By Riva Preil
June marks Pelvic Organ Prolapse Awareness Month. Pelvic organ prolapse (POP) is a descent of the uterus, bladder, and/or rectum. It is often associated with stress urinary incontinence or bowel dysfunction. Patients often report a feeling of fullness in the vagina or the feeling of a tampon falling out.
Multiple factors affect the development of POP, including genetic predisposition, number of previous pregnancies and deliveries, age (ex. post-menopause), and ethnicity. Furthermore, women who have worked in professions that involve heavy lifting and increased intra-abdominal pressures (ex. flight attendants) are at a greater risk of developing prolapse.
A woman’s chances of developing prolapse increase significantly with her third child’s pregnancy and delivery. Furthermore, women with a connective tissue disorder (ex. Ehlers-Danlos or Marfans Syndrome) are at increased risk of developing POP.
Research has shown that pelvic floor physical therapy targeted at STRENGTHENING the pelvic floor muscles can help reduce the severity of prolapse. Therefore, pelvic floor physical therapy is an appropriate and minimally invasive treatment. The best position for Kegel exercises is with hips elevated (ex. on a wedge or stacked pillows- refer to picture). This position takes advantage of the gravitational pull which naturally reduces organ descent. It sure beats having to do your Kegels standing on your head!
Should physical therapy alone not suffice, a pessary may be an appropriate device to help provide additional support to the system’s laxity. In more severe cases, surgery may be the appropriate intervention. One should speak to their doctor if they think that either of these options may be appropriate.