What Is Pelvic Organ Prolapse?
Pelvic organ prolapse (POP) is a condition in which one or more pelvic floor organs (bladder, rectum, small bowel, uterus, etc.) move toward or into the vaginal canal. This happens due to imbalance of the muscles and ligaments supporting the pelvic floor. Folks who have experienced pelvic organ prolapse often describe symptoms as feeling a “stuck tampon” sensation, bubbles in the urethra, and heaviness in the pelvic floor. Other symptoms may include constipation, pelvic pain during intercourse, and incontinence (fecal and/or urinary).
Pelvic floor prolapse falls under the category of pelvic floor dysfunction.
“A 2008 study found that while pelvic floor dysfunction in general affects approximately 23% of women, pelvic organ prolapse affects about 3% of women. These numbers increase significantly with age—nearly 50% of women over 80 report at least one pelvic floor disorder.”
However, a deeper dive into the research by Julie Wiebe has found that the numbers are a bit different: with physical examination rather than self-reporting, you’re looking at closer to 30% of women experiencing POP at some point in their lifetimes. But not everyone will develop symptoms with a grade 1 (mild) prolapse. While pregnancy is often a factor in developing a pelvic floor disorder, since many women who have never been pregnant also develop these conditions, we cannot assert that pelvic floor dysfunction and POP are strictly pregnancy-related.
Pelvic organ prolapse is a complex condition
Pelvic organ prolapse is out of my scope as a movement teacher to diagnose your condition. A urogynaecologist is the kind of medical professional who can diagnose prolapses. You can also see a pelvic health physical therapist, who can prescribe exercises to help correct the imbalances that contribute to prolapse.
What Causes Pelvic Organ Prolapse
Intra-abdominal pressure is a term used to describe the pressure that occurs within the abdomen. Excess intra-abdominal pressure can be a contributing factor to pelvic floor dysfunction. When there is excessive intra-abdominal pressure, the pelvic floor muscles are placed under a load greater than what they are capable of handling.
While for many people the increased load of pregnancy and birth lead to pelvic floor dysfunction and/or prolapse, it is not always *caused* by pregnancy and birth. The pelvic floor muscles are designed to hold up the weight of the pelvic organs (reproductive system + bladder, rectum, small bowel); however, these muscles are not always functional. Reasons for this dysfunction can be too much load, muscles too tight, or muscles lacking strength. A non-pregnant person is carrying a lighter load than a pregnant one, and the combination of too much intra-abdominal pressure, muscle imbalance, and the increased load of pregnancy can exacerbate an existing predisposition to prolapse.
As the body ages, the muscles and ligaments change, as do the loads placed on them, hence the higher prevalence of pelvic floor issues such as incontinence and prolapse as women age: “The relationship between pelvic floor disorders and age is usually attributed to age-related connective tissue and neuromuscular changes and to comorbidities, such as obesity, pulmonary disease, and diabetes, that occur more commonly among older adults.”
Movements that can aggravate Pelvic Organ Prolapse
With prolapse, movement intensity can become an issue. Activities like jumping, running, too much walking, carrying heavy objects, baby carrying, bike riding, pushing a heavy stroller (especially uphill), strenuous hikes, or horseback riding can make a people with POP feel more symptomatic. Your pelvic floor physical therapist or doctor can help you determine to what extent you should limit your activities. A good rule of thumb is: any exercise that causes you to bear down (as if you’re pushing something out of your body) is a NO for prolapse. High-impact activities are generally limited during recovery and rehab as well, because they increase the load on the pelvic floor. Making a shift from higher-intensity to lower-intensity movement can be challenging, but I have seen many women regain the ability to go back to the activities they love after taking time to learn better core and pelvic floor strategies and improving their prolapse.
Kathryn: I’ve been doing the program for about a year now and it’s given me so much joy, strength, and stability- inside and out. I just got home after doing my first 2mile run and I feel Woohoo!!!
Strategies to Relieve Symptoms Associated with Pelvic Organ Prolapse (POP)
Having a Pelvic Organ Prolapse and not knowing what tools are at our disposal can be extremely disempowering. When we know what we can do today to begin to shift things, we are better informed, and when we have a plan of action, things get easier. Here are my recommendations, step-by-step, of what to do when you discover you have a pelvic organ prolapse and how to heal your prolapse.
Step 1: Reduce Intra Abdominal Pressure: Breathing Mechanics Matter
A key piece in resolving pelvic floor dysfunction is breathing mechanics. I spend a lot of time with clients and in the Restore Your Core program teaching breathing mechanics because how we breathe can make a huge impact on the integrity of our pelvic floor. Without realizing it, a lot of us are what is known as belly breathers: when we inhale, our bellies inflate. If you were to fill an oval-shaped water balloon and squeeze the top, what would happen? The bottom would bulge. When we belly breathe, we bulge and the bulge happens in our core and pelvic floor and we place an excessive amount of strain and downward pressure on the muscles and organs. Our pelvic floor is not designed to handle that level of pressure with each breath. A much better scenario for our pelvic floor would be to utilize the movement of the ribs when we breathe. As we inhale, our ribs expand (see below for video demo). There is a slight moving of the belly at the end of the inhale. 3-dimensional rib breathing, as you will learn in the video below, does not place excessive pressure on our pelvic floor; in fact, it allows our core and pelvic floor to be more responsive to the demands of daily life. The pelvic floor is connected to the function of our core, so when we are looking at resolving a pelvic floor issue we are essentially talking about a core issue as well. Habitual belly breathing during daily activities is not only hard on the pelvic floor but it can also make having a functional core very difficult.
Here is a video I made discussing the connection between belly breathing and pelvic floor/ core issues and how to begin to re-train your breath.
Step 2: Reduce Intra Abdominal Pressure: Alignment Matters
How we use our bodies on a daily basis can affect the health of our pelvic floor as well as our joints, muscles, and bones. When I work with clients with pelvic organ prolapse, we always ensure that there is integrity in their pelvic alignment. What many of us do in our standing posture, without realizing it, is push our hips forward. That shift forward affects the muscles of the pelvic floor, and to restore integrity to our pelvic floor, we must ensure that our muscles are at a mechanical advantage. Hip thrusting is a mechanical disadvantage. In this video I discuss pelvic alignment as it related to back pain; HOWEVER, the same concepts apply to pelvic organ prolapse. Remember that years of standing in one way does affect your muscles, and your muscles usually hold you in your current alignment, so shifting how you stand will likely feel very awkward and strange at first. If it feels hard at first, know that it does change with time and practice.
Step 3: Get to Know Your Pelvic Floor
With pelvic organ prolapse, the imbalances of the pelvic floor muscles are usually hard to feel and perceive. It is made worse by the incessant and misguided advice to “do your kegels” which can make things tighter and harder to feel. One of the keys in the process of healing is awareness. When we are aware of what a structure is or is not doing, we can begin to resolve its imbalances. When we are blind to it, we are often just continuing in habit mode and running along the same motor program. However, if we want things to shift in our pelvic floor, we need to also shift the habit mode of our muscles. In the case of our pelvic floors and pelvic organ prolapse, there tends to be much confusion. Is my pelvic floor too tight? Not tight enough? How can I tell the resting tension? How can I fix it? Before we set out to resolve/fix our pelvic floor dysfunction we need to first “know” our pelvic floor. Know what engaging it feels like, what releasing it feels like, and how to control both contracting and releasing it. Only then we can discern what our tendencies are and create new movement patterns and choices. I made this audio experience to give you the tools you need to become familiar with your pelvic floor. This exercise is very different from a kegel in that the end goal is not about the contraction but about the ability to control the muscles of our pelvic floor. Many women struggle at first and find that they have little to no control over the muscles. Over time and with regular practice, this often changes. If not, I do recommend seeing a women’s health Physical Therapist who will be able to do an internal exam and give you feedback.
Know Your Pelvic Floor Audio
Step 4: Restore Your Pelvic Floor and Core: Exercises
Now that you are better versed in breathing, alignment and your pelvic floor, you will want to begin to do exercises that support strengthening your pelvic floor, core and whole body. As you know by now, those go way beyond kegels. My 13 Week Program: Restore Your Core offers a step by step approach to strengthening your pelvic floor and whole body. If you are not ready to dive into a whole program just yet, here is a video of 5 exercises that are wonderful to get you started. You can also visit my YouTube page for many more videos.
In summary, there is a lot you can do right now to begin healing from pelvic floor dysfunction, including prolapse and incontinence. In addition to the videos I mentioned above, here is a video summary of these topics. In the video I demonstrate key concepts to these steps, so be sure to watch it. Having concrete tools, honing in on your habits, your breathing, your alignment and doing exercises to help your pelvic floor be functional are all keys to success for healing a pelvic organ prolapse. While there are no overnight success stories, there are many, many success stories of women like you who have healed their pelvic organ prolapse by taking these steps slowly and surely.
For additional support and resources, check out the following:
A basic summary and FAQ about POP is available from the US government’s Office on Women’s Health
Restore Your Core Facebook Group: this amazing community of women includes MANY who have become asymptomatic using the tools and techniques outlined above.
APOPS website: The Association for Pelvic Organ Prolapse Support has extensive information related to many of the common medical approaches to healing POP, including surgery and physical therapy.
If you’re interested in looking at prolapse from a PT’s perspective, Julie Wiebe’s blog has a wealth of information.
If you work as a movement teacher or trainer, this article does a nice job of outlining how to work with your clients with POP. And if you’d like to learn how I work with my POP clients, check out the RYC™ Teacher Training program.
1. A sensation of heaviness in the pelvis
2. A feeling of your insides falling out, or a palpable bulge in the vagina, or a “stuck tampon” feeling
3. Bladder leakage, stress & urge incontinence, incomplete emptying of the bladder
4. Fecal incontinence
5. Chronic constipation
6. Back/pelvic pain