PROLAPSE

A prolapse is the descent of one or more of the pelvic organs as described below.  You can have a single prolapse or a combination of one or more.   

The main causes of a prolapse are: 

  1. Pregnancy 

  2. Giving birth via vaginal delivery

  3. Chronic obesity (especially visceral fat in the abdomen)

  4. Chronic coughing/sneezing

  5. Repeated heavy lifting and/or carrying

  6. Chronic constipation - due to the straining

Symptoms of a Prolapse: 

  1. Heaviness

  2. Dragging

  3. Feeling of something in your vagina - like a tampon that's slipping

  4. Feeling a bulge inside or outside your vagina or anus

  5. Feeling a downward pressure in the pelvis/vagina with impact

  6. Low abdominal or back discomfort or pain

Types of  Prolapse:

Cystocele/Anterior Wall Prolapse

  • The tissues supporting the front wall of the vagina, bladder and/or urethra lengthen resulting in the wall 'sagging' down towards the entrance of the vagina

  • May be associated with urinary retention, hesitancy or incontinence

Rectocele/Posterior Wall Prolapse

  • The tissues supporting the back wall of the vagina, rectum and/or internal aspect of the perineal body lengthen resulting in the back wall protruding into the vagina 

  • It is often worse when your rectum is full​ or just after a bowel motion

Uterine Prolapse

  • The tissues supporting the uterus lengthen resulting in the uterus descending into the vagina

Vault Prolapse

  • After hysterectomy, the tissues supporting the top of the vagina (and/or cervix if it hasn't been removed) lengthen resulting in the vault (top) of the vagina descending further down the vagina

 

Rectal Prolapse

  • Not to be confused with a rectocele, this is a protrusion of the rectum or anal canal through the anus​

Prolapse Management: 

 

Surgery is often thought of as the only treatment for prolapse. This is not true.  Along with weight loss and good management of any chronic coughing, sneezing or constipation (which in themselves can make a huge symptomatic difference), physiotherapy with a Pelvic Health Physio can be a really effective way to manage your prolapse and help you to avoid surgery. Mild to moderate prolapses respond especially well.   

Physiotherapy management of prolapse includes the following: 

  • Pelvic floor muscle retraining to help support the organs

  • Activity modification 

  • Intra-abdominal pressure management (this is the internal abdominal pressure that is increased with activities like lifting, carrying, coughing, sneezing, jumping, running). We teach you how to modify this pressure to decrease the aggravation of the prolapse. 

  • Specific load management techniques to decrease symptoms (for example, modifying your running technique to minimise the loading through the pelvis)

  • Pessary fitting (see below)

Pessary Fitting: 

  • Vaginal pessaries are silicon supports that are used inside the vagina to support the prolapsed tissue, in the same way that an ankle brace supports the ankle ligaments  

  • There are many different kinds of pessaries that are used for different presentations, your Therapist will recommend the right one for you. 

  • Pessaries don't work for everyone but when they do, they are a brilliant way to manage symptoms

  • They can be used long term and are a great alternative to surgery

  • Pessary fittings are done within a dedicated session with a follow up appointment the following week

Pre-/Post-Operative:

  • When conservative treatment fails to provide sufficient relief from your symptoms then surgery may be indicated

  • Rest assured that the work that you've done will help protect the surgery afterwards

  • If you have had surgery without seeing a Physio first, we recommend seeing you approximately 6 weeks after the operation to check your pelvic floor function and teach you all the above techniques to protect the surgery

PLEASE NOTE

General advice and information found on "Dr Google" can be very fear inducing with regards to prolapse. You will often read that if you have a prolapse you should never lift anything over 5kg again, or run, jump or do anything fun.  At Beaches Pelvic Physio we STRONGLY disagree with this approach to management. Whilst we understand that generic advice needs to be conservative, you are an individual with your own lifestyle and goals.  Our job is to help you work through the stages of recovery, gradually building up to as high a level of function as you desire and can tolerate.  In this way we help you achieve maximum function safely and find if there are any specific limitations for you.  

At Beaches Pelvic Physio we treat all aspects of the pelvis both internal and external,

together with associated areas of the body.  

We work closely with many Specialists, Therapists and Trainers including: GP’s; Integrative GP's; Sports Physicians; Gynaecologists; Obstetricians; Urologists; Urogynaecologists; Gastroenterologists; Colorectal Surgeons; Nutritionists; Naturopaths; Massage Therapists; Exercise Physiologists; Personal Trainers; Yoga & Pilates Instructors, to achieve the best results for you.

If you are unsure about anything, please don't hesitate to call us on: 0435 150136 or 02 8964 5579.

Alternatively you can email us at: hello@beachespelvic.physio 

or via the contact form

 

For online bookings:

 

 

Beaches Pelvic Physio                                             Suite 4219 

Lvl 2, Dee Why Grand Commercial          

834 Pittwater Road

Dee Why NSW 2099                                                               
M: 0435 150136

T/F: 02 8964 5579                                                    E: hello@beachespelvic.physio

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