Pelvic Organ Prolapse - What It Is and How To Avoid It

Have you ever heard of pelvic organ prolapse or POP? Maybe not! Unless you or someone you know has suffered from it or has had treatment from a women's health physiotherapist for it, you might never have heard of pelvic prolapse. In fact, there's no guarantee you would be familiar with it even then. Because prolapse can cause embarrassing symptoms, women can sometimes find it difficult to talk about. 

Yet pelvic organ prolapse is surprisingly common.  

The National Institute for Health and Care Excellence (NICE) reports that up to 50% of all women have some degree of prolapse.

Some of them don't even know they have it!

This figure is set to rise and become more common as women live longer. It has been found that there are women who are living with less severe pelvic organ prolapse that have not had their POP diagnosed. So the true number of affected women could be much higher.

This is part one of a two-part feature on prolapse. Read on for a definition of pelvic organ prolapse and what you can do to avoid it happening to you.  

What is the Pelvic Floor?

If you're a regular to this blog or to the PelviCare social media channels, you have probably seen references to the pelvic floor once or twice. Or a lot more than once or twice! Why? It's because the pelvic floor plays such an important role in the health and wellbeing of women - and even of men.  

The pelvic floor is made up of muscles and connective tissues that extend from the pelvic bone at the front to the tailbone (coccyx) at the back. The tubes for urine (urethra), vagina and anus all pass through openings in the pelvic floor.

These muscles are one of the four groups that make up the "core" muscles. The pelvic floor works with the muscles of your back and torso to provide strength and stability to your spine and organs whenever you move. As such, it is critical to your physical wellbeing.  

In women, the muscles of the pelvic floor are also responsible for supporting the womb (uterus), bladder and bowel (colon). Not only do they support the position of these organs, but they also have an important role in controlling the function of the bladder and bowel.  Furthermore they are involved with sexual function too.  

Because of these extremely important roles, it's important to keep the pelvic floor strong to ensure it can continue to support these functions. 

Illustration showing cross-section of women's pelvis including vagina, bladder, urethra, bowel and uterus in normal position with no pelvic organ prolapse.

What is Pelvic Organ Prolapse?

Prolapse is a pelvic floor disorder. The word "prolapse" refers to organs slipping from their natural position in the abdomen. When the pelvic floor is damaged or weakened, such as through childbirth, the pelvic muscles may no longer be able to support the organs. When this happens, they can droop down into the vagina, causing a range of uncomfortable symptoms.  

There are different types of prolapse, depending on which of the pelvic organs is affected. The uterus, bladder, urethra (the tube that carries urine), vagina and bowel can all be subject to prolapse. The result can be distressing, embarrassing and unpleasant, causing pain and bladder or bowel incontinence.

Diagram illustrating three types of pelvic organ prolapse, including bladder prolapse, rectal prolapse and uterine prolapse.

Causes of Pelvic Organ Prolapse

Prolapse happens when the pelvic floor muscles are damaged, stretched or weakened. Therefore anything that causes this weakness can increase the chance of developing pelvic organ prolapse.

The most common causes are:

  • Pregnancy and childbirth, particularly in the case of a long labour or difficult birth, or in women who have given birth to a large baby or multiple babies.
  • Age-related problems and going through menopause.
  • Having long-term constipation or other conditions that encourage straining, such as a persistent cough.
  • Being overweight.
  • Having a hysterectomy.
  • Excessive heavy lifting or incorrect lifting.  

 

Prolapse Grading

The severity of pelvic organ prolapse is described by a four-stage system called the Pelvic Organ Prolapse Quantification System (POP-Q). A grade 1 prolapse will be relatively minor and may not even cause symptoms. The stages move through to grade 4, which is a serious condition in which the affected organ actually protrudes outside the vagina.   

Pelvic organ prolapse sounds frightening, but it isn't life-threatening.  However, the problems it causes can be very hard to live with if left untreated. Luckily, treatment is available, and there are also a number of things you can do to avoid being affected by pelvic prolapse in the first place. 

How to Prevent Pelvic Organ Prolapse

In it's most severe form, pelvic organ prolapse can be serious. Considering at least half of all women will experience prolapse at some point in their life, it's clear that we should be doing everything we can to ensure good pelvic floor health.  

There are several actions you can take to maintain your pelvic floor muscles and help avoid or lessen symptoms of prolapse.

Young black woman with long, straight black hair wearing blue vest, shorts and trainers, performing a side plank in a gym illustrating safe ways to exercise the core muscles for a strong pelvic floor.

Take these 7 steps to prevent pelvic organ prolapse happening to you:

1.  Learn how to lift properly

Lifting heavy objects can cause or exacerbate a vaginal prolapse.  However, it's rarely possible to avoid lifting - especially for mums who have to carry their children and are also at greater risk of developing symptoms. There are ways to lift safely, including holding the weight close to your torso, keeping your back straight, and engaging your core muscles.  

And in case you missed it earlier, your pelvic floor is part of your core!

2.  Improve your posture

When you slouch with rounded shoulders, your tailbone tucks under.  This puts unnecessary strain on your core muscles which can weaken them. It's also extremely important to maintain the correct posture when exercising to avoid making any existing problems even worse.  

3.  Maintain a healthy weight

 We all know that being overweight puts excess strain on the body in many ways. But did you know that it can also cause prolapse?  The heavier you are, the more likely it is that you will develop a pelvic floor disorder. NICE recommends keeping your BMI under 30 to avoid damaging your pelvic floor.  

4.  Seek treatment for constipation

Chronic constipation can cause you to strain when you try to go to toilet, and this will also put too much pressure on your pelvic floor. Straining due to constipation can cause rectal prolapse leading to faecal incontinence, so it's very important to find a solution for constipation. A healthy diet, drinking plenty of water, and sitting properly for a bowel movement can all help. If you are still having problems, you should seek advice from your healthcare provider.

5.  Quit smoking

There are plenty of reasons to quit smoking, including protecting your pelvic floor. Not only do smokers usually have a chronic cough which can strain the pelvic floor, but the chemicals found in cigarette smoke can also damage the body's sensitive tissues.

6.  Do the right kind of exercise

 Maintaining good physical fitness is the best answer for anyone's overall health and wellbeing. However, if you have a weak pelvic floor then you should take care when choosing your exercise. Avoid high-impact activities like running, doing crunches or lifting weights. Instead, aim for low-impact exercise that will benefit your core muscles, like yoga or Pilates, swimming and cycling.  

Older white woman with shoulder-length grey hair wearing grey workout clothes, performing yoga while sitting on a grey yoga mat in a white room with a brick wall behind her.

7. Pelvic floor exercises

The most important workout you can do for your pelvic health is your pelvic floor exercises. Strengthening and toning these muscles is the best way to ensure they can do their job in supporting your pelvic organs properly.

Also known as "Kegel exercises" or "Kegels", these exercises are the number 1 way to protect your pelvic floor.

They are very simple and easy to perform, and you can do them while sitting at your desk working, while you're watching television, or anytime. No one will even know you are doing them.

It can sometimes be tricky to identify the pelvic floor muscles. Like all exercise, though, pelvic floor exercises must be performed correctly in order to be of benefit and not to cause more problems. A women's health physiotherapist can ensure you have identified the correct part of your body and teach you how to do your Kegels properly.

Following our top tips can help you avoid pelvic organ prolapse altogether. Our next blog about pelvic organ prolapse will focus on how to know if you are already showing signs of prolapse and treatments to fix the problem or stop it getting worse.  

If you feel you might already have any of the symptoms of vaginal prolapse, we would urge you to seek advice from a pelvic physiotherapist. A trained professional women's physio will be able to assess your condition and give you effective treatment to ensure your prolapse doesn't get any worse or to resolve your symptoms altogether.

For more information about physiotherapy treatments for pelvic organ prolapse or other women's pelvic floor issues, call Magdalena on 07877 017 936 or drop PelviCare an email.  Alternatively, you can book an appointment online.

PelviCare Women's Health Physiotherapy is located in Greenwich, London, serving women across South London, East London, Essex, Kent and beyond.