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Pelvic Organ Prolapse: Surgery is not the only option

Ever get the sensation of heaviness, bulging, or pinching “down there”? Maybe it is only noticeable after walking or standing for a long time, carrying kids, or having a bowel movement. Or maybe you have to strain or don’t feel you are emptying fully with bladder or bowel movements. Do you ever leak when getting up from the toilet even though you feel like you’re empty? Or with coughing, sneezing or lifting the kids?

Any of these symptoms may indicate that you have a pelvic organ prolapse (POP); which is the falling out of position of a pelvic organ including bladder, urethra, rectum, uterus, or lower digestive tract. While not a life threatening situation, a prolapse can severely impact a woman’s activity level, confidence and quality of life. Women may notice prolapse symptoms soon after delivery, or when returning to activities 1-2 years later, or after a cold or flu . Sometimes symptoms don’t show up until years after their last child after starting a new exercise or activity or during menopause.

Prolapse can occur due to a variety of factors including a long pushing phase of labour, lack of tension in the supportive sling of the pelvic floor, improper breath patterns, or a change in abdominal pressure systems and core activation during daily activity and exercise. This can result in bulging or heaviness, incomplete emptying (bladder or bowel), urinary or fecal incontinence, discomfort or pain with intercourse, and tailbone pain. Sometimes these symptoms can get worse as your bladder or bowels fill, or just before and during menstruation due to the heaviness of the uterus. A prolapse can become more medically important if you are retaining urine or stool, increasing the risk of infection. You should see your doctor if you have any burning, pain, abnormal odours, or blood with bathroom visits.

Prolapses are graded on a scale of 1 to 4, with 4 being the most severe and likely in need of surgery. Grades 1-3 can be helped with pelvic floor physiotherapy, limiting symptoms and progressing you back to your activities.

As you can see a prolapse can severely impact a woman’s quality of life. However, there are many treatment options to help with POP’s including manual therapies on the organs, varying breathing techniques, digestive health education, toileting positions as well as core exercises and instruction on progressive return to activities. As a last effort prior to surgery a woman can use a splint (e.g. insertable device like a tampon or pessary) to help with support.

For more information on POP’s and how you can facilitate its correction and return to activities contact your local pelvic floor physiotherapist.

In the meantime, here are a few ideas to get you started on helping to correct your prolapse.

  • Watch your breath: The largest contributing factor to the aggravation and progression of a prolapse is breath holding or valsalva. Do not push to empty bladder or bowels and make sure you are not holding your breath during exercises or while lifting heavy loads. Instead, relax your pelvic floor to go to the bathroom and make sure you breathe out as you do the most amount of effort (with exercise or lifting). Be careful with pilates! It can seem like it is working in your favour, but if your breath pattern is off it can make things worse.

  • Watch your posture: Poor posture can negatively influence the intra-abdominal pressure, ​creating more downwards force reinforcing the prolapse and pushing it out. Make sure you stand tall while thinking about creating space between hips and ribs, stacking ribs on top of pelvis, and keeping a modestly proud chest and head.

  • Support with the pelvic floor: Focusing on endurance of the pelvic floor muscles to help support the fallen organs can help. Doing a proper kegel/ pelvic floor activation for the duration of your exhale for 2 minutes twice per day (lying down to begin) can help build muscular support. Think about subtly stopping the passage of gas, or picking up a little bean with the vagina, or winking the pubic bone to meet the tailbone to contract the pelvic floor properly. Make sure you are not tilting the pelvis or activating surrounding muscles like the abs, bum, or inner thighs. Doing the kegel on your exhale will work with its natural shortening (i.e. contraction & work).

  • Help reposition after aggravating activities: Running, walking, or carrying baby can aggravate the prolapse and symptoms associated with it. Help reposition the prolapse and feel better by taking time to allow gravity do some work. To do this, lie on your back and prop your hips up on 3-4 pillows so you are in a decline position. Rest here for 5 minutes, focusing on your breath and doing some basic kegels as you breathe out.

  • Suspend high impact activities: High impact activities like running, bootcamps, jumping, etc. can make the prolapse worse. Take a break from those activities until you can see a pelvic floor physiotherapist who can help you progress back to those activities in a safe and non-aggravating manner. In the mean time, opt for lower impact activities like biking, swimming, walking up hill, and yoga.

(Photo credits:;

Published in the Summer 2014 Edition of From Belly to Baby, a local prenatal journal

Disclaimer - Everything shared is for informative purposes only. It is not intended for assessment, diagnosis or treatment purposes. If you feel there needs to be further investigation, please seek out a qualified health care professional for a proper assessment.

#pelvicfloor #core #incontinence #postnatal #menopause

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