here is a picture with the grading scale we use for prolapse:
What do we do if you have a prolapse?
Freak out??!!
No, we make a plan together that fits your life and comfort.
This might look like:
Whole body + pelvic floor muscle strength training
Pelvic floor muscle re training (reducing tenderness)
Working on poop habits to reduce straining/constipation
Looking at how you manage pressure in your belly when you lift items
Assessing and fitting a pessary (more on this in an upcoming blog!)
Or working with your urogynecologist to prepare for a prolapse repair surgery.
What does prolapse feel like….after treatment?
Pelvic floor muscle training is shown in research to reduce symptoms of bother from prolapse. While it does not change the significance of movement of the prolapse it helps people feel the prolapse less!
A pessary, when well fitted, may help reduce the severity of the prolapse for certain folks. This will also make the prolapse feel…well not there when the pessary is in place.
Typically, people report being able to return back to areas of life they love with less annoyance of prolapse symptoms after pelvic floor therapy! YAY!
If you have prolapse and are interested in pelvic floor therapy or a pessary please don’t hesitate to reach out!
Look for an upcoming blog on pessaries!
