Nose Creek Physical Therapy Information on Pelvic Floor Prolapse

A prolapse or descent of the urinary or genital organs occurs when the structures that support the pelvic floor become weak. The organs then descend, sometimes through the vagina or rectum. Prolapse often decreases a person’s quality of life, and can lead to bladder and bowel dysfunction. Prolapse is quite common, and approximately 50% of women over the age of 50 report a symptomatic prolaps(1)

- The pelvic floor becomes stretched or damaged during pregnancy and childbirth, and becomes worse with multiple pregnancies.

- As we age, there are hormonal and cellular level changes to the muscles and tissues of the pelvic floor which contribute to the floor becoming weaker(2)

- Increased pressure in the abdomen, such as when constipated and straining at stool, or with chronic coughing, can further stress the pelvic floor.

- Chronic obesity also increases the stress on the pelvic floor and organs.

- Certain types of exercise increase the stress on the pelvic floor: for example, heavy weight-lifting, high-impact aerobics, and long-distance running

- Pelvic surgeries such as hysterectomies alter the anatomy of the pelvis, and may reduce the effectiveness of the ligaments that suspend the pelvic organs.

You might feel a heaviness or discomfort in the pelvis, it might be a 'lump' a 'bulging'. There might be some pain in the pelvis, or in the low back. You may have difficulty retaining urine, have a feeling of urgency to urinate, or may have trouble completely emptying the bladder after urinating.

How is a prolapse detected, and how it is treated?

 Your physician will do an internal pelvic examination to identify a prolapse. Medical treatment involves treating the causes of the prolapse (constipation, coughing, obesity etc.), and sometimes providing a pessary (a small silicone device inserted into the vagina to support the pelvic organs). If necessary, surgery may be an option.

Physical Therapy treatment for prolapse compliments the medical treatment provided by your physician:

- The Physical Therapist offers advice about how you should modify your activities of daily living, or your sport, to minimize pressure on the pelvic floor

- She will provide exercises to strengthen the specific pelvic floor muscles (PFMs) where they are weak. As the muscles are strengthened, they provide more adequate support to the bulging organs. The Physical Therapist performs an internal examination, to identify the specific areas of muscles weakness. In medical research studies, activity modification plus PFM strengtheningimproved symptoms and quality of life in women with prolapse.(3)

1) Swift SE, Pound T, Dias JK 2001 Case-control study of etiologic factors in the development of severe pelvic organ prolapse. International Urogynecology Journal and Pelvic Floor Dysfunction 12(3):187-192

2) Bo K, Berghmans B, Morkved S, Van Kempen M 2007 Evidence-Based Physical Therapy for the Pelvic Floor. Churchill Livingstone p. 235

3) Jarvis SK, Hallam TK, Lujic S et al 2005 Peri-operative physiotherapy improves outcomes for women undergoing incontinence and or prolapse surgery: Results of a randomized controlled trial. Australian and New Zealand Journal of Obstetrics and Gynaecology 45(4):300-303