by Sue Croft Physiotherapist
Adapted from blog published at SueCroftPhysiotherapist.com.au Nov 21, 2020
I remember the day I was standing outside my children’s school and a friend told me she had a prolapse and I said to her “How do you know?” -which was rather weird because I was a physiotherapist taking antenatal classes and heavily pregnant with my third child!
She said: “I can feel it every night in the shower when I am washing and some days I can feel it when I am just walking – it feels like a tampon is dislodged”.
A few months later, after I had my third child, I unfortunately knew exactly what she was talking about.
They call it “livin’ the dream”.
Soon after, I was offered a locum position at QEII Hospital. What began as a short-term role became the start of my lifelong passion for pelvic health physiotherapy. I started with the courses and conferences that would become a ritual for me for the next 30 years. My own pelvic floor dysfunction has made me a better pelvic health physiotherapist, because it has given me deep empathy and insight into the physical and emotional burden that comes with having problems ‘down below’.
Through my years working in women’s health, I’ve seen what really makes a difference to pelvic organ prolapse symptoms, and how to manage them effectively.
So here are my top tips to most effectively manage prolapse and pessaries, based on current evidence and practical clinical experience.
Understanding pelvic organ prolapse
Pelvic organ prolapse occurs when the pelvic floor muscles and connective tissues stretch and weaken, allowing one or more pelvic organs (such as the bladder, uterus, or rectum) to drop or press into the vaginal wall.
Tip 1 - Know the facts about prolapse and treatment options
It’s common — around half of women who have had a vaginal birth will experience some degree of prolapse. However, only about 15% will notice symptoms such as heaviness, dragging, or a feeling of a lump or bulge.
So if you get told by your obstetrician, GP or Pelvic Health physiotherapist that you have a prolapse – try hard not to panic. Fortunately, for many women, prolapse symptoms can be managed well using conservative strategies.
Evidence-based treatments may include:
- Pelvic floor muscle training, guided by a physiotherapist
- Behavioural and lifestyle strategies, such as bracing or the knack, defaecation dynamics (an easy position and coordination for emptying your bowels) and correct lifting techniques
- Pessary support, when appropriate
The Australian Commission on Safety and Quality in Health Care have a number of documents that help women understand what the course of treatment should be when considering any pelvic health treatment progression and they have one for prolapse making it easy for you to read and consider the best approach. Generally, conservative management is often the first approach and surgery would only be considered if other options don’t provide sufficient relief.
Tip 2 - Stop checking and start healing
It’s tempting to keep checking your body with mirrors or your fingers for signs of prolapse, especially when you’re worried. But this can heighten anxiety and make symptoms feel worse. Women are often encouraged to look at their perineum and vulva to learn about all their anatomy ‘down below’, but when you have just had a baby, the ‘look’ of the area can change and look quite distorted, scary even. This blog talks about how your anxiety can make the prolapse feel worse than it actually is.
Instead, focus on recovery and rehabilitation. A pelvic health physiotherapist can assess your pelvic floor at around six (6) weeks postpartum and help you begin a tailored home exercise program.
If you are unsure where to find one, the Continence Foundation of Australia and the Australian Physiotherapy Association both have directories of qualified pelvic health physiotherapists across Brisbane and each state.
Tip 3 – Exercising with a prolapse: Finding the right balance
Don’t let your fear of exercising with a prolapse ruin your life.
Our knowledge about prolapse and exercise prescription is a work in progress. The evidence is evolving constantly. For example, Dr Jenny Kruger from Auckland is working on a device to check the effect of intra-abdominal pressure rises in women undertaking certain exercises or manoeuvres. Other researchers around the world, such as Dr Ingrid Nygaard, are asking questions about what truly constitutes necessitating the banning of a certain exercises.
Exercise is vital for physical and mental wellbeing. Itsupports bone density, heart health, mental health, strength and muscle mass, keeping joints well lubricated and working well, and finally it can help with weight management. So suddenly stopping
exercise because you have a prolapse is a serious thing to contemplate and needs to be justified and well thought out.
The key to exercising is obtaining individualised, progressive guidance. A pelvic health physiotherapist can help you:
- Identify exercises that are safe for your current level of support
- Adjust intensity gradually
- Learn how to breathe and engage your core safely during exercise
Remember the benefits you reap from exercising throughout your life far outweigh the risks with prolapse. Stopping exercise altogether is rarely necessary. With the right advice, most women can continue moving confidently while respecting their pelvic floor.
Tip 4 – How a pessary can help support prolapse
Pessaries can be a game changer!
A pessary is a small silicone device that sits inside the vagina to help support the pelvic organs. It works like a splint to help support the structures to stay in a better position.Not every woman will need a pessary, but for many, it can be a game-changer in improving comfort and quality of life.
Pessaries should be:
- Fitted by a trained pelvic health physiotherapist or medical practitioner
- Regularly checked and cleaned, as advised
- Removed and reinserted safely as per professional guidance
While pessaries don’t “cure” prolapse, they can provide valuable mechanical support and symptom relief when used correctly.
Pessaries need to be treated with respect. Read our “Remember your pessary” article to understand the importance of diligently following pessary guidelines to help prevent any unfortunate complications, such as bacterial vaginosis (serious infection in the vagina), fistulas, migration of the pessary into incorrect positioning.
Tip 5 – Strengthen your pelvic floor muscles daily
Pelvic floor muscles are like any other muscles. They need regular, correct exercise to stay strong.
The evidence shows that pelvic floor muscle training can:
- improve symptoms of prolapse and incontinence
- enhance vaginal and pelvic support
- help prevent worsening over time
Finding time to exercise can be challenging but try and make it a routine, remember them, add them into your general exercise programme. Aim for short, consistent sessions each day. Focus on both contraction and relaxation and always breathe normally during exercises.
Some women find using biofeedback or exercise devices (such as the Perifit) helpful, but it’s best to seek professional advice to ensure proper use.
Living well with prolapse
Having a prolapse doesn’t mean giving up the activities you love. With the right knowledge, support, and self-care, most women can continue exercising, working, and enjoying life fully.
Remember:
- Seek early assessment and guidance from a women’s health physiotherapist
- Focus on evidence-based strategies
- Be kind to yourself because recovery takes time
If you’re struggling with symptoms that are affecting your quality of life, reach out to one of our qualified pelvic health physiotherapists in Brisbane. Embarrassing problems are our core business — and help is available.
To learn more about how prolapse and how Active Women’s Health physiotherapists can help, visit our services page.
