Rehabilitation for Pelvic Organ Prolapse
Pelvic organ prolapse is a pelvic floor disorder that affects about half of all childbearing women at some point. It is most often diagnosed in menopause, as estrogen levels decrease and result in further weakening of the muscles and tissues of the pelvic floor that were damaged during pregnancy and childbirth.
Prolapse occurs when the pelvic floor, or the support structure for the pelvic organs, is no longer able to hold organs—like the uterus, intestine and bladder—in their proper place, allowing them to drop downward and rest against the walls of the vagina.
The most common symptoms of prolapse include pressure or a downward pulling feeling in the pelvis, pelvic pain, urinary incontinence, pain during intercourse, low back pain and constipation.
Many women are asymptomatic, and as such do not require treatment, but would benefit from pelvic floor maintenance to prevent future problems. For women experiencing symptoms, rehabilitation comes in many forms.
Women should be especially mindful of pelvic health throughout pregnancy and during the postpartum recovery phase. Multiple vaginal births, difficult labor, a baby with a large birth weight, or children born in short intervals of one another all increase risk.
Performing Kegel exercises to strengthen the pelvic floor throughout pregnancy can help achieve shorter labor time and an easier birth. They can also prevent urinary leak issues that are common during the third trimester.
Other risk factors associated with lifestyle are smoking, obesity, chronic cough and high-impact activities. Women should work with doctors or physical therapists to decrease these risk factors.
Pelvic health has become a specialty in the field of physical therapy, which is no surprise considering its success in treating pelvic floor disorders. A physical therapist can help prepare a mom for childbirth and recovery afterward. Physical therapists will focus on improving pelvic muscle function, increasing core strength and decreasing symptomatic pain.
Using biofeedback, therapists can locate and offer instruction on how to isolate the pelvic floor muscles to get optimal results when performing Kegel exercises or pelvic clocks. Other techniques used by therapists include pelvic massage, manual stimulation, Pilates-based exercises for core strength and posture correction.
A pessary is ring, square or other shape made up rubber or silicon that is put into the vagina to take up space and halt prolapse. Certain sizes and shapes work better for different people and different types of prolapse; the right one will be determined by your doctor during the initial fitting.
Women with severely deteriorated pelvic muscles may not be able to keep a pessary in place; however, many women do experience relief. Pessaries can be worn for up to three months, at which point they need to be removed, cleaned and replaced. Some pessaries can be kept in during sex, but most women choose to remove them.
A pessary can be worn to reduce symptoms, but not as a cure for prolapse. A pessary treats symptoms while in place, but prolapse returns when the pessary is removed. Pessaries can cause constipation, urinary tract infections and increased vaginal discharge.
Surgical intervention to treat pelvic organ prolapse is fairly common, but women should be aware of the risks involved. One method uses transvaginal mesh to provide support to the pelvic floor, and another more conservative method uses sutures. Organ perforation, mesh erosion and infection have been reported with transvaginal mesh—often leaving women to face revision surgery and ongoing pain.
A statement issued by the Food and Drug Administration (FDA) reported that complications with transvaginal mesh are NOT rare, and the procedures using them are no more effective than conventional options. Discuss these and other surgical options with your physician.
Linda Grayling writes for Drugwatch.com. Linda has a number of professional interests, including keeping up with the latest developments in the medical field. Join the Drugwatch community on our Facebook page to find out more.