Vaginal Prolapse and Pelvic Floor Muscle Training

A diagnosis of vaginal prolapse can feel like the end to your goals and dreams of living an active and healthy lifestyle.

But it doesn't have to mean a sedentary lifestyle, elimination of exercise, impact and lifting or a definite slot on the surgeons waiting list. I'm hoping that this newsletter will help to define vaginal prolapse, symptoms, treatments and hope for your future lifestyle. I'll be linking in to useful podcast episodes, lifestyle changes and exercises to help you move on from the fear and disappointment you may be feeling right now.

Why not start by clicking the button below to listen to a podcast episode about pelvic organ prolapse from the Pelvic Health Podcast...

Accepting Pelvic Organ Prolapse with Hayley Shevener

Anterior Vaginal Wall Prolapse

Often described as cystocele, this prolapse affects the front wall of the vagina. The vagina softens and the bladder support reduces, allowing the bladder to slip downwards into the vagina. This can feel like a soft bulge or lump in the vaginal entrance. It can feel heavy and cause a dragging sensation, almost as though a tampon has slipped and become uncomfortable. You may also experience difficulty completely emptying your bladder. The slippage can lead to a pocket forming below the bladder neck which can be difficult to fully empty in a normal seated position on the loo. When you then stand up, thinking you've finished, your bladder sends signals that there's more to empty. This can be really frustrating. The pull on the bladder can also lead to reduced capacity, increased frequency and often urgency.

Posterior Vaginal Wall Prolapse

The rectum can also slip into the vagina, causing a posterior wall prolapse and a soft bulge in the vagina, often felt towards the back of the vaginal entrance. Again, complete and full bowel emptying can be a challenge if a rectal pocket has formed. Sensations of a desire to empty the bowel can be sudden due to a loss of the anorectal angle which usually supports the stool and lifts it away from the sensitive areas of the sphincters until you get to the loo. You may also struggle to initiate a bowel movement, with some women needing to apply pressure to the perineal body or posterior wall to support the tissues and allow the stool to move more freely. The heaviness and dragging can also feel like a tampon has slipped, but may also lead to a deep lower back and buttock ache, especially if standing for a long time.

Uterine or Womb Prolapse

The vaginal walls can sometimes struggle to support the womb, allowing the cervix to descend into the vaginal area. The stage of prolapse is diagnosed by the range of movement that has occurred from the normal or ideal position. The further down the prolapse has descended, the higher the stage of prolapse. As the cervix descends, the lump now feels firmer, almost like the tip of your nose or a polo mint if touching it with your finger internally. If you have had a hysterectomy, the sensation will be different because it is not the womb descending but the top of the vagina, commonly called the vault following hysterectomy surgery. The common symptoms of heaviness, dragging, discomfort, irritation, bladder and bowel dysfunction and either increased lubrication or dryness continue to be experienced by women experiencing this type of prolapse. Because of these symptoms, women can become nervous to lift, exercise, move and even cough! It's so important to to ease these worries!

Normal Anatomy - the goal of pelvic floor training

The aim of pelvic floor muscle training, core rehabilitation, breath work and lifestyle changes is to restore normal anatomy as far as possible. See below for more information on the pelvic floor muscles and how they relate to pelvic organ position and support. I often talk to my clients about the 'tampon friendly zone' that is, the top half of the vagina. If a tampon is in the right position, nice and high up in the vagina, you can get on with your day, not knowing that it's there. However, if the tampon isn't quite inserted all the way or if it slips into the lower half of the vagina, it becomes a distraction and can even feel uncomfortable or painful. If we think of pelvic organ movement like this, then it helps to visualise what we're trying to do with pelvic floor muscle training. We're trying to increase the support from the muscles so that your organs are in the 'tampon friendly zone'. And that needs to apply to sedentary, active, lifting, impact lifestyle activities. 

But it's not just about pelvic floor muscle training. We also need to think about posture and breathing.

If your posture is slumped and the front of your body is shortened, there is greater downwards pressure to the pelvis. If the pressure from above is greater than the pressure exerted from below, the pressure from above will win the battle. But not before the pelvic floor puts up a fight! If the ceiling feels like its falling in, your immediate reaction would be to reach your hands up to protect yourself. The pelvic floor is exactly the same. If there is a constant and sustained pressure from above, the pelvic floor will try to overcome by tightening and gripping.

This isn't sustainable!

Eventually the pelvic floor will become tired, achey and fatigued, like any other muscle would in similar circumstances. Think of how your hands feel after gripping hold of heavy shopping bags for hours. It's not pleasant!

So let's aim to do something about the pressure we exert on our pelvic floors, lets elongate our spines, open and lengthen the front of our bodies and allow the pressure to ease. 

Pilates, Yoga, Strength Training and many other forms of exercise will help to improve your posture. But start gradually, ease into the process and don't head straight for the 20kg barbell!

Physiotherapy led training is a great way to begin your journey to better posture, better breathing patterns and a better pelvic floor muscle function.

The first step doesn't need to be consultant waiting lists, pessaries or surgery. These are all options for treatment but not your first line treatment options. Pelvic floor muscle training, lifestyle advice and adaptations to posture, breathing and core function are all essential first stops on your journey to elimination of the prolapse symptoms.

Download your copy of the Pelvic, Obstetric & Gynaecology Physiotherapy Group Advice booklet on Pelvic Organ Prolapse here.