What is Pelvic Organ Prolapse? What treatments are used in Pelvic Floor PT?

Pelvic organ prolapse (POP) occurs when pelvic floor muscles (PFM) and ligaments fail to support the pelvic organs resulting in the drop of tissue or an organ from their normal position into vaginal canal. Pelvic organs that can prolapse are the vagina, cervix, uterus, bladder, urethra, and rectum. Pelvic floor physical therapists specialize in diagnosis and treatment of POP. Treatment for POP can include PFM strengthening, biofeedback, manual techniques, deep breathing techniques, posture retraining, and specific strengthening or stretching exercises to help you get rid of pain and discomfort, restore your function, and improve your quality of life.

Symptoms and Grading of POP:

Common symptoms include pelvic pain, discomfort, aching, fullness in the pelvis, pressure that gets worse with standing, coughing, or later in the day and with physical activity or sex. POP presents as bulging of tissue or organs that protrudes to or past the vaginal opening (depending on the grade of POP) that can been felt or seen. Other associated symptoms are urinary incontinence (leakage of urine), urge and frequency (polyuria), waking up in the middle of the night to go use the bathroom (nocturia), difficulties with bowel movement, fecal incontinence, and difficulties using tampons or having gynecological examinations.

Types of POP:

• Cystocele: prolapse of the bladder
• Rectocele: prolapse of rectum
• Urethrocele: prolpapse of the urethra
• Uterocele: prolapse of the uterus
• Enterocele: prolapse of the intestine
• Vaginal vault: vaginal wall prolapse

Grading

There are 4 degrees of POP determined by the relative distance of prolapsed organ to the perineum located between vaginal and anal openings:

• Grade 0: no prolapse
• Grade 1: the most distal part of the prolapsed organ is >1 cm from the hymen/perineum
• Grade 2: the most distal part of the prolapsed organ is <1 cm from the hymen/perineum
• Grade 3: the most distal part of the prolapse is >1 cm beyond the hymen and everted no more than 2 cm past the hymen/perineum
• Grade 4: complete vaginal eversion [affects 3-6% of women

Risk Factors and Causes of POP: 

There is an array of genetic and lifestyle factors that could increase the odds of developing a POP, such as:

• Family history of prolapse
• Ethnicity (increased risks for POP in individuals of white and hispanic descent)
• Obesity
• Frequent constipation, pushing and straining for bowel movements
• Adbanced age
• Multiple vaginal childbirths
• History of hysterectomy

Physical Therapy for POP:

If it is determined that you have a POP, your PT will design a specialized program for you to address the strength, flexibility, and endurance of your core and pelvic floor muscles. The goal of therapy is to reduce and alleviate symptoms, and prevent exacerbation of the prolapse. Your PT will also give you with strategies so you can independently manage your condition. Studies show that POP can be reduced by one grade with pelvic floor physical therapy. Your PT will also be able to make an appropriate referrals to other health care providers for any concerns outside our scope of practice arise.

Available Surgical Treatment Options:

In some cases, conservative treatment alone is not enough to restore normal function. It may be necessary to consider alternate measures including the use of a pessary or surgical repair. A pessary is a non-permanent device inserted into the vagina that gives additional support to the pelvic organs. Women can choose to use it when they are active and remove it for sleep or sex. Additionally, 300,000 POP surgeries are performed annually in the US. Surgical repair may be done using synthetic mesh or your own body tissue. A board certified surgeon will be qualified to make the decision regarding which is the best option for you.

Most importantly, remember that there is no shame in having POP. If you have any questions regarding this condition or think you may need help to get Back to Life, please do not hesitate to reach out to the Pelvic Health Physical Therapists at SPEAR!