Introduction
Hands up who wants to chat about what’s going on down there! No one right. But you could be sitting on (literally!) a pelvic organ prolapse (POP) without knowing it.
Pelvic organ prolapses are really common! About 50% of women have one, but only 3% have symptoms. Unfortunately, when you have one it can progress to be symptomatic, so like everything it’s best to know as early as possible so you can get some help.
So…..what is POP? How do you know if you have one? And what to do about it if you think you do?
What is Pelvic Organ Prolapse?
Women have a potential space in their body, the vagina (and the uterus above), supported by ligaments and fascia in the bowl of the pelvis. In front of the vagina is the bladder, behind the rectum, and all of them rest on the pelvic floor.
A pelvic organ prolapse is when one or more of these organs moves into the potential space of the vagina, sometimes bulging through the vaginal opening. Either the bladder moves backwards (cystocele), the rectum moves forwards (rectocele), or the uterus and vagina descends straight down (uterine prolapse). For women who have had a hysterectomy, you can just have a prolapse of the vagina itself called a vaginal vault prolapse.
How do you know if you have one?
Firstly…..be aware of the symptoms. Often these can start insidiously, leaking urine or faeces or feeling like you can’t empty your bladder completely. Sex can become painful, tampons difficult to insert and orgasm becoming more difficult to achieve.
Later it can feel like a bulging or heaviness into your vagina, a feeling of pressure or fullness. Some women report throbbing pain in their vagina. You could develop constipation which requires insertion of fingers into your vagina to manually push against the vaginal wall and help move stools out of the anus.
Secondly….have a look! Get a mirror and just have a look. But remember a prolapse is dynamic, it might be there when you stand up but not when you sit down. Or it could only appear when you try to go to the toilet.
Start with an empty bladder, lying slightly propped up and use a mirror. Relax your pelvic floor muscles and look for a bulge. Cough or bear down for a few seconds to see if something appears. Next try changing your position. Stand up with one foot up and repeat the cough / bearing down. If a golf ball shape protrudes then you do have a significant prolapse.
Finally, if you haven’t seen anything yet but still suspect a prolapse, insert 1-2 clean fingers into your vagina and feel the front and back wall whilst coughing or bearing down strongly. If a bulge appears, more than likely you have a small prolapse.
You’ve got one…now what?
Don’t panic! You are not alone. There are several things that can be done, both at home and by professionals, to help with the symptoms.
More fibre & Water – straining to achieve bowel movements can make POP worse. Fibre and water help make bowel movements easier so you are not pushing down so much.
Lose a little weight – excess weight creates more pressure down into the pelvis aggravating symptoms.
Pelvic floor exercises – strengthening the pelvic floor can help alleviate the symptoms of a mild prolapse, though these are best done with professional advice. Many women do these incorrectly, with the potential of worsening the POP. Also these cannot reverse a POP, but can help with the symptoms.
Pessaries – Small devises inserted into the vagina that help support the anatomy. They come in lots of different shapes and sizes. Must always be used with care as they do need regular cleaning and fitting is crucial to good function.
Surgery – When seriously affecting quality of life surgery may be the only option. The most successful surgery for the physical symptoms is vaginal obliteration but this is not always best for the person because it leaves you with no sexual function at all. Another option is reconstructive surgery, either using your own tissues, small stitches or mesh for support.
And finally……..
Remember, early symptoms can be mild and easily dismissed. Seeking help for a proper diagnosis and personalised treatment plan is always a good idea if you are worried. Self help advice is never a substitute for professional advice. Don’t be afraid to ask for help. Pop is a common condition and effective treatment is out there, you just need to ask.
If you are still struggling, please do come in for a diagnosis and treatment with your local Farnham based Women’s Health osteopath, specialising in getting you back to doing what you love. Get in touch by calling 01252 850814, emailing enquiries@outlinehealth.com or book online.
Additional Resources
Association for Pelvic Organ Prolapse Support
NHS Pelvic Organ Prolapse
National Institute of Child Health and Human Development article on Pelvic Organ Prolapse