What is Prolapse?

Pelvic organ prolapse is when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina. It can be the womb (uterus), bowel, bladder or top of the vagina. A prolapse is not life threatening, but it can cause pain and discomfort and have some embarrassing and lifestyle consequences.

There are four stages to pelvic organ prolapse:

• Stage 1 – the uterus is in the upper half of the vagina.
• Stage 2 – the uterus has descended nearly to the opening of the vagina.
• Stage 3 – the uterus protrudes out of the vagina.
• Stage 4 – the uterus is completely out of the vagina.

Bladder prolapse also has four stages:

• Stage 1 – the bladder protrudes a little way into the vagina.
• Stage 2 – the bladder protrudes so far into the vagina that it's close to the vaginal opening.
• Stage 3 – the bladder protrudes out of the vagina.
• Stage 4 – most severe form, in which all pelvic organs including the bladder protrude out of the vagina.

Signs & Symptoms

When the muscles and ligaments supporting a woman's pelvic organs weaken, the pelvic organs can drop lower in the pelvis, creating the prolapse. Women most commonly develop pelvic organ prolapse years after childbirth, after a hysterectomy or after menopause.

There is some suggestion that strong exertion (childbirth, long term constipation) as well as declining estrogen levels that contribute to weaker vaginal walls, contribute to the likelihood of pelvic organ prolapse.

What else can happen? Many women who report an increased incidence of UTIs, atrophy, or incontinence should be checked, as these can be precursors to pelvic organ prolapse.

Yikes, then what?!

Well, depending on the severity, laparoscopic surgery might be considered. This is when a doctor (usually a urogynecologist) performs surgery by going in through the belly button and stitching the organ back into place, or stitching it to something else to hold it in place. Another type of pelvic organ repair surgery involves thigh muscle (fascia specifically) being used to help create a mesh web to support the organs.

Whilst this works in the immediate present, it does not prevent another incident, since any straining will cause the prolapse to reoccur. Surgery will often be recommended if the prolapse is stage 3 or 4, in conjunction with pelvic floor therapy. For milder prolapse, pelvic floor training and other options might be effective.

So, what are those other options?

Kegels, Again!

Kegels are the foundation of pelvic floor therapy training. We have a whole blog about them, but they are an effective - and recommended - way of strengthening the muscles of the pelvic floor, including the vaginal walls. This can help with incontinence, vaginal pain, pain during sex, and prolapse.

To read more about how kegels can help you and a full on ‘Vagina Workout Of the Day’ check out this blog!

Pessaries

A vaginal pessary is a device, usually round in shape, that is placed in the vagina and supports the pelvic organs (vagina, uterus, bladder and rectum). It is typically fitted by an Ob/Gyn. They can be left in during sex, and they are often easy to clean, insert, and remove. They support the pelvic organs, and in conjunction with pelvic floor therapy, are a good option for those who don’t want surgery or have moderate prolapse.

There are also surgical pessaries which are fitted for long term use.

What Else Can I Do?

Kegel Exercisers:

There are two kinds of kegel devices. One is a probe that reads you doing kegels, and helps train you via games and then gives feedback on the strength and duration of your kegel muscles/kegels. The other is a stim device that essentially does the kegels for you - think a vaginal tens machine.

There is a small probe attached to a little device that has adjustable levels/time. There are numerous different kinds of these, but they are widely available on amazon at a reasonable price. Most suggest that you try to perform a kegel during the stimulation to help increase the strength and tone of the muscles, as well as bring greater awareness to how to do proper kegels.

Hyaluronic Acid:

Vaginal hyaluronic acid has been shown to be effective at gentle repair of vaginal cellular tissues. Whilst the healing effects of hyaluronic acid are small, it has been clinically shown to improve dryness, atrophy, and incontinence. Gynatrof is a brand name that is widely available, and works to lubricate the vagina internally; in fact, this could be used as the lube on a stim device!

Vaginal Estrogens:

A new study demonstrates how an ultralow dose of vaginal estriol gel used before and after pelvic organ prolapse surgery can improve recovery time and results. The study outcomes are published online today in Menopause, the journal of The North American Menopause Society (NAMS). You can see those studies here and here!

These studies show that estriol is good for overall vaginal health, especially post-menopause, and even more so after prolapse surgery.

Silky Peach is a great option here as it is low dose and topical, and can be applied directly to the vulva.

Prolapse WOD

Whilst we have linked our ‘Vagina WOD’ (workout of the day) above, there are some additional moves that are good to do specifically for pelvic organ prolapse. This is a combination of stretching moves, that help relax overly tight muscles in the hips - which can surprisingly contribute to prolapse, as well as strengthening moves in the lower abdomen, thighs, and of course, specific types of kegels!

Stretch Moves:

1. Wide leg child’s pose
2. Cobra
3. Low lunge
4. Deep squats
5. Bridge
6. Figure 4 Pose

Kegel Moves:

1. Elevators
2. Cat & Cow Kegels
3. 10 x 5 second hold
4. 5 x 10 second hold
5. 20x Pulse
6. Quad-plank kegel x10 (on hands and knees, engage the core, all the way to a kegel - when you do the kegel, lift the knees about 1-2 inches).

Tone Moves:

1. Supine Toe Tap x20
2. Thigh Squeeze x20
3. Bridge x20
4. Hinge x10 (seated with the legs straight in front and back straight, then lean back slightly, and come back to upright).
5. Squats x20
6. Bird Dog x10 per side
7. Fire hydrant x10 per side
8. Banded thigh openers x10 per side
9. Curtsey lunge x10 per side

For more workouts or pelvic organ moves check out YouTube and other great content like this!