Q. I am having more urinary incontinence and at my last PAP test the nurse practitioner mentioned that my pelvic floor is in the beginning stages of a prolapse. What exactly does that mean and what can be done about it?
A. The pelvic floor is comprised of the muscles and connective tissues that are located between the tailbone and the pubic bone within the pelvis. It supports the bladder, bowel and the uterus and thus helps with bodily functions such as urinating, defecating (bowel movements) and sexual function. A strong pelvic floor keeps the bladder, uterus and bowel supported. Pelvic floor prolapse, also known as pelvic organ prolapse (POP), occurs when these important muscles and tissues in our pelvis weaken. When this happens, it allows one or more of our pelvic organs, such as the bladder, uterus, or rectum, to drop from their usual position and press against the walls of the vagina or anus. Prolapse is much more common in women and usually involves the vagina but men and women may also find themselves experiencing a prolapse into the anus.
There are several types of prolapse, each involving different pelvic organs:
Cystocele (bladder prolapse): Occurs when the bladder drops into the vagina.
Rectocele (rectal prolapse): When the rectum bulges into the vagina or the anus.
Uterine prolapse: When the uterus descends into the vaginal canal.
Enterocele: Involves the small intestine bulging into the vagina.
The symptoms of pelvic floor prolapse can vary widely depending on the type and severity. In mild cases, there may be no symptoms at all. However, if you do not pay much attention to your pelvic floor, the prolapse may progress and you may experience the following:
· A sensation of pressure or fullness in the pelvic area: Some describe it as a feeling of something “falling out.”
· Visible bulge in the vaginal area, especially during activities like lifting or straining.
· Discomfort or pain during intercourse.
· Difficulty with bladder control: This may include urinary incontinence, frequent urination, or an inability to fully empty the bladder.
· Bowel issues: Constipation or difficulty with bowel movements can occur with rectal prolapse.
· Lower back pain or aching around the pelvic region.
· Recurring urinary tract infections (UTIs) can sometimes accompany pelvic prolapse.
These symptoms can significantly impact daily activities, from exercise to basic mobility. It is not uncommon for patients to feel embarrassed discussing their symptoms with healthcare providers making it difficult to predict how prevalent it truly is. We encourage anyone experiencing these symptoms to have a discussion with their healthcare provider.
If you are curious how our pelvic floor weakens, there are several factors that increase our risk of POP such as:
- Pregnancy: The pelvic floor muscles support your growing baby and may get stretched during your pregnancy
- Childbirth: Vaginal deliveries, especially those involving prolonged labor or large babies, increase the risk due to the strain placed on the pelvic muscles
- Age: The risk increases with age, particularly after menopause, when lower estrogen levels can weaken pelvic tissues
- Genetics: A family history of prolapse may indicate a genetic predisposition to weaker pelvic tissues
- Obesity: Excess weight can put additional pressure on the pelvic floor
- Chronic Cough or Constipation: Straining due to chronic coughing or constipation can weaken pelvic muscles over time
- High-impact activities: Regularly engaging in activities like weightlifting or high-impact sports may increase prolapse risk.
Currently, it is estimated that 40% of women worldwide will be affected by pelvic organ prolapse at some point. As you can see, aging is one of the risk factors associated with POP. Since we cannot reverse our aging process (wouldn’t that be nice?} and our elderly population expected to double by 2030, we will most likely see a rise in POP in years to come. Therefore, we need to pay more attention to prevention. While not all cases of pelvic floor prolapse are preventable, several lifestyle changes and habits can help reduce the risk or slow the progression:
· Practice Pelvic Floor Exercises: (Kegels): Strengthening the pelvic muscles through Kegel exercises can improve support for the pelvic organs. To do a Kegel exercise, squeeze (tighten) the muscles you would use to stop urine flow, hold for five seconds, and release. Aim to do these exercises several times a day.
· Maintain a Healthy Weight: Losing excess weight can reduce pressure on the pelvic floor, reducing the likelihood of prolapse.
· Prevent Constipation: A fiber-rich diet, adequate hydration, and regular exercise can help prevent constipation and minimize straining during bowel movements.
· Avoid Heavy Lifting: If lifting is necessary, use proper form—lift with your legs, not your back or pelvic muscles.
· Stop Smoking: Smoking can lead to chronic coughing, which in turn places strain on the pelvic floor muscles. Additionally, smoking reduces collagen production, potentially weakening the connective tissue that supports pelvic organs.
· Hormone Therapy: For some postmenopausal women, hormone replacement therapy (HRT) may help strengthen pelvic tissues by maintaining estrogen levels. This is a decision to discuss with a healthcare provider, as HRT is not suitable for everyone.
Treatment for pelvic floor prolapse depends on its severity, symptoms, and the patient’s preferences and lifestyle. Bear in mind that not all treatment choices are viable options for everyone.
1. Lifestyle Adjustments and Pelvic Floor Therapy: Mild cases can often be managed with the Kegel exercises and the lifestyle modifications mentioned above.
2. Pessary Device: A pessary is a removable device placed in the vagina to provide support for prolapsed organs. Available in various shapes and sizes, a pessary can be an effective non-surgical option, especially for women who want to avoid surgery or who may not be good candidates for it.
3. Medications: In cases where urinary symptoms, like frequent UTIs, are associated with the prolapse, medications may help manage these symptoms. Topical estrogen, applied directly to vaginal tissues, may also help strengthen the pelvic area in postmenopausal women.
4. Surgical Options: For more severe cases, surgery may be required. Surgical options include repairing the prolapsed organ or, in some cases, removing the uterus. Some procedures can be done vaginally, while others may require abdominal surgery. Surgery generally has a good success rate, but it’s important to weigh the benefits against potential risks with a healthcare provider.
5. Physical Therapy: Physical therapists specializing in pelvic health can guide patients through exercises to strengthen and support the pelvic floor. Some patients may benefit from biofeedback, a technique that helps improve control over pelvic floor muscles. We have a few of these specialized therapists in our Grey Bruce area so consider getting in touch with one of them.
Living with pelvic floor prolapse can be challenging and often feels isolating due to the sensitive nature of symptoms. Some may be experiencing unbearable pain associated with their prolapse. If you are silently suffering from any stage of prolapse, we strongly encourage you to discuss your symptoms with your healthcare provider. Early intervention can help manage your symptoms and prevent progression. With a range of non-surgical and surgical treatments available, many patients find a solution that allows them to return to the activities they love.
For more information on this or any other health topic, contact your pharmacist.
