• Jo Dyson

Pelvic organ prolapse....what pregnant women and new mums need to know!

Pelvic organ prolapse (POP) is a really common condition; around 1 in 2 women experience it to some degree after childbirth. For a number of those women, it's completely asymptomatic but for others it will give a feeling of: - vaginal heaviness, - a sensation of something bulging down below, - feel like a tampon is in the wrong position. This could be an issue on a daily basis or only be present at certain times for example during exercise, towards the end of the day or at certain times during your cycle. POP can be very gravity dependant, hence being worse with periods of standing/walking/exercise and better in the mornings or with rest. It may also present with an interruption of normal bladder and bowel function - strange symptoms like not feeling like you've emptied your bladder/bowel fully, hesitation in starting your flow/weak flow of urine and leaking immediately after visiting the toilet.

But what exactly is it?

Well, it's helpful to understand a little about the anatomy of the pelvic organs and how the pelvic floor muscles are involved. The pelvic organs, namely the bladder, uterus and bowel sit in a row, with the bladder sitting on the front wall of the vagina and the bowel in contact with the back wall of the vagina. The pelvic floor muscles loop from the pubic joint at the front of the pelvis to the tailbone at the back, with openings for the urethra, vagina and back passage. This muscle helps to lift up and support the weight of the pelvic organs, and assists in the closure of the sphincters at each opening to keep us continent. The pelvic organs are also held up in position by strong ligaments and connective tissue attaching to the pelvis. In pregnancy, hormones which help to slacken the joints of the pelvis to allow delivery of the baby also slacken the supportive ligaments of the pelvic organs. These hormones also soften and weaken the pelvic floor, and the added pressure from increased body weight further stretches and weakens the muscle. Combined with vaginal delivery, perineal tears and other factors such as constipation, heavy lifting and chronic coughing - you can begin to see where the strain on the supportive ligaments and pelvic floor comes from. In POP, the lack of support to the pelvic organs from the connective tissue above and the pelvic floor below allows the bladder/bowel to sit a bit lower in the pelvis and bulge into the respective side of the vaginal wall - often giving rise to some of the symptoms described above (but not always!). A POP can be graded according to the extent of the prolapse, if it's sitting high up inside the vagina it would be considered Grade 1, a little lower towards the vaginal entrance a Grade 2, and Grades 3+ (keeping in mind this is MUCH less common) - the prolapse starts to come outside of the vagina. ***If you think you are experiencing symptoms of POP, know that this is NOT an inevitable part of having a baby and is a VERY treatable condition. A good place to start would be your GP but ultimately you would benefit from the assessment and treatment from a specialist women's health Physiotherapist*** What can I do about it? Is it treatable? Any downward pressure into the abdominal cavity can increase your symptoms, so with POP we need to be really mindful of how much pressure we are putting into this area. Strategy #1 - Do no harm. We want to avoid overloading these stretched and fragile tissues - reducing the downward pressure in the area is important so we don't make things worse. This involves: - avoiding/treating constipation - no straining on the loo whatsoever! - optimising toilet position (see the Poo blog!), - avoid high load and high impact exercise initially after birth, - minimise coughing and sneezing (ie manage coughs/colds/hay fever really well) - aim to pre-contract your pelvic floor a split second prior to a cough/sneeze, - exhale on exertion, ie co-ordinate an out breath with lifting/pushing/pulling.

Strategy #2 - improve the support to the pelvic organs. We can't influence what's going on with the ligamentous structures but the strength, endurance and co-ordination of the pelvic floor we can change for sure! A pelvic floor strength and conditioning exercise program will improve the ability of the muscle to support the pelvic organs. [It's not possible to advise the right formula for each individual without an examination so do seek treatment in order to find out what type of exercise will meet your needs.] Support underwear or compression garments can help the pelvic floor perform its support role, available from Jojo Maman Bebe and EVB Sport. EVB shorts/Capri pants and highly recommended for day to day wear and return to exercise too, available from Horizontal rest - yes, lying down! This allows complete rest for the pelvic floor and removes the effects of gravity for a while, so reducing that downward compressive force on he pelvic organs (sitting isn't enough!). If you can throw in 10 mins of lying down with every hour or so of activity on your feet in those early months, it can really help. Get an assessment. From around 6 weeks after delivery, if you suspect you have symptoms of POP, now is the time to start thinking about seeing a women's health Physio. An assessment will reveal if you are performing a correct contraction of the pelvic floor plus enable guidance on how to approach an exercise programme which is tailored to meet your needs. There is strong evidence to support the value of pelvic floor rehabilitation and you can expect to see an improvement within a 3 month timeframe. Speak to your GP with any concerns. Specialist postnatal women's health Physiotherapy is available in Leighton Buzzard at St Judes Clinic, visit the website for further information Here's what a recent client of mine at St Judes Clinic had to say.....

"Highly recommended for woman’s health. I was facing surgery for a prolapse and discovered that with the help of a pelvic floor physio I could improve my symptoms and even avoid surgery. Within 6 weeks of exercise I have noticed a huge difference and have cancelled my surgery for the time being. My continence issues have greatly improved, I am so relieved I discovered St Jude’s!"

Physiotherapist led Mother Nurture Pilates incorporates exercises known to be highly beneficial for ladies with pelvic floor dysfunction, POP and incontinence post delivery. Learn exactly what Pilates movements are safe and effective for you to perform, adapted to suit your needs. Look out for my next blog.......Follow my Facebook page to be sure you don’t miss it. Mother Nurture Pilates | Physiotherapist led Antenatal and Postnatal Pilates classes | Leighton Buzzard, Bedfordshire #postnatalpilates #womenshealthphysiotherapy #leightonbuzzard #mothernurturepilates #antenatalpilates #pelvicorganprolapse

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