Lifting the lid on prolapse
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Lifting the lid on prolapse Training your pelvic floor muscles throughout life can reduce your risk of prolapse. By Muriel Reddy Every woman is at risk of pelvic organ prolapse, yet most of us find it too embarrassing to talk about. “It’s about the genital area and it’s private,” explains Jean Hailes urogynaecologist Dr Payam Nikpoor. What is prolapse? Prolapse happens when the muscles supporting a woman’s pelvic organs – the bladder, uterus and bowel – weaken and cause one or more of those organs to drop. Women often report the feeling of a bulge or a pressure in the vagina; like a feeling that they are sitting on an orange or a tennis ball. Sometimes they will notice tissue sticking out of the vagina. Two of the more common symptoms of prolapse are the leaking of urine (wee) or faeces (poo), known as urinary and faecal incontinence. The Continence Foundation of Australia estimates that one in four people in Australia are incontinent, meaning they have trouble controlling their bladder and/or bowel. 12 VOLUME 1 2021
Some women can experience Train the pelvic floor
urinary problems such as slow Ms Webb believes it is helpful
stream, a feeling that they are for women to train their pelvic
not completely emptying the floor muscles throughout all
bladder. Others suffer from the stages of their lives – after
urgency and stress urinary childbirth, at menopause and in
incontinence. Bowel problems the later years – even if they do
can develop when women suffer not have issues. Women who do
from constipation, or a feeling of experience prolapse will need
not fully emptying the bowel. a tailored intensive pelvic floor
program. This has been shown
What causes prolapse? to reduce symptoms. They will
For women who experience also be given correct techniques
prolapse, it will usually occur for bladder and bowel emptying.
after menopause, from the ages Ms Webb says many women
of the mid-50s through to the fear they will be unable to return
70s. “However, what we know is to the sorts of physical activities
that childbirth is a risk factor,” they have always enjoyed, but
says Dr Nikpoor. “So too is this is not necessarily true.
constipation, obesity, people
who have chronic raised intra- “Undergoing a pelvic
abdominal pressure [straining], floor training program and
and chronic cough.” Ageing and adopting some lifestyle
a family history of prolapse are
also risk factors.
advice can reduce or
Women with prolapse can eliminate symptoms.”
experience pain during sexual
intercourse. Others report a lack “There’s a device that has
of sensation during intercourse. been developed that allows
Not all women with bulge women to continue with
will need surgery, but they will regular forms of exercise while
need to see a physiotherapist monitoring its impact on their
and learn pelvic floor exercises, pelvic floor,” she explains. “It’s
and may need to make healthier inserted into the vagina and has
lifestyle changes. a little Bluetooth monitor that
tucks into your undies.
Speak up early “It’s suitable for anyone who
Early intervention is key in wants to train [their] pelvic floor
the treatment of pelvic floor and monitor what’s happening
prolapse, says Jean Hailes pelvic during exercise.”
floor physiotherapist Janetta
Webb. “It’s important for women What you can do
to talk to their GP if there’s Making lifestyle changes
any change to their bladder or can lower risk factors of
bowel function,” she explains. prolapse. Dr Nikpoor says
“Undergoing a pelvic floor these include eating healthily,
training program and adopting exercising regularly, keeping a
some lifestyle advice can reduce normal weight, and avoiding
or eliminate symptoms.” constipation. This lifestyle
JEANHAILES.ORG.AU 13
HOW TO STRENGTHEN YOUR PELVIC FLOOR approach, along with pelvic
Start practising this exercise daily, either sitting or lying down floor muscle exercise, is the
on your back with your knees bent and feet flat. This is easiest conservative approach to
on your bed or couch. treatment. If this doesn’t work,
Learn more about pelvic floor exercises health professionals will consider
the next steps in management.
Steps What to do
Next steps
• Tighten the muscles around the anus, vagina Dr Nikpoor says he always
and urethra all at once and try to lift or draw considers the use of vaginal
them up inside pessaries – supportive devices
Tighten
• Make sure you are not pushing down, that hold the prolapsed organ
holding your breath or squeezing your in place – before surgery.
buttocks or legs together Neither uncomfortable nor
• Nothing should be working above the belly painful, pessaries come in a
button, but you may feel your lower abdominal range of shapes and sizes to suit
muscles switch on. the type and degree of prolapse.
Once inserted, they require
• Slowly count to 3 regular monitoring.
• Let your muscles go completely – this should “They can be managed either
feel smooth and quick and the muscles should by a pelvic floor physiotherapist,
stay relaxed while you rest a continence nurse or a
• Rest your pelvic floor muscles while gynaecologist,” Dr Nikpoor says.
Level 1
you count to 6 “They can stay for as long as they
• Repeat are effective – for the rest of their
• Do as many as you can up to 10 lives if they work.
• If you find it difficult to let your muscles Surgery is considered the
go, softening your belly and letting your last management option. “This
abdominal muscles go might help, as well involves procedures that would
as quiet, relaxed breathing. reinforce the supporting tissue
in the pelvis to rectify the
Please note, if you have an issue with vaginal prolapse,” says Dr Nikpoor. MR
or pelvic pain, you will need a special program
from a pelvic floor physiotherapist before 3 THINGS TO
proceeding any further KNOW
• Instead of counting to 3, slowly count to 6 or 8
• Let your muscles go completely 1. Pelvic floor muscle training
Level 2
• Rest and relax your pelvic floor muscles while is important at all stages
you count to 6 or 8 of a woman’s life.
• Repeat 2. See your doctor if there’s a
• Do as many as you can up to 10 or 15 change to your bladder or
• Rest a minute. Then try some shorter, hard bowel function.
squeezes. Tighten hard then completely 3. Pelvic floor muscle training
let go straight away. Build up to doing 20 and a healthy lifestyle can
of these in a row. reduce the risk of, and
symptoms of, prolapse.
After you have done 10 of the level 2 exercise,
Level 3
do some really strong squeezes – as strong as
you can, then let go.
Learn more
Do as many of these as you can, up to about 10.
about prolapse
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