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Pelvic Organ Prolapse

Your pelvic organs are your bladder, uterus and vagina, rectum and small intestine.

These organs are supported by the pelvic floor from below, and a system of fascia and ligaments around and above.

Pelvic Organ Prolapse is when these organs are not supported in the correct position up in the pelvic cavity, so drop downwards with gravity. There are several types and grades of prolapse, depending on which organ has dropped and by how much.

Commonly the bladder may drop down into the vagina from the front, or the rectum may drop down from the rear. More severe cases involve descent to the entrance of the vagina and sometimes past the entrance to the outside. Prolapse can also vary depending on activity, and the time of day or month.

Prolapse can occur as a result of poor body mechanics (slump sitting / standing), high impact sports putting regular and intense pressure on the organs e.g. gymnastics / running, and fascial or muscle tearing during childbirth. A weak pelvic floor is a big culprit for prolapse occurring or worsening over time, which is why recovering your pelvic floor strength post labor is so important.

The “ship on the dock” theory is a good analogy;

Imagine your bony pelvis is the dock, your pelvic floor the ocean, your pelvic organ (say bladder) the ship, and the ropes tying the ship/bladder to the dock/pelvis are your ligaments and fascia. 

If you have a weak and loose pelvic floor, so the ocean is resting lower than it should, it is not holding up the ship/bladder, so the ship/bladder is just hanging off the dock/pelvis by its ropes/fascia. Over time the ropes/fascia stretch and the ship/bladder sinks lower onto the ocean/pelvic floor. This is prolapse.

Prolapse can feel like looseness, heaviness and weakness, and often there is a lack of sensation. It can contribute to and is associated with low back pain, incontinence, constipation, and reduced sexual sensation.

More severe prolapse may require surgery, and surgery is in fact commonly offered as treatment for prolapse. Surgery can be very successful, but a solution isn’t always guaranteed and scar tissue and further muscle damage may exacerbate the problem long term.

Pelvic Floor Physiotherapy can help avoid surgery by reducing the prolapse, or resolving the symptoms so the prolapse doesn’t bother you. If surgery IS necessary, then physiotherapy before and afterwards would help to optimize and maintain the results.

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