Pelvic organ prolapse. Anterior vaginal wall prolapse. Posterior vaginal wall prolapse. Cystocele. Rectocele. Uterine prolapse.

Sounds terrifying right? And yes, it is often scary for someone who feels it for the first time. But, Prolapse is very common. It’s usually manageable with physio and there are many things a woman can do to help herself. But people often don’t know it, because people don’t talk about it. Keeping these sorts of topics under wraps helps no one. Knowledge is power, and we should be shouting it from the rooftops, not whispering about it.

So what exactly is it?

How did I get it?

How can I fix it?

What is prolapse?

Our three pelvic organs: the bladder, bowel and uterus, sit inside our pelvis ontop of our pelvic floor muscles. Our pelvic floor muscles form a bowl or hammock shape, at the base of our pelvis. This provides support to our organs from the bottom.

Imagine the three organs like puppets on strings. We have ligaments (the strings) that hold the pelvic organs up and attach to our pelvic bones and suspend them. They provide support from the top.

Prolapse is a result of these strings/ligaments being overstretched and can no longer support or suspend the organs like they normally would. This results in more laxity and movement of the organs. Gravity moves the organs downwards, and results in the organs pressing into and bulging into the vaginal walls, which are very flexible.

There are three main types of prolapse

1.    Anterior vaginal wall prolapse: when the bladder bulges into the front wall of the vagina

2.    Uterine prolapse: when the uterus bulges down into the vagina

3.    Posterior vaginal wall prolapse: when the bowel bulges into the back wall of the vagina

Prolapse can range in severity of symptoms. Some people have mild symptoms, some people are severely bothered by them. Symptoms include:

•      A lump, bulge or dragging sensation in the vagina, often when sneezing, standing for a long period or performing physical activity

•      Pain in the vagina or lower back

•      Bladder leakage, urgency to wee and/or needing to wee more often

•      Constipation or feelings of incomplete emptying of the bowels

How does prolapse happen?

The main cause of prolapse is a vaginal birth. The ligaments, and the pelvic floor muscles can stretch and weaken from the stretch of baby’s head and shoulders coming through the pelvis.

Other risk factors include:

Birth related risks:

-    The use forceps or suction to help get the baby out

-    A baby that is bigger than 4kg when born

-    Having a very long labour (having to push for more than 2 hours)

Other risks:

•      Smoking or having a chronic cough (stop smoking, and treat those allergies girl!)

•      Having a high BMI

•      Constipation or straining on the toilet

•      Regularly perform high impact exercise (interestingly, a high percentage of elite athletes who’ve never had a baby have prolapse and/or incontinence)

•      Regularly lifting heavy things (ie toddlers, or as part of your job or exercise regime)

•      If your mother/grandmother/sister has prolapse

•      Large uterine fibroids or pelvic tumours

How can I fix it?

Fix is probably not the correct word to use here. The only way to change the anatomical structures that have changed, is by surgery. Surgery can be done by a urogynaecologist, and usually involves strengthening up the vaginal walls and/or internal ligaments surgically. However, most mild to moderate prolapses can be managed with physiotherapy +/- a pessary.

A pessary is a small plastic or silicon device, inserted into the vagina for support, like internal scaffolding, otherwise called a ‘bra for your vagina’. You should be taught how to insert it and remove it yourself, and, much like a tampon on menstrual cup, you shouldn’t be able to feel it when it’s in there. You can have a pessary fitted by a pelvic health physio or a gynaecologist. They are very useful in eliminating symptoms of prolapse and, because they support your organs, they protect against the excess force that can further weaken your supportive “strings” – thereby protecting against making your prolapse worse

Other physiotherapy management includes:

•   Pelvic floor muscle training (done correctly and well, can improve some symptoms, and help prevent worsening of prolapse

•   advice on how to avoid making the prolapse worse

•   small lifestyle changes ie reducing BMI, improving constipation, general exercise, fluid intake advice, lifting techniques

So, talk about prolapse! There’s many management strategies. These stigmatised topics need to be bought to light, in order for other people with prolapse to know there is help, and there is hope.