Types and Degrees of Pelvic Organ Prolapse
There are a few different types of prolapse. For females in particular, the vaginal wall, the uterus, urethra, bladder, small intestine, or rectum can descend. Males have a much lower incidence of prolapse because their external genitalia provide an immense amount of structural support to their organs. However, men can experience rectal prolapses. It is also possible for transexual females to have a “neovaginal” prolapse after a male-to-female sexual reassignment surgery.
There are different degrees of prolapse, from zero to four. Zero represents no prolapse and four represents the organ fully descending outside of the body. If you have a 4th degree uterine prolapse, then you should see a pelvic floor physical therapist for preoperative strengthening, but having surgery is more than likely the solution. If you have a first, second, or third degree prolapse, then pelvic floor physical therapy is the go-to way to help fortify the pelvic floor muscles and learn body mechanics, understand proper breathing mechanics, reduce constipation, and manage symptoms.
So how do you know if you may have a prolapsed pelvic organ? Often times, people will complain of a “pressure” or “bulging” sensation down by their vagina or rectum, as if something is falling out. They may feel like something is stopping them from going to the bathroom and need to physically “splint” or put their finger in their vagina to help pass stool. Urinary and fecal incontinence are common as the degree of prolapse increases. People often have low back pain to top it all off. Usually these symptoms happen at the end of the day when they have been moving around and their body has been fighting gravity for many hours. Symptoms often reduce when they lay on their back or in an inverted position with their pelvis higher up than their chest (yoga poses like bridge and headstand). It is also very much possible to have a prolapse and be completely asymptomatic.
Why does it happen?
There are a host of factors that contribute to pelvic organ prolapse. In essence, whenever the load of the “10 jumping kids” is too great, organs can prolapse. Also if the “trampoline” itself is loose to begin with, this could also cause organs to descend. Here is the breakdown of some reasons for both:
Too much load and pressure:
1. Poor breathing during movement → When we lift heavy objects, we should never hold our breath.
Sometimes, when a movement is difficult, people tend to do this. I even see people performing a “valsalva” where they hold their breath and turn red in the face when they are lifting heavy weights at the gym. This is TERRIBLE for our pelvic floors. Why? This is basically like dropping a bowling ball into our pelvis every time we do this. We need to be breathing correctly during movements. Exhaling in a controlled way as we contract our deep core and pelvic floor muscles during powerful movements is a great start.
2. Constipation → Many of you have sat on the toilet and held your breath to push out a bowel
movement, right? Similar to the point above, holding your breathing and pushing hard during a BM is also going to add excessive pressure to your pelvic floor and cause undue stress to this area.
3. Pulmonary Disease → There is a correlation between prolapse and chronic obstructive pulmonary diseases like asthma and chronic bronchitis. This is because coughing excessively throughout life increases intra-abdominal pressure or pressure within the abdomen that pushes down into the pelvis.
4. Obesity → Imagine if the 10 jumping kids turned into 50. If you have more weight above your pelvic floor, this can lengthen and weaken the pelvic floor as well.
Compromised pelvic floor tissues:
1. Connective tissue dysfunction & Hypermobility → Many systemic diseases can impact the laxity of the tissues in your body, including Ehlers-Danlos Syndrome and Marfan syndrome. When the tissues stretch excessively, there is less support to hold up the organs. Also women with benign joint hypermobility (BJHS) tend to have more prolapse.
2. Pregnancy → Normal childbirth is trauma to the pelvic floor. Even more trauma occurs with a vacuum-assisted birth, perineal tears, episiotomies, and forceps delivery.
3. Previous Surgery → A history of a hysterectomy, for example, can predispose you to future prolapse. This is because the surgery itself can compromise the integrity of the tissues in the pelvis.
What can I do about it?
A pelvic floor physical therapist can evaluate you for the type and degree of pelvic organ prolapse. Here are a few tips I give my patients:
Prolapse sounds like a scary word. But it doesn’t have to be. If you don’t have a prolapse, then think about the few points mentioned above as preventative strategies. If you do have a prolapse, there is help!