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Has this happened to you?
I'm here to explain what is happening, why it is happening and what you can do about it.
Prolapse: That is the name of this condition
This is called a pelvic organ prolapse and it often feels like your insides are falling out or there is a bulge or pressure in the pelvis.
A prolapse can be from the bladder, urethra, uterus or rectum in women.
This doesn't really happen in men, except in rare cases they can have a prolapse of their rectum from chronic constipation usually.
In women these organs usually feel like they are falling out of the vagina. There can be prolapse into the rectum but this is less common.
If there are rectal issues it is more likely that the rectum is falling into the vagina and creating a pocket, which makes it difficult to poop. Poop can get stuck in this little pocket or loop and have difficulty exiting the body.
What Causes a Prolapse?
A prolapse is caused by chronic or forceful downward pressure.
Chronic constipation, pregnancy, and childbirth are the most common causes.
I often get referrals for women who lift weights and they, or their doctors, think weightlifting is the cause and that they should stop weightlifting. That is never my recommendation. Keep reading.
I most often see patients with prolapse symptoms after childbirth, after menopause or during the menopause transition. Hormones play a role and I'll explain why.
Can I Prevent Prolapse?
Probably not. While we don't understand a lot about prolapse we don't think there are many things you can do to prevent a prolapse.
Prolapse might come from prolonged pushing with a vaginal birth or from a complicated birth, like one requiring forceps or vacuum delivery.
Some things you can control that may contribute to prolapse:
-obesity
-smoking
-breath holding with exercise
-chronic constipation
Some things you can't control that may contribute to prolapse:
-genetics
-how you give birth (like how long you labor, if you need intervention like forceps or vacuum, if baby gets stuck, etc)
-IBS, Chron's or other chronic gut issues that contribute to constipation
What Can I Do To Help My Prolapse?
See a pelvic floor therapist. This is my recommendation for where to start.
A pelvic floor therapist can check for the amount of prolapse (grade 1-4), assess whether your pelvic floor muscles are tight or weak and help you work on optimizing the pelvic floor muscles.
Other contributing factors:
Hormones: When estrogen is low the labia (outer lips of the vagina) thin out and then there is less support from the outside supporting the pelvis. This is common while breastfeeding or pumping in postpartum and it happens permanently in menopause.
If this is the case I have my patients ask their doctor for vaginal estrogen. This is a localized cream or suppository that helps increase the thickness of the vaginal tissues which will give more support to your organs.
Do I need to stop lifting weights?
No! Exercise and weightlifting are good for you and you can and should continue. The one thing I work on with my patients is to make sure they aren't holding their breath and causing more downward pressure. I've even worked with competitive weightlifters who have prolapse and they continue lifting heavy weights and competing without making their prolapse worse.
Other Medical Interventions:
Pessary:
A pessary is an internal support to help hold the organs in a better position.
There are a variety of pessaries to try that have varying levels of shapes and support. The majority of pessaries are removable, so you can use it as much or little as you need. Often my patients will start out wearing it most of the day and as their symptoms improve they will wear it less and less. After awhile they may only wear it for a few hours in the afternoon or only when they exercise.
You would get fitted for a pessary by your doctor. If you think this might help but can't get to a doctor or the cost is prohibitive, you can try this over the counter support called the Poise Impressa.* It is similar to a pessary and is a good thing to try to see if this kind of device would help you. *I have no affiliation with this product. It is just something I believe in.
Surgery:
Surgery is not always necessary to heal a prolapse. I think it is only necessary for grades 3 and 4 prolapses which are literally coming out of the body. A grade 3 or 4 prolapse usually means some of the ligaments that hold up the organ have been damaged. A grade 1 or 2 prolapse usually means those organs have just been stretched out and can most of the time be healed without surgery.
I always think physical therapy should accompany surgery. This is standard for almost any other surgery, you get physical therapy afterward. Even if you need surgery it is still best to optimize how the pelvic floor functions so that those surgeries will last. If we surgically repair the organs but have poor habits, tightness or weakness in the muscle that is going to put the same long term strains on the organs, then the surgery is not going to last. See a pelvic floor therapist as well.
Conclusion:
I hope this article gives you some hope and a place to start with getting help for your prolapse. There are many things you can do besides getting surgery, and in fact most people will not need surgery for their prolapse. There is help and you can return to your normal daily life and activities without symptoms, if you get the right help.
If you are local to me, schedule an appointment or set up a free phone call so we can discuss if this is a good fit for you.
If you are not local, you can do a virtual consult with me or find a pelvic floor therapist near you.
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