What You Should Know About Prolapse

By physiotherapist Janetta Webb and gynaecologist Dr Elizabeth Farrell

While many women may have heard of prolapse, some of us may not understand what it is, how to recognise it and what you can do to prevent prolapse.

What is prolapse?

Prolapse is caused by a stretching of the ligaments that support the pelvic organs, causing those organs to stretch and ‘drop down’. The word prolapse literally means ‘to fall out of place’.

What causes prolapse?

The walls of the vagina, which may have been overstretched by childbirth, can bulge downwards towards the vaginal entrance. This is known as vaginal prolapse. The bulging can either be the front vaginal wall with the bladder in front of it or the back vaginal wall with the rectum immediately behind. In some women the cervix and uterus also prolapse down towards the vaginal entrance. This is known as uterine prolapse.

Vaginal and uterine prolapse are more likely to occur after menopause, when the vaginal and supporting tissues lose elasticity, but can also occur before. The loss of muscle tone strength and coordination, which are associated with normal ageing and a reduction in the female hormone oestrogen, are also thought to play an important role in the development of prolapse. Prolapse can also occur in some postmenopausal women who have not had children because of a loss of elasticity in their tissues. Other causes can be chronic coughing or lung disease, regular straining with constipation, heavy lifting or being overweight.

Prolapse can also be caused by a pelvic tumor, for example an enlarged uterus containing fibroids, however, this is quite rare.

How does prolapse differ from incontinence?

Incontinence is unwanted leakage of urine or faeces. Poor muscle tone in the pelvic floor can result in bladder and/or bowel problems. As well as leakage, associated urinary problems include frequency (wanting to go to the toilet often) and urgency (a sudden urge to go to the toilet).

Some women may experience both prolapse and incontinence.

Who is at risk?

As mentioned women who are postmenopausal, have given birth vaginally, have a chronic cough or lung disease, strain with constipation, lift heavy objects or who are overweight are all at risk.

Research has also shown that women who are hyper flexible (have an unusually high level of flexibility) are more at risk of prolapse.

Also, women whose mothers or sisters have a history of prolapse may be more at risk due to inheriting a weaker type of supportive tissue.

How is prolapse diagnosed?

Prolapse is diagnosed by symptoms and a vaginal examination performed by your doctor.

What can I do?

Without intervention the symptoms of prolapse usually worsen over time. The good news is that there is much that we can do ourselves, or with the help of a physiotherapist, to strengthen our pelvic floor. Before a prolapse occurs, there may be slight slackening in the walls of the vagina, so awareness and prevention are vital in preventing further weaknesses.

Prevention

• Always aim to keep your weight in the ideal range for you height, regardless of other health issues you may have.
• NEVER strain to empty your bowels - always take your time!
• One incidence of straining can be enough to cause prolapse. Always aim to keep your bowel actions soft. You may need to add some extra fibre into your diet, increase your water intake and do some general physical activity, such as walking, every day.
• If you have respiratory problems, use your preventer and treatments to limit coughing and sneezing episodes.
• Always avoid heavy lifting at home and at work. That one move of the freezer or repetitive lifting of young grandchildren may be enough to cause problems.
• It shouldn’t be necessary to strain to empty your bladder and don’t ‘hover’ over public toilets. Sit down!
• Be aware if you know that you have an unusually high degree of flexibility or if you have a mother or sister who has had a prolapse.
• Choose low impact forms of physical activity such as power walking or dancing rather than running. Chose the ‘low impact’ classes at your gym.
• If you need to stand for long periods of time, use breaks to sit down whenever possible to partially relieve the pressure of gravity. Women who have a prolapse are advised to lie down for up to 30 minutes in the middle of the day. Lying down eliminates gravity.

How can physiotherapy help?

Physiotherapy aims to strengthen and improve coordination of the pelvic floor muscles. These muscles provide support to the pelvic organs from below. Pelvic organs include the uterus, bladder and bowel.

Your muscles will be individually assessed and a program worked out for you. This can be helpful if you have tried pelvic floor exercises in the past with little success, or if you cannot successfully work your muscles when you try to. Treatment may also involve equipment, such as biofeedback or muscle stimulation, that a physiotherapist may use to help you to learn how to effectively work and strengthen you muscles.

Believe it or not, most of us don’t go to the toilet in the most effective way. A physiotherapist will teach you the correct positioning and muscle coordination so you don’t ever have to strain again.

You can learn how to modify your daily activities to complement your pelvic floor exercise program and also how to strengthen other core stabilisers, such as abdominal muscles.

Treatment options

Treatment will depend on the severity of the prolapse and the degree that it interferes with a woman’s lifestyle. In some women strengthening pelvic floor and modifying daily activities (see tips for prevention) may be all that is required.

Some women may benefit from a personalised physiotherapy program, or by using a pessary to hold the prolapse up in place. A pessary is a rubber-like ring, which is fitted into the vagina, holding up the vaginal walls and lessening the symptoms. It is sometimes used as a temporary measure before prolapse surgery but in elderly women may be used as a long-term treatment.

To find an Australian Physiotherapy Association physiotherapist please log onto www.physiotherapy.asn.au and click on locate a physio.

For those without Internet access please call the national office on 03 9534 9400.

Content updated May 30, 2005