What’s Going On Down There?

Monday, May 2, 2016

Rebecca Posthuma Batalden, MD, FACOG, FPRMS

Being a woman is hard work. We learn about our bodies from mothers, friends, classes, the internet, and doctors. There’s one condition—a very common one— that’s often overlooked: pelvic organ prolapse. Let’s take a closer look.

What is prolapse?

Pelvic organ prolapse is dropping or falling of the pelvic organs including the uterus, bladder and rectum. Normally, your pelvic organs sit in their rightful location up inside the body, but in women who develop prolapse, the organs fall to the vagina opening or outside of the vaginal opening as the condition worsens.

What does it feel like?

Some women describe the sensation of sitting on egg or feeling a golf ball between their legs. Other women describe heaviness in the pelvis or a pulling that causes low back pain. While prolapse is not usually a dangerous condition, it is incredibly uncomfortable and often prevents women from living their life fully and enjoying the things they want to be doing.

Could I have prolapse?

If you are a woman, yes, you could have prolapse. If you are a woman with any of the symptoms above, even more likely. Prolapse is a very common condition that may affect up to half of women. If others in your family have prolapse or you’ve carried children, you run a higher risk of developing prolapse. Like many conditions, prolapse is more common as a woman matures, but it still frequently occurs in women in their 30’s and sometimes even in their 20’s.

How can I treat prolapse?

The first things to do are 1) know that you’re not alone and 2) find a doctor who specializes in treatment of pelvic organ prolapse, such as a urogynecologist, so that you can understand all of your options to deal with prolapse. Many women begin strengthening the muscles in the pelvis (Kegel exercises) either on their own or with the help of a physical therapist who specializes in the pelvic floor.

Other women find that using a pessary—a soft silicone device that is placed in the vagina like a diaphragm—alleviates their symptoms. Because prolapse is often caused by stretching or tearing of pelvic ligaments, the cure for prolapse is surgical. There are many excellent surgical options and your doctor can work with you to find one that fits your lifestyle and goals.

How can I prevent prolapse?

Strengthening the pelvic floor is the best way to prevent prolapse. Engaging your pelvic muscles is a critical part of good body mechanics – when your body is functioning the right way, you’re less prone to injury. Engage your pelvic floor when you are exercising or lifting something heavy. And it’s important to spend extra time strengthening your pelvic floor after carrying a baby to counteract all of the hard work your pelvis did. About half of women properly engage their pelvic floor muscles but the other half of us have a hard time knowing exactly what to do.

So what’s the right way to do a Kegel exercise? Think about squeezing the muscles to hold in gas and urine at the same time. This is a Kegel exercise. Do two sets a day, each with 10 reps of quick squeezes (hold for 1 second) and 10 reps of long squeezes (hold for 5 seconds). Still have questions? Ask your doctor to evaluate your pelvic floor strength.

Are there other problems that are associated with prolapse?

Difficulty with bladder control (you’re not alone—even the glamorous Kate Winslet won’t jump on a trampoline) or feeling like stool is getting caught when you have a bowel movement are common symptoms that go hand-in-hand with prolapse. Many women find that sex becomes uncomfortable because they feel like something is in the way.

For more information, check out a recent article from the Washington Post or go to Voices for Pelvic Floor Disorders, the American Urogynecologic Society’s patient education page.