POP Pelvic Organ Prolapse - What you need to know
Pelvic Organ Prolapse is one of those taboo subjects - we hear about it but unless we ask anyone, do we know what it really means?
Well, here’s a rundown for you if you really don’t want to ask and perhaps get a bit squeamish!
A prolapse occurs when the pelvic floor muscles are weakened and the pelvic organs can bulge (prolapse) from their natural position into the vagina. Sometimes the prolapse can be so severe that it can protrude from the vagina. Personally I can’t imagine how scary this must feel to literally have your insides falling out. This is the reality for many women, though the majority will only suffer a partial prolapse.
Pregnancy and childbirth
Pregnancy and childbirth place a lot of stress on the pelvic floor and if your baby was large, you had an assisted birth (forceps/ventouse) or your labour was prolonged you are at increased risk of developing a prolapse. However if this applies to you, do not panic! We are talking about risk and how you can take back control to ensure you can avoid issues in the future.
Straining on the toilet (IBS for example) can cause weakness and overstretching and can be a factor in developing prolapse.
Remember to always use a stool when doing a bowel movement.
Issues following a hysterectomy
If you’ve had a previous hysterectomy you can suffer because the top of the vagina is supported by ligaments and muscles. If these supports weaken, as can be the case when you’ve had a hysterectomy, a vault prolapse may occur.
Chronic coughing and heavy lifting can cause an increase in pressure on your abdomen resulting in pressure on your pelvic floor muscles as everything is interconnected.
Other factors increasing your likelihood of developing a prolapse include:
high impact exercise, age, obesity and family history of prolapse. Now don’t go giving up your exercise classes and, lord knows, none of us can do anything about our age or our families, but there are lifestyle factors that we can adopt to reduce our chances of developing a prolapse. There is significant research to say that prolapse is also more common after the menopause, as the hormone oestrogen is significantly reduced if you’re not taking HRT (Hormone replacement therapy).
How do you know if you’re suffering with a prolapse?
So there are 3 areas to be aware of in noticing symptoms.
Notice changes with your bladder
With the bladder, signs to look out for are feeling like your bladder is not emptying fully. If you’ve had children like me, you’ll remember needing to go to the toilet more often - if this is becoming a regular issue for you, you may need to investigate further. Failing to get to the bathroom in time or needing to go to the toilet at night is not just about drinking too much before bedtime! We know we need to keep our bodies hydrated so it’s really important to continue to do that and not reduce our water intake. And finally if you suffer with stress incontinence, ie. leaking when you cough, sneeze or exercise or a feeling of heaviness around your lower tummy and genitals, you could be seeing the early signs of a prolapse.
Changes in the vagina
The second area to look out for signs is the vagina, where you could feel a dragging discomfort inside like there is something coming down into your vagina – it may feel like sitting on a small ball. The sign that is the most terrifying sign is feeling or seeing a bulge or lump in coming out of your vagina - if you haven’t seen a nurse or doctor by this time, you need to take action now. You may suffer with discomfort or numbness during sex or notice dislodged or dropped tampons.
Which leaves us with the third area, the bowel, where signs may include experiencing constipation, lower back pain or incomplete bowel emptying. Sufferers have described uncontrollable leakage from the anus along with difficulties getting clean after a bowel motion and uncontrollable flatulence. If you have noticed you have an anal prolapse, you may need to push back the prolapse to allow stools to pass.
Occasionally, pelvic organ prolapse has no symptoms at all and is found during an internal examination carried out for a smear test, but make sure you do your research before you agree to any procedures that a doctor may suggest and perhaps get a second opinion if you’re feeling frightened about the situation.
There are 4 Main Types of Prolapse and it is possible to have more than one of these at the same time.
1. The bladder bulging into the front wall of the vagina (anterior prolapse)
2. The womb bulging or hanging down into the vagina (uterine prolapse)
3. The top of the vagina (vault) sagging down (vault prolapse) – this happens to some women after they have had surgery to remove their womb
4. The bowel bulging forward into the back wall of the vagina (posterior wall prolapse)
I understand if this is all sounding scary but if you feel you may have a prolapse PLEASE PLEASE Don’t Panic!
Head to the GP for a diagnosis but please don’t ignore it - it likely will get worse if left alone - but if you know you can start to take positive active action to improve it. For the doctor to diagnose you will need a vaginal examination, which will require insertion of a speculum (this is a plastic or metal medical instrument that is used to separate the walls of the vagina in order to show or reach the cervix) to determine which organ(s) are prolapsing. If you’ve had a smear test before you will know what to expect.
I personally recommend that you ask to be referred to a pelvic floor physiotherapist. I can highly recommend the Mummy Mot, the have physios who specialise in the pelvic floor all over the country