5 facts about vaginal prolapse
Written by Taryn Watson, Women’s Health & Continence Physiotherapist, FitRight Physio.
Vaginal Prolapse is not something you may have thought all that much about – it’s not a visible ailment and may not be something anyone has spoken to you about.
However, considering it affects 50% of us, you should have heard of it. And you should be telling your friends, daughters and mothers about it too.
5 facts about vaginal prolapse
Here are five facts about vaginal prolapse designed to enlighten you about what could be going on in your nether regions and what to do about it…
1. What is a Vaginal Prolapse and are they all the same?
We have three organs in our pelvis, namely our bladder, uterus and bowel, and these should be held in place by a network of muscles, ligaments and connective tissue.
In a nutshell, a vaginal prolapse is what happens if this support system has deficits in it and the organ, or organs start to descend into the vagina.
And no, not all prolapses are created equal. You can have a prolapse of one or more of the following:
- The uterus, called a uterine prolapse
- The front wall of the vagina, with the bladder behind it, called an anterior wall prolapse, or a cystocele.
- The back wall of the vagina, with the bowel behind it, called a posterior wall prolapse, or a rectocele.
Once it’s determined which area of the vagina the prolapse is coming from, it is then graded into 4 ‘stages’ relating to severity. These are tested at rest and on straining and are usually spoken about with what is happening when straining.
- Stage 1 is inside the vagina
- Stage 2 is close to the opening of the vagina (1 cm inside or outside)
- Stage 3 is more than 1cm outside
- Stage 4 is full eversion of an organ
2. What causes a vaginal prolapse to occur?
Prolapse will only occur if there’s a deficit in the support of the organs – sometimes just the connective tissue, and sometimes also the pelvic floor muscles.
There is a gap in the two sides of the vaginal support system – there needs to be to allow wee and poo to get out, a penis to get in, and a baby to be born.
The mechanical issues start to happen when this gap becomes larger and organs have more chance of falling down into it.
The most common reason for this gap to get bigger is pregnancy and in particular, vaginal birth.
But remember – your body didn’t know you were going to have a caesarean, so it still would have spent nine months preparing and softening and widening in the expectation that a baby was coming through, and that has been shown to take a number of months to return to its usual width and size.
But with vaginal birth, the area is physically stretched (the muscles can be stretched up to 2.5 times their normal length!) and what’s called ‘levator avulsion’ can occur. This is where the muscle tears away from the pelvic bone, which understandably can increase the gap into which things can fall.
Prolapse doesn’t only occur from birth-related trauma, it could be a general stretching of the connective tissue over time. This is more likely to occur in people who:
- Are overweight
- Chronically cough and sneeze
- Chronically strain on the toilet
- Regularly lift heavy weights
- Regularly participate in high impact and/or high load exercise
3. How would I know if I have a prolapse?
There are some typical symptoms that usually lead women to a prolapse diagnosis:
- Feeling of a bulge or ‘something being there’ in the vagina
- Feeling of heaviness or dragging in the vagina
- Dragging sensation/pain lower back or lower abdomen
- Difficulty emptying bladder and bowel
- Discomfort with sex
But remember – not all prolapses are symptomatic. It is possible to have a prolapse and not realise.
It’s debatable whether all prolapses should be considered ‘a problem’. Perhaps a stage 1 prolapse is like getting wrinkles – an inevitable part of ageing! And if it isn’t causing symptoms, nothing needs to be done about it.
The issues start happening when the prolapse gets closer to the opening of the vagina. If it could be picked up before this point, and measures put in place to stop it progressing, that would be ideal.
This is why it is highly recommended to have pelvic floor assessments done soon after childbirth by a women’s health physiotherapist – prevention is better than cure.
You can be officially diagnosed with a prolapse by having a vaginal examination done with someone who is proficient in prolapse management. This would include GPs with an interest in this area, physiotherapists with extra training in women’s health, or gynaecologists.
4. Are there times of life when prolapse is likely to be more symptomatic?
Yes, your hormones can play a huge role in how much you are aware of your prolapse and how much it descends.
Oestrogen is a hormone that causes an increase in flexibility in the vaginal tissues. This means that during pregnancy, and at certain times of your menstrual cycle when oestrogen is high (usually just before your period), the tissues in your vagina can be more flexible and therefore a prolapse can descend further.
You would, therefore, assume that when oestrogen is low, such as during menopause or breastfeeding, that a prolapse would be better. And for some people, it is.
However, what low oestrogen does is cause a thinning and dryness of the vagina, which often increases the sensitivity of these tissues. So for some people, menopause and breastfeeding lead to more awareness of a vaginal prolapse, than they would have otherwise experienced. Vaginal oestrogen is sometimes prescribed to manage these symptoms.
As well as hormones, the physical changes associated with the vagina during pregnancy and childbirth can make a prolapse more symptomatic. It took nine months to get to childbirth, it may take just as long to have the space in the vagina decrease again.
5. How is vaginal prolapse managed by physiotherapists?
Vaginal prolapse is not managed by all physiotherapists. Go to your local sports physiotherapist about your vagina and he or she will probably run a mile!
But there are a number of us who have done a Masters degree in Women’s Health & Continence Physiotherapy and now pelvic floors and prolapses are our thing.
We can help you with the following:
- Pelvic floor muscle training
- Finding the right exercise regime that will allow you to keep as fit as possible without aggravating your prolapse. This may include looking at weight loss and how to approach this.
- Help you modify the way you go about your daily tasks to minimise strain through the vagina.
- Advice on the best way to empty your bladder and bowels.
- Pessary fitting – some physiotherapists have been trained to fit support pessaries, which you wear inside to prevent the organ/s from descending. Some GPs and gynaecologists are able to do this too.
Through FitRight, I have created a series of exercise classes and online workouts that are unlikely to flare up vaginal prolapse.
If you think that you are suffering from prolapse symptoms, or if you would like to proactively determine your risk for developing symptoms in the future, I would highly recommend seeing a women’s health physiotherapist for an individual assessment.
Then, in conjunction with what they tell you to do, the FitRight workouts are there to keep you moving and help you to feel empowered that you can keep active. Prolapse is not a life sentence to be sedentary – you just need good advice and support on the best way to keep fit!
Taryn Watson is a Women’s Health & Continence Physiotherapist from Perth, Western Australia, with a particular passion for providing pelvic floor friendly exercise options for women in their childbearing years.
You can find out more about FitRight’s extensive range of classes here.
This post is sponsored by FitRight.