June is world Pelvic Organ Prolapse (POP) awareness month. Have you heard of POP before? Do you know what it is?
I heard this term once or twice whilst I was pregnant and after giving birth to our daughter Emily but I don’t think I ever really understood what it is and what can be done about it until I started studying women’s health & fitness. Given how common POP is it really saddens me that there is such a lack of education out there about this topic (and pelvic health in general) and guidance about where to get help. I don't know about you but at my 6 week check up I was briefly asked about contraception but not much else and there was barely a mention about my pelvic floor.
More advice and education is slowly getting out to women but there is still a way to go. It can also be difficult to sift out the ‘good’ information from the ‘bad’ when we ask ‘doctor google’ in the middle of the night. Women need more education about this and in my opinion it needs to start when we are young to help remove the stigma and embarrassment around talking about these topics. One thing you can do straight away is to start chatting to your daughters about their pelvic floors, vulvas and vaginas and use the correct anatomical names like you would for any other part of your body. Let's empower our future generation with the knowledge and tools to be body confident and strong.
It is estimated that up to 50% of women will experience POP of some degree during their life. It may be even higher as unfortunately many suffer in silence as they either feel too embarrassed to talk about it, think it is something unavoidable that happens after child birth and as we age or just don’t know where to go to for help. Some may even experience POP without any symptoms.
The good news is that there is help out there. Below I try to explain in simple terms what POP is, the symptoms you may experience if you have POP and what you can do about it.
What Exactly is POP?
Our pelvic organs - that’s your bladder, uterus and bowel - are supported by ligaments, fascia and pelvic floor muscles. Pelvic organ prolapse occurs when the tissues and muscles have become weakened and stretched and as a consequence the pelvic organ(s) start to drop. POP can also be caused by sustained increases in intra abdominal pressure over time which the supporting fascia and pelvic floor muscles are not strong enough to withstand eg chronic coughing or constipation.
You can have a bladder, bowel or uterus prolapse or a mix of them. The grade or severity of the prolapse depends on how ‘far’ the organs drop from their ‘normal' place. The photos below illustrate the different types of prolapse. (Image courtesy of Burrell Education).
Some women who have prolapse do not have any symptoms, however, the majority of us will experience some symptoms which can include:
Feeling of heaviness or dragging in the vagina
A feeling of something ‘coming down’ or a lump in the vagina
Painful sex
Loss of sensation during sex
Difficulty fully emptying your bladder and or bowels
Leaking
Recurring urinary tract infections
Inability to insert a tampon or keep one in place
What Causes POP?
The most common causes which can lead to POP include:
Pregnancy and childbirth
Ageing and menopause
Hysterectomy
Being overweight
Chronic Constipation
Excessive coughing and or heavy lifting
The most common cause of POP is childbirth (both vaginal and c-section). You are at a higher risk of POP if you had a long pushing stage and had interventions like forceps or ventouse to help the labour along.
POP is also common in older women due to the onset of menopause and the associated drop in oestrogen which causes the pelvic floor muscles and supporting fascia and ligaments to lose their strength and ‘springiness’. This is one of the many reasons I recommend that all mums see a Women’s Pelvic Health Physio (WHP) - even if they have no symptoms - as one of the best things you can do to prevent against getting POP in the future is to make sure you have well functioning pelvic floor muscles (i.e. ones that can fully contract AND relax and are well co-ordinated) which a WHP can check for you.
I also highly recommend seeing a WHP during your pregnancy as there is more and more evidence to show that knowing about your pelvic floor muscles and whether they are ‘weak’, or ‘tight’ or in fact well functioning and then doing something about this before giving birth can help prevent birth trauma. Strengthening those potentially already tight pelvic floor muscles during pregnancy isn’t going to result in an easy delivery - instead you should be focussing on being able to relax them. These muscles are internal and therefore only a WHP can really tell you what’s going on so my top tip for all mums (pregnant and post natal) is to go and see a WHP!
What Can you Do about POP?
If you think you suffer from POP then you should see a women’s pelvic health physio (WHP) who can diagnose and help you get treatment.
You can see a women’s health physio by getting a referral via your GP or alternatively you can make an appointment to see a private WHP. I have put details of where to find your local WHP in the resources section at the bottom.
The treatment will vary depending on your symptoms and the severity of the POP.
Alongside seeing a WHP there are also things that you can do yourself to help manage the symptoms:
Learn to connect to and strengthen your deep core (think transverse abdominus muscles) and protect your pelvic floor muscles with diaphragmatic breathing techniques. These breathing techniques can also be employed when lifting (which is pretty much unavoidable as a mum) to help protect your pelvic floor. Check out my blog about breathing and the core to find out more about this: https://www.carlatonksfitness.com/post/let-s-take-a-breathe
If you suffer from constipation try to minimise excessive ‘pushing/bearing down’ when trying to empty your bowels as this can put unwanted additional pressure on your pelvic floor. Tips to help with constipation include keeping well hydrated and upping your fibre intake. You can also try raising your feet up off the floor when on the toilet which can help ease bowel movements.
Coughing a lot (which may be unavoidable at this time of year with coughs and colds around) can lead to unwanted increases in intra abdominal pressure which puts further pressure on your prolapse. If you suffer from persistent coughing try and cough while seated. It can also help to use a strong pelvic floor contraction before and during the cough to try and support the pelvic floor muscles and prevent further damage.
Lying on the floor with your legs raised on to a chair or up against a wall can provide relief from some of the symptoms of POP.
Can you Exercise with POP
YES. Many people with POP are scared of moving their bodies but yes you can exercise with POP.
Everyone is unique so it is all about finding out what movements are good for you and modifying those that don’t feel good or bring on any symptoms. By working with a WHP and an experienced trainer you can continue to exercise safely and effectively and find the best exercise for you. You might even find that movement helps with symptoms.
It can be mentally tough finding out you have POP - especially for those who are suffering in silence or who have problems getting treatment. Talking more openly about POP, moving your body (in nature is even better) and finding a community of other mums that ‘get’ it are a couple of things that you can do to help with the mental load.
If you’ve found this article useful please do share and chat about it with your friends. You never know but they may be suffering in silence and not have the courage to speak up about the symptoms they are facing and you could be that safe space that encourages them to open up and get help.
Resources
Here are some additional resources that you may find useful.
Women’s Health Physios:
Use the link below to locate a physio in your location.
If you are in Whanganui or Palmerston North then I work closely with:
Podcasts:
The links below are to particular episodes I’ve listened to and found useful for POP but both podcasts have great information about pelvic health including prolapse so do take a look at some of the other episodes.
At Your Cervix:
Why Women Don’t Jump:
Squeezy App:
This app (designed by chartered physiotherapists specialising in women's and men's health) helps support you with your pelvic floor muscle exercise programmes
Pelvic Organ Prolapse Guide:
A more detailed guide for women about pelvic organ prolapse