How to fix a prolapse and 8 risk factors you should be aware of
We’d like to start this blog by dispelling a couple of myths about pelvic organ prolapse (POP):
First, pelvic organ prolapse is not inevitable. Even if you’ve had several vaginal births, even if you’re post-menopausal, even if you’re on your feet all day, you can still take steps to reduce your risk.
Second, surgery may not be a cure for POP. According to ACOG, the American College of Obstetricians and Gynecologists, women who undergo prolapse surgery have a 6 – 30 percent chance of needing a second prolapse surgery, and some women develop incontinence as a result of POP surgery.
Brianna of Four Pines Physical Therapy and Meagan of Orthopedic Spine Therapy, the physical therapists who have informed us about the dangers of wearing high heels and the six-ish things you’re doing that you really shouldn’t, have some wise words on the question of prolapse: Basically, if prolapse can – to a large degree – be prevented, and if surgery often has to be repeated, why wouldn’t you take steps to reduce your risk?
What is pelvic organ prolapse?*
The pelvic floor is sometimes described as a “hammock” of muscles that support the pelvic organs (vagina, bladder, uterus, small bowel, and rectum), keeping them in place. When pelvic floor muscles are weak or not working properly, pelvic organs can droop into the vaginal canal or anus.
What causes pelvic organ prolapse?
According to our PTs, there are two main factors at play:
The strength and integrity of the pelvic shelf
Are the muscles strong enough and flexible enough and aligned properly? The pelvic shelf, according to Meagan, is really the most straightforward piece of the puzzle. Do your Kegels properly, to be sure you’re lifting and squeezing the pelvic floor. Work on stretching hip flexors so they don’t restrict the movement of the pelvic muscles, Brianna says. And deal with scar tissue in that area, particularly from previous vaginal tears or surgeries. Keeping scars “mobile” helps improve mobility of the pelvic floor, says Bri, preventing pain and allowing the pelvic floor to relax completely.
Can pelvic prolapse be reversed?
The pelvic muscles can take a lot over a lifetime, but you can help reduce the burden by being aware of these 8 gravity related issues:
One: Bad breathing. Shallow breathing that takes place in our neck, shoulders, and upper chest doesn’t allow our abdomen to expand properly. Diaphragmatic breaths that make your belly pooch out are much better because they direct the force of your breath out into the “body balloon,” Meagan says. When we breathe in our upper body, the stiff rib cage directs breaths vertically, up and down, like a piston, hammering away at the pelvic floor. So, yeah, your belly might stick out in a way that society deems “unattractive,” but we reckon that’s a small price to pay for avoiding incontinence and prolapse.
How to fix it. Consciously breathe with your belly until it becomes natural. Get help to stretch and loosen your abdominal muscles so your breath can go out instead of only up and down. Your thoracic spine has your 24 ribs attached to it; work that spine so your ribs can move and wiggle with the coming and going of each breath. “Being aware of breathing mechanics is where we start,” Meagan says; “it’s happening all day long and under the radar, so it can have a huge cumulative impact over the thousands of breaths we take every day.”
Two: Poor posture. Think of your pelvic floor as a bowl with a soup of organs: keep it straight and lined up, or things start to spill out. Plus, hunching over our desks for hours can restrict breathing and tighten hip flexors.
How to fix it. Again, stretch those hip flexors! Also, wear things that don’t cinch tightly around the waist when you sit, as these can change your posture and mess with your breathing. When we sit correctly, we have the right amount of tilt, so our pelvic bones bear some of the weight of the organs and the muscles aren’t carrying it all.
Three: Constipation. When you have to push or strain to have a bowel movement, you are, in effect, pushing your guts out, says Meagan. Having to do this repeatedly over time can eventually result in prolapse.
How to fix it. Drink enough water so stools don’t get hard and dry; eat plenty of dietary fiber; avoid foods that contribute to constipation. Bowel massage, Bri suggests, can help keep things moving along so there’s less chance for constipation to occur. Called the “I love you” massage, this is one you can give yourself, and it helps with a variety of issues, including constipation.
Four: Coughing. Your average cough due to a cold or something in your throat doesn’t have much of an impact, say our PTs, but chronic, prolonged coughing from smoking, emphysema, allergies, etc., can. Coughing increases abdominal pressure, nudging organs down and out.
How to fix it. Quit smoking, if you possibly can. If you have emphysema or chronic allergies, talk with a doctor about how to control the coughing.
Five: High-impact activity and exercising incorrectly. Jumping, kickboxing, crossfit, even running … all of these can mean a lot of repeated impact on the pelvic floor. If you’re passing gas in class, that can be a warning sign that you’re not managing the pressure correctly. Also, your pelvic floor needs to be flexible as well as strong, so don’t go crazy on core exercises: too many crunches done incorrectly can make the pelvic shelf rigid or in constant spasm, which means it doesn’t relax normally. That too can contribute to pelvic issues.
How to fix it. Find a different activity that means less impact, or learn to do your chosen activity correctly; talk to your instructor, a PT, or your doctor about your form and how to breathe through the repetitions. According to Meagan, when she goes to a Pilates or core-based class, about 70 percent of the activities the class does can damage your pelvic floor over time. Consult the instructor about how to adapt the exercises, or talk to a PT for strategies to minimize impact. Runners, for example, can maximize “shock absorption” by shortening their stride.
Six: Obesity. After repeated vaginal childbirths, obesity is actually the #2 risk factor for developing prolapse.
How to fix it. If you can, reduce extra weight to reduce the amount of gravity impacting your pelvic floor.
Seven: Standing. If you’re on your feet all day, gravity is not your friend. Particularly if your job includes a lot of lifting or twisting from the waist, you could be doing some serious pelvic-floor damage.
How to fix it. If your job and/or life require you to stand most of the day, try to at least lie down for a few minutes in the middle of the day. Get your hips and pelvis up, and “let gravity squash your guts back upstream where they belong,” says Meagan. If you already have mild to moderate prolapse, ask your doc about getting fitted for a pessary. This can provide additional support during the day by supplementing the work done by the pelvic floor.
Eight: Hypermobility or connective tissue disorder. Women with CTDs such as Ehrler-Danlos or Marfan syndrome, or who are hypermobile (double-jointed), may be at higher risk of prolapse because muscles may be too flexible and weak.
How to fix it. If you have other risk factors plus a CTD, consult with a pelvic PT right away to learn how to increase the integrity of the pelvic floor muscles.
Warning signs of prolapse
Worried about POP? If you have one or more risk factors, it’s good to know some warning signs to look out for. If you’re leaking urine or gas, especially during a core workout; if you feel a heaviness in your pelvis that worsens during the day; if you urinate or have a bowel movement, then feel you’re not quite “empty,” or if you stand up and a little leaks out, there may be something obstructing the pipeline. If you’re “splinting” – pushing on that section between your vagina and your rectum to help relieve constipation – there may be a “pocket” of tissue that’s holding waste material in, and that can be a sign of a prolapse as well. Backache and painful intercourse are also warning signs.
If you have any of these issues, or if you’ve already had prolapse surgery and are worried about a repeat, make an appointment with a pelvic PT, even if you don’t actually feel like you have a prolapse. Many women aren’t aware it’s even happening until it’s pretty far progressed, and in those cases, there’s less that physical therapy can do to reduce or reverse the problem.
According to Meagan and Bri, seeing a PT even if you have zero issues is never a bad idea – a pelvic PT can teach you to breathe correctly, how to stand and sit with the best posture for your body, how to exercise to protect and strengthen your pelvic floor, how to prepare your body to carry and deliver a baby, and a whole lot of other preventative measures.
*This blog is for informational purposes only and is never intended to replace the care of a medical professional. Please seek expert help if you think you need it.
Have you seen a pelvic PT? Do you think you might need one, but you’re feeling a bit shy and unwilling? Drop your comments below or on Facebook, or join our closed Facebook group, and we’ll pass your questions and concerns on to Brianna and Meagan. And if you have any other questions you’d like to ask them, please let us know, and we may build a future blog around your great question!
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