Pelvic Organ Prolapse + Why Kegels Aren’t Enough
Pelvic Organ Prolapse (POP) doesn’t only happen to older women, and it happens more than you might think. In fact it is estimated that 50% of women of childbearing age will experience some level of Pelvic Organ Prolapse.
Sadly though it is rarely discussed, frequently dismissed as ‘just the way it is after you have babies’ and many women are not as informed as they could be on preventive and healing strategies that can ease symptoms.
The list just below of definitions and symptoms is compiled with thanks to the Association for Pelvic Organ Prolapse Support.
WHAT IS PELVIC ORGAN PROLAPSE?
There are 5 types of pelvic organ prolapse: cystyocele (bladder drops and bulges into the vaginal canal), rectocele (large bowel or rectum bulges into the vaginal wall), enterocele (intestines), vaginal vault (vagina caves in on itself, possibly after uterus is removed-hysterectomy), and uterine (uterus).
It is measured in Grades 0-4. 0 is normal or optimal positioning, 1 or 2 may result in mild or moderate symptoms but are unlikely to require surgical intervention, Grade 4 refers to a prolapse that has actually protruded right outside of the body. A prolapse will not inevitably worsen, so if you are suffering from Grade 1 or 2 symptoms, preventative and healing strategies and changes can prevent your prolapse escalating.
WHAT DOES IT FEEL LIKE?
Each of these 5 types of POP has its own symptoms, but in general, symptoms can include:
- Pressure, pain, bulging or fullness in vagina, rectum, or both.
- Feeling like your “insides are falling out” or like you are sitting on a ball.
- Urinary incontinence.
- Urine retention (you have to pee, you just can’t get it to come out).
- Fecal incontinence.
- Back/abdominal pain.
- Lack of sexual sensation.
- Painful intercourse.
- Can’t keep a tampon in.
It’s not at all nice, it feels horrible and it’s not something you’re likely to want to discuss in polite company… so we’re fine to discuss it here 😉
WHAT CAUSES POP?
I explained in this post about Postpartum Hernia, that Prolapse, Hernia + Diastasis Recti are related conditions in that they are all caused by excessive pressure inside your abdomen and pelvis. The pressure that pushes everything away, outwards and downwards.
Pregnancy doesn’t cause these conditions and neither does simply a weak pelvic floor. However, there is no question that prolonged labour and pushing, or medical intervention such as forceps or ventouse, may increase the likelihood of prolapse occurring.
But it is not only your pelvic floor muscles’ job to ‘hold everything up’ – You have a complex system of fascia and ligaments that hold your organs suspended in their optimal positions inside your pelvis. Think of them as the puppeteer’s strings.
This applies to all the pelvic organs that have their openings at your pelvic floor – your vagina, uterus, bladder and rectum… none of these organs are reliant solely on your pelvic floor to do all the holding work, so therefore to focus only on squeezing your undercarriage like crazy can only ever be a band-aid or a temporary distraction from a much more serious problem: that your pelvis is not containing your organs effectively and they are heading south. Pelvic floor exercises are important, but they’re not the whole story.
Of course, your pelvic floor muscles are fundamental to the whole ‘Prolapse’ conversation. They’re integral, forming the under-carriage of the cavity which houses all these organs.
At the top of that cavity is your diaphragm muscle, and the deepest muscle that wraps around the sides is your Transverse Abdominis muscle. At the back are the Multifidus muscles of your spine. Your transverse sits inside your obliques (sides of your waist) and inside your Rectus Abodminis (the six-pack muscle at the front).
When the intra-abdominal pressure builds or is not contained effectively by the core muscles, due to excessive straining or pushing, poor alignment, ageing or a combination of factors, it gets too much. Whilst our bodies won’t actually explode, something still has to give. It might be a hernia popping out at the weakest point, it might be a widening of a diastasis recti, or the force may go downwards, pushing and shifting pelvic organs downwards and in severe cases, actually out of our bodies.
That’s Prolapse. When the supportive core muscle, fascia and ligament structures can no longer hold one or more of these organs in place, and they descend. Whilst a ‘weak pelvic floor’ didn’t exactly help the situation, it didn’t single-handedly cause it either.
WHAT CAN YOU DO TO PREVENT OR RELIEVE SYMPTOMS OF POP?
The solution involves, but is not isolated to, your pelvic floor. Here are some ways you can start to correct the pressure inside your abdomen and pelvis right away and start to reverse the symptoms AND CAUSES of pelvic organ prolapse:
1. Follow the alignment tips on how to relieve the pressure inside your abdomen here – exactly the same principles as for hernia
2. Find your pelvic floor: lie on your back with your knees bent and your feet flat. Breathe deeply and easily for a few breaths, then: Purse your lips and exhale as you consciously lift your pelvic floor – right in the middle – imagine gently drawing up the walls of your vagina, as if pulling a tampon deep up inside. Don’t ‘tuck your tailbone’ under.
Relax your muscles as you inhale (don’t push away – just fully relax) and repeat.
Your shoulders, chest or pelvis do not move – so you don’t tuck your tailbone underneath as you contract the muscles, and don’t squeeze or clench your backside or your inner thighs..
The inhale-relax phase is absolutely vital, remember this isn’t all about the squeeze! Too much contraction, with not enough relaxation of the muscles, will exacerbate the problem.
If your rib cage rises or thrusts, if your shoulders hunch or if you’re sucking in your stomach – then it’s not working right. All these movements will do is displace air and body mass upwards into your ribcage. This increases the pressure inside, not decreases it.
3. Change the way you go to the toilet The Western toilet does not offer a good position for elimination – whilst a full squat is much more functional and comfortable. Recreate a more natural posture by using a Squatty Potty, raising your feet to angle your pelvis and pelvic organs to eliminate easily, completely and without strain. It’ll change your life… seriously 😉
4. And now this one… Squat. Why? because your glutes need to be strong and your sacrum needs to be flexible and hanging in space, not all tucked under you so your pelvic floor muscles are shortened.
Important: Squatting with POP needs to be done right and may not be suitable for your individual circumstances. If you feel any bearing down or feelings of discomfort in this or any other exercise, STOP and consult with a specialist physiotherapist.
Your pelvic floor muscles are attached to your pubic bone at the front, and your sacrum at the back, so if you tuck, then you shorten the distance between them. A shortened muscle will tighten up over time, but it’s not strong. A muscle needs to be at full length to work and be strong.
To squat correctly, your shins should be vertical, but not tucked underneath, weight through your heels and the outsides of your feet. As above, if it doesn’t feel right, stop doing it and get one to one help.
5. Isolated pelvic floor exercises to re-connect and identify the right muscles, you need to isolate and focus on them. On an exhale, try that little squeeze at the front where you wee, then on the next exhale lift the middle – your vagina, then on the next, lift your back passage, imagine drawing your rectum up inside. Don’t clench your butt (this is hard!).
Try these pelvic floor acrobatics a few times to focus on the 3 openings of your pelvic floor and re-connect your brain’s nerve pathways to the muscles. Go front, middle, back… then back again!
Whilst Kegels or traditional pelvic floor squeezes may ‘tighten up’ your pelvic floor muscles in the short term they are simply not enough, and there is a vital element missing in the way these are often performed. The relax-phase of any muscle action is every bit as important as the contract-phase, and nowhere is this more pertinent than in the case of your pelvic floor. A hypertonic (too tight) pelvic floor is equally as likely to be the problem as a ‘too loose’ pelvic floor. So if when you are Kegel-ing you are doing any of the following: bending your knees, tucking your backside under, or clenching your butt muscles… you’re not actually getting to the deep pelvic floor muscles at all.
MUTU System is recommended and endorsed by Pelvic Physical Therapists the world over.
If you suspect you have a prolapse, we recommend you seek one on one specialist help from a women’s a health physiotherapist / pelvic health physical therapist
FURTHER RESOURCES + LINKS
Great information in this article ‘What is Pelvic Health Physiotherapy?’ from Pelvic Guru
… and also from Tracy Sher at the Pelvic Guru, The Ultimate Pelvic Anatomy Resource! Links, articles and videos – this post has EVERYTHING and is kept updated – an amazing resource.
Downloadable (free) PDF information leaflets and very helpful diagrams available from the International Urogynecological Association (IUGA) (click ‘Patient Leaflets’)
Articles from world-renowned Physiotherapist Diane Lee Diane Lee and Associates
Nutritious Movement | Blog, resources and education products from renowned Biomechanist Katy Bowman
The Pelvic Partnership | Great resource for pelvic pain in pregnancy
Please also see the MUTU System Medical Disclaimer here.