What does prolapse feel like? Wondering if you have it? Often, prolapse is treatable without surgery. It is likely you can find solutions with easy, at home pelvic floor prolapse exercises! But to know how to treat prolapse, we first have to understand what it is.
What is pelvic organ prolapse?
Different types of prolapse exist. It occurs when connective tissue that normally holds these organs in place weakens or stretches over time. Uterine prolapse is a condition in which the uterus descends in the pelvic cavity.
What does prolapse feel like?
Pelvic organ prolapse (aka POP) can cause a variety of symptoms including discomfort during intercourse and chronic cough. Pelvic organ prolapse may feel like:
- Vaginal pressure or bulging (like something is trying to bulge out of the vagina)
- Feeling that your insides are falling out of your vagina
- Low back pain that is worse as the day goes on
- Pelvic heaviness that is worse at the end of the day
- Difficulty emptying when peeing or pooping
- A need to re-position during poops
- Urinary leakage
The stages of prolapse
There are also varying stages or degrees of prolapse. Pelvic organ prolapse quantification (POP-Q) is a tool used to measure the degree of pelvic organ prolapse. It measures the location, descent and size of the bladder, uterus and rectum. It does this using standardized points relative to the hymen or anterior commissure.
The grades of prolapse range from 0 (not present) to 4 (full eversion or lowering of the tissue). Stage 4 occurs when the organ involved is actually protruding out of the vaginal opening. This needs surgical intervention.
You can treat Grades 1 through grade 3 with physical therapy and supportive devices. Pelvic floor prolapse exercises can help you strengthen your core without surgery!
Causes of prolapse
While pregnancy and delivery is one known cause, it is definitely not the only one. Other causes of prolapse can include:
- Vaginal and/or vulvar trauma via vaginal deliveries
- Tissue restriction from healing cesarean scars or perineal scars
- Chronic pelvic muscle overactivity
- Hormonal changes during menopause
- Pelvic surgery
- Congenital factors
- Race (Caucasian women are at higher risk)
- Activities that increase pressure in the abdomen
- Improper breathing with weight lifting
- Chronic constipation
- Chronic obstructive airway disease
Where to start with treatment
There are many treatment options available. Before an internal assessment, your PT will take a thorough history.
- What does your day to day look like? Do you have a physically taxing job?
- What is your bowel and bladder function like? Do you have pain with intercourse?
- How many pregnancies and deliveries have you had, and was there any trauma? What does your exercise routine consist of?
These are all questions your pelvic PT should be asking you at your initial evaluation. Gathering this gives us an idea of the types of stresses your tissue are sustaining on a daily basis. This will help us determine the best treatment!
Kegel exercises may not be appropriate
Prolapse often occurs because of inadequate pressure management with activity. Another reason is pelvic floor muscle overactivity with muscle inefficiency (weakness). Because of this, “doing your kegels” will likely not improve your symptoms and may even make them worse.
What you can do to help
#1 Get a squatty potty
This puts your pelvic floor muscles in a more lengthened position. Doing so will make pooping and peeing easier, reducing the likelihood of straining. Thus, reducing the pressure on the already weakened vaginal wall.
#2 Swap out your desk chair for an exercise ball
A popular alternative seating solution to alleviate symptoms is sitting on a ball. Sitting on an exercise ball engages your pelvic floor muscles and core, while providing support to the pelvic area.
#3 Don’t push to pee!
That’s right, straining to get the flow of urine going is not how you should pee. So, when you sit on the toilet, let the flow of urine begin on its own. The same applies to “just in case” peeing. You should only be peeing if you have true urgency.
#4 Breathe
Breath-holding can increase the pressure in your abdomen. It can also increase the pressure on the muscles of your pelvic floor and your vaginal wall. So, start using a slow exhale (like blowing out birthday candles) when you exert energy. This includes when working out, picking up kiddos or pets, at work if you have a physical job, etc).
Pelvic Floor Prolapse Exercises
Modify any activity that causes:
- Increased pelvic area heaviness or pressure
- Urine leakage
- Pelvic or low back pain
- Protruding of your tissues out of the vaginal opening
Find a balance between lengthening any overactive pelvic floor muscles and retraining them. You want to improve their strength and motor control.
Always incorporate activities that improve pelvic floor relaxation (walking, gentle yoga, stretching). This is important if you do HIIT (Orange Theory, Crossfit, powerlifting, Pilates, competitive sports or running).
- Find stretches that help including:
- Child’s pose
- Knee to chest stretch
- Butterfly
- Pigeon
- Deep squat
- Piriformis stretch
- Cossack squat
- Spiderman lunge
Stretch before AND after high intensity activity.
Performing stretches prior to working out can help address any tightness present before you begin your workout, which ensures proper muscle function during the workout.
Knee to Chest
Sit on the floor with your feet flat on the ground. Inhale deeply and, as you exhale, bring one of your knees up towards your chest. Wrap your hands around the back of the thigh to pull your knee in closer and hold the position for 15 to 20 seconds.
Child’s Pose
Start by kneeling on the floor with your knees hip-width apart. Keep your big toes touching each other and sit back onto your heels. Then, bring your chest towards the floor and rest your forehead on the ground.
Reach forward with your hands and spread your palms out flat onto the floor in front of you. Hold this position for 30 seconds to a minute before slowly coming back up into kneeling position.
Pain management options
External support devices include:
- Bao Bei maternity support leggings, shorts, or bloomers
- SRC compression shorts or leggings
- V2 Pelvic Floor press
Internal Supportive devices include:
- Poise Impressa (order the sizing kit first to determine appropriate size)
- Pessary (you’ll need an OB/GYN or Urogynecologist to fit you)
- A regular tampon (use a tampon for added support with exercise)
- 10 minutes of pelvic elevation at the end of the day. Use a pelvic wedge or place pillows under your pelvis. This can help reduce swelling and pressure in the vulvar and vaginal regions. You can also put ice on your pelvic floor if you have a lot of vaginal or vulvar pain.
Pelvic floor therapists can help with preventative exercises and stretches for those experiencing prolapse. The Vagina Whisperer offers online sessions with our board-certified therapists (and V-Hive members get those at a discount, too!)
