Pelvic Organ Prolapse: Beyond Kegels
Written by Tara Johnston, PT, DPT
Pelvic Organ Prolapse or POP is common in women after having a baby or around menopause, but can happen at any stage of life. POP is when your bladder, uterus, or rectum pushes into your vaginal canal giving you a sensation of heaviness or like something is “falling out”. Sometimes this can accompany problems going to the bathroom, but not always. Traditionally women were prescribed Kegels to strengthen their pelvic floor, but we now know that strength is only one small component of POP management. Think of a balloon. If you press on the balloon in any direction, you will see a bulging somewhere else on the balloon. Chronically “sucking in” your tummy, abdominal scars, altered breathing patterns, and low back tightness can all have a profound effect on POP.
DO NOT STOP EXERCISING!
Many women with prolapse stop exercising due to fear that they will make it worse. There is no evidence to support this thought. Exercise has numerous benefits for our health including bone density, mental health, hormonal balance, and prevention of muscle loss with aging. If we think about the balloon idea above, it is true that lifting and high impact exercise increase our intra-abdominal pressure and thus the pressure on our pelvic floor. You may be surprised to find out that coughing and standing up were shown to increase pressures more than lifting 20 pounds. Are you never going to cough or stand again to protect your pelvic floor? NOPE!
If you experience symptoms with a certain exercise, it is important to look at modifications, pelvic position, breathing, and strategies to reduce symptoms, but it is not recommended to stop exercising. Another great bonus of exercise that most people don’t know, is that our pelvic floor muscles activate reflexively with exercise. It’s like doing Kegels without having to remember to do them!!!! Pick something you love for exercise, do it, and if you have symptoms, seek out advice from a pelvic health PT.
WHAT IS A PESSARY ANYWAY?
Pessaries can also be a helpful tool to support your pelvic floor muscles. Think of a pessary like a sports bra for your vagina. It is a small device inserted into your vagina to support the tissues. Pessaries can be used to prevent prolapse from worsening, prolong the need for surgery, and reduce symptoms of POP. A study by Cheung, et al in 2016 demonstrated that using a pessary in addition to pelvic floor muscle training, resulted in decreased symptoms and improved quality of life in women with mild to moderate prolapse (grade1-3). Pessaries may not be for everyone, but they are another tool to consider in managing pelvic organ prolapse.
If you have POP or feel heaviness or dragging in your pelvic floor try a few of these tips:
· Eat a well balanced diet including healthy fats, protein, and lots of veggies
· When having a bowel movement, put your feet up on a step stool so your knees are above your hips
· Do not hover over the toilet or push your urine out
· Breathe when lifting. A good strategy is “exhale with effort” or breathe out as you do the hardest part of the lift.
· Kegels -- YES! Pelvic floor muscle strengthening is part of the pressure system and Kegels will help to improve the tone and strength of these muscles
There are many other ways to improve your body’s ability to manage pressure and often women need a hands-on approach to make sure abdominal, back, pelvic floor and diaphragm muscles are working optimally. At Advanced Rehabilitation Services we are here to assist you along this journey and ensure you are doing everything possible to reduce these bothersome symptoms.
Pessaries, Pelvic Organ Prolapse and Physical Therapy: A Literature Review. Kathe Wallace, PT and Kimberlee Rudeen, SPT 2019.
Movement, Exercise and Breathing with Pelvic Floor Dysfunction (PFD): A Literature Review. Kathe Wallace, PT and Kimberlee Rudeen, SPT 2019.
Cheung et al. Vaginal pessary in women with symptomatic pelvic organ prolapse. Obstet Gynecol. 2016;128(1):73-80.