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  • Deborah Thomas BPT MCSP MAPPI Chartered Physio

Pelvic Organ Prolapse (POP)

Some of you will be familiar with this scenario:

You have been told you have a prolapse, and recommended to do pelvic floor exercises,

or,

You can feel a heaviness, discomfort, something bulging - and you’re not sure if to exercise or not?


So what is a prolapse, why does it happen, and what can be done about it?

Interestingly, 50% of women who are found to have a prolapse on assessment, will be asymptomatic, so they will not feel any symptoms. Having said that, it can have a significant impact on quality of life and psychological well-being of the affected woman.

The NICE guidelines from 2019 regarding POP, recommend specialist pelvic floor physiotherapy for all stages of assessment and treatment of this condition.


To understand this, it is helpful to understand:

  • The basic structure and organisation of the organs inside the pelvis.

  • The forces coming from above and below these organs and the pelvic floor.

  • What affects our ability to control these forces.

  • What can a pelvic health physio do to help you reach your goals and exercise comfortably.


The Pelvis

The pelvis is a bony structure composed of three bones, the ilia (x2 Ilium bones) and the sacrum (tail bone), and so we have a structure that is like a bony ring.

Inside this ring shape, we have organs from the digestive system - the Rectum, the reproductive system - the uterus, cervix, vagina, fallopian tubes and ovaries, and the urinary system - the bladder, ureters and urethra. Surrounding all these and supporting them is an impressive network of connective tissues (fascia) and muscles (pelvic floor & wall).

This flexible supportive network is designed to be flexible, responsive and mobile, to allow movement inside the rectum, cervix and urethra; to allow filling and emptying of the rectum and bladder, as well as the uterus. The movement of the diaphragm - our main breathing muscle, creates a constant movement of the pelvic floor muscles, and this constant movement is important for our breathing, digestion, circulation of blood & lymph fluid.


One of the roles of the pelvic floor muscle group is to act like a hammock - to support the weight, structure and alignment of all the organs inside the pelvic ring. This ability to support, can be compromised by forces coming from above the pelvic floor:

  • Repetitive, heavy lifting

  • Incorrect breathing strategies, like breath holding

  • Chronic coughing

  • Hormonal changes, especially the levels of Oestrogen and Testosterone.

  • Constipation

  • Over-stretching of the tissues due to pregnancy & child birth

  • Pelvic surgery

  • Connective tissue disorders


And forces coming from below the pelvic floor:

Altered alignment , as well as

Muscle power and coordination of the legs (from the ankle to the hip & pelvis) in running, jumping & landing, Hockey, Cross Fit & other exercises -


This affects the forces absorbed by the lower limb structures, as well as the pelvis, and therefore what is transmitted onto the pelvic floor and pelvic bony ring.


It is more the how, rather than the what we do that affects the balance of the forces above & below the pelvic floor that makes the difference.


A pelvic health physio will assess all these to establish how you breath, manage forces, and what is influencing the pressures inside the abdomen & pelvis, as well as assess the biomechanics of movement and muscle function from the Ankle all the way up to the trunk.


When there is less support inside the pelvis, or more movement and flexibility inside the pelvis, or the pressures from above / below are more than the soft tissues can withstand, people may experience symptoms of heaviness, dragging, bulging and discomfort:

The rectum can lean onto the cervix, or the bladder can lean onto the cervix, or the uterus can be less supported by the cervix and lower into it. As organs and tissues can move and be flexible - this is very individual in how it presents and feels to each person.


A Pelvic health physiotherapist will perform an evaluation to include a thorough history, assessment of symptom severity, physical examination, and goals for treatment. Symptom assessment is the most important part of the evaluation of a woman with POP. She will, as per the recommendations and guidelines - take a history to include symptoms of prolapse, urinary, bowel and sexual function.


A pelvic health physio has many strategies to help and address the forces affecting the pelvis: how you move / lift / squat / jump / land; How you breath, move and use your thorax, rib cage, diaphragm; we’ll assess how you manage pressures inside the abdomen, rib cage and pelvis; We may add pelvic floor muscle training, address lifestyle habits and behaviours. We may use or recommend pessaries to improve your symptoms and ability to exercise.

A discussion about all the options of treatment is carried out , and you are a part of the team deciding which way you are comfortable going ahead with, to suit your goals.


To find out more, and see how I can help you feel more comfortable and achieve your goals, contact me on:

Email: inspirationpilatesphysio@gmail.com, or

Call me: 08976 977 247,

You can always book in with me: https://my.powerdiary.com/clientportal/kqyz5





References:

Pelvic Organ Prolapse 2017: CHERYL B. IGLESIA et al, American Family Physician,Volume 96, Number 3 August 1

Pelvic organ prolapse: the impact on quality of life and psychological well-being. Antonio Simone Laganà et al : JOURNAL OF PSYCHOSOMATIC OBSTETRICS & GYNECOLOGY, 2017

http://dx.doi.org/10.1080/0167482X.2017.1294155

Pelvic Organ Prolapse, AUGS GUIDELINES, The American College of Obstetricians and Gynecologists and the American Urogynecologic Society , Female Pelvic Med Reconstr Surg 2019;25:397–408

NICE guidelines: Urinary incontinence and pelvic organ prolapse in women: management, Last updated: 24 June 2019, https://www.nice.org.uk/guidance/ng123


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