Do you worry about prolapse?

Prolapse affects approximately 1 in 3 women and can cause all manner of problems, not least incontinence. But symptoms can be eased with exercise and good habits.

When former TOWIE star Ferne McCann bravely spoke to OK magazine about her prolapsed bladder, and the incontinence she suffered as a result, it probably touched a nerve with many women across the UK.

Pelvic organ prolapse (POP) is a condition that causes the bladder, bowel, rectum or uterus to move downwards in the vagina. It affects approximately 1 in 3 women and is particularly prevalent in those who’ve had children. Prolapse can be mild, causing few problems or it may be more severe causing bladder, bowel or sexual symptoms.

Incontinence isn’t something you’d associate with a woman in her twenties but in the interview with OK, Ferne explained how the incontinence she experienced as a result of the prolapse has affected every aspect of her life, including her confidence. It has prevented her from doing some of the activities she used to enjoy, such as fitness workouts, and was so troublesome that she was reluctant to leave the house for fear of wetting herself.

What causes prolapse?

The pelvic organs are held and supported inside the bony pelvis by ligaments and muscles; commonly called the ‘pelvic floor’. These muscles help to support the pelvic organs and control the bladder and bowel. If either the pelvic floor muscles or the supporting structures weaken, such as during childbirth, this puts strain on the pelvic organs and pelvic floor muscles, the pelvic organs can bulge into the vagina causing the vaginal walls to move downwards resulting in a prolapse.

But it’s not only vaginal birth that causes prolapse, there are other lifestyle factors that can cause or exacerbate it. If you are overweight or obese, for example, this causes extra pressure through the pelvis and onto the pelvic organs and increases the risk of prolapse. Heavy lifting may also make a prolapse more likely, if the pelvic floor supports are weak.

As we age, muscle strength and the vaginal supports can deteriorate. This, together with lower levels of oestrogen post-menopause, may make prolapse more likely. Also, chronic constipation and straining to empty your bowels cause increased intra-abdominal pressure and may cause prolapse. Asthma, smoking or other conditions that cause a persistent cough, and therefore strain the pelvic floor muscles, could also make a prolapse more likely.

What types of prolapse are there?

There are different types of pelvic organ prolapse; there is a front vaginal wall prolapse, where the wall supporting the bladder bulges down into the vagina, causing problems with emptying the bladder and causing urinary tract infections and incontinence. The back vaginal wall prolapse is where the wall supporting the rectum/back passage bulges down into the vagina, resulting in difficulty emptying your bowels or incomplete emptying which can lead to straining and bowel or wind leakage. A Uterine prolapse (‘fallen womb’) is where the uterus moves downwards into the vagina due to the lack of support. The cervix will then sit lower in the vagina. A Vaginal vault prolapse can happen after a hysterectomy, whereby the top of the vagina (known as the vault) can bulge downwards.

What’s the solution?

Pelvic organ prolapse is not a life-threatening condition, but it can cause problems. However, there is good news. In many cases, prolapse symptoms can be improved with pelvic floor physiotherapy including exercises to strengthen the muscles and increase vaginal support and manual therapy to treat muscle and tissue imbalances. And good bladder and bowel habits such as avoiding constipation or straining can help too.

Other lifestyle changes that reduce the downward pressures through your pelvis such as weight loss and avoiding heavy lifting, and changes such as eating plenty of fibre and drinking plenty of water can also help. Try low impact exercises too, such as modified aerobics, cycling, cross-training, walking, Pilates, Yoga, Thai Chi or swimming.

What are pelvic floor muscle exercises?

The pelvic floor muscles act like a hammock to support the pelvic organs. Pelvic floor muscle exercises will strengthen these muscles and retrain them to support the pelvic organs.

So how do you do it? Breathe gently and allow the pelvic area to relax. Imagine that you are trying to stop yourself from passing wind at the same time as trying to stop passing urine. You should feel a squeeze and a lift inside. Make sure you release the muscles and breathe in between. Work the muscles with long squeezes as well as short, quick squeezes.

If you're not sure you're doing these exercises properly, you may need some help. Hypopressive exercise is a tool some therapists use to help with pelvic floor dysfunction. As a physiotherapist trained in Level 1 Hypopressive training I can help to ensure you are doing the exercises effectively. I will also look at your diet and lifestyle choices which can affect prolapse and help to manage your symptoms.

If you suffer from pelvic prolapse, don’t suffer in silence. Contact me on 07956 629147 to arrange an appointment.