How to Fix Your Prolapse Without Surgery
Pelvic organ prolapse can be managed through non-surgical interventions such as pelvic floor physical therapy and pessary support. Symptoms of prolapse can be greatly reduced through pelvic physical therapy. Some individuals will benefit from a urogynecology consult and potential surgery, however pelvic therapy can help all patients improve strength and pressure management.
Introduction
Are you feeling heaviness, pressure, a bulge or the sensation of something coming out? Experiencing symptoms of prolapse can be very distressing. Navigating finding information about prolapse can also be difficult. Prolapse is a unique injury that often has more of a psychological impact than a sprained ankle. While prolapse is very common, especially in women who have had children, it is often not discussed as a potential post birth injury or complication. This can lead to feelings of being surprised and overwhelmed.
A prolapse itself may not be able to be reversed, however you can often drastically improve any symptoms or discomfort that you feel. Non-surgical options such as pelvic floor physical therapy and pessaries can be very helpful. The question is not necessarily how to fix your prolapse without surgery, but more so how can we decrease symptoms and improve quality of life.
What Is Pelvic Organ Prolapse?
Pelvic Organ Prolapse is the descent of one of the organs in the pelvis. This can be caused by increased laxity in the ligaments that support the organs due to pregnancy, childbirth, constipation, trauma, coughing or decreased pelvic floor strength. The organs affected can be the bladder, uterus or rectum resulting in a bladder prolapse, uterine prolapse or rectal prolapse. Prolapse symptoms can include heaviness, pressure, the feeling of a bulge, the feeling of something coming out, low back pain and sometimes difficulty urinating or having a bowel movement.
Can You Fix Your Prolapse Without Surgery?
Prolapse is a difficult diagnosis because while most women who give birth have a mild bladder prolapse, many of them do not have any symptoms or problems. It is possible to have a mild prolapse and to not have any symptoms. Many people feel that there are some changes to the anatomy after having a child, however this does not mean that you will have any issues. Prolapse can also be difficult to understand also because symptoms can come and go.
What is important to understand is that we generally cannot change any stretching or laxity that has happened to the ligaments. However, since the ligaments are only one part of the structures that support the organs, we can work on improving the strength of the other structures (such as the pelvic floor muscles). We can also work on how we manage pressure in our bodies by decreasing constipation and working on lifting mechanics. In these ways we can decrease symptoms and improve our quality of life.
Most patients that seek out pelvic floor physical therapy are generally feeling symptoms of pressure, heaviness or bulge that are coming and going. This is usually indicative of a less severe (grade 1 or 2) prolapse. More severe grades of prolapse (grade 3 and 4) usually present with lasting symptoms that do not come and go. These patients require a urogynecology consult and may benefit from a discussion of surgical options. These patients can still learn valuable skills in pelvic floor physical therapy such as pressure management.
How to Fix Your Prolapse Without Surgery: Pelvic Floor Physical Therapy
Pelvic floor physical therapy can be very helpful for prolapse and goes beyond teaching Kegels. A pelvic floor therapist will take on a holistic approach. We can first assess your pelvic floor muscle tone, endurance and coordination. For example, many patients have increased pelvic floor muscle tone that will need to be addressed first. We also discuss your bowel health and make sure to address any constipation or straining.
Patients with prolapse symptoms also greatly benefit from targeted strengthening to the hip and core muscles. Exercise programs should progress to include resistance training that challenges the trunk and that includes overhead, single leg and dynamic movements. While many patients see improvement in weeks, therapy needs to be consistent for long-term goals to be met.
Correct Pelvic Floor Exercises (Beyond Kegels)
While many people associate Kegels with pelvic floor exercise, they are not the most important exercise for your pelvic floor. A Kegel is an isolated maximal pelvic floor contraction. We often want to make sure that there is good coordination of the pelvic floor. This means that you can both contract and relax the pelvic floor. Therefore, while some patients may be able to do Kegels, they may have difficulty with relaxing their pelvic floor. Also, if you have pelvic floor tension, Kegels may make you feel worse. By continually tightening your pelvic floor you may feel more symptoms if you have increased tone there.
Lifestyle Changes That Reduce Prolapse Pressure
Outside of pelvic floor therapy, we can reduce pressure and symptoms of prolapse by:
· Using proper lifting techniques
· Avoiding bearing down or creating more downward pelvic pressure by not straining or bearing down with exercise
· Decreasing constipation
· Reducing chronic coughing
· Staying active and at a healthy weight
Vaginal Pessaries as a Non-Surgical Option
A pessary is a removable device made of silicone that can act as a support for the pelvic organs. A urogynecologist can help fit a pessary. Sometimes, you need some time and trial and error to find the right fit for comfort. A pessary can help decrease the symptoms of heaviness and pressure associated with a bladder or uterine prolapse. Some patients use a pessary only for high impact activities, whereas others will wear their pessary all the time.
What to Avoid If You Have Prolapse
Excessive straining with bowel movements
Bearing down during exercise (can be checked by a pelvic floor PT)
Too many isolated Kegels (if you have tension)
Instant cures promised by the internet
Activities that increase symptoms
How Long Does It Take to See Improvement Without Surgery?
It can take weeks to see improvement without surgery. A good way to track improvement is to pay attention to how long we can do a provocative activity without symptoms. It is important to be consistent with exercises and with pelvic floor therapy to see results.
When to Talk to a Healthcare Provider
You should urgently see a healthcare provider if you are experiencing intense pelvic pain, bleeding, the inability to empty the bladder or bowel, or see any organs visibly protruding outside your body.
Frequently Asked Questions About Fixing Prolapse Without Surgery
1. Can prolapse heal on its own?
Prolapse generally cannot heal on its own, however in the early postpartum period the use of a pessary has been shown to improve long-term healing of a prolapse. This can lead to improvement in the grade of the prolapse. The evidence presented by the research is very good so if you are feeling persisting heaviness and pressure after giving birth, see a urogynecologist and get fitted for a pessary! Also, as this blog post discusses, while a prolapse cannot be healed or fully resolved, resolving symptoms is very possible.
2. Can exercise make prolapse worse?
Exercise can only worsen prolapse if it creates excessive downward pressure. For example, if you are bearing down with exercise, this can worsen prolapse symptoms due to excess pressure. If you are doing an exercise that is too difficult, this can also worsen downward pressure. Otherwise, exercise is absolutely recommended to help decrease the symptoms of prolapse. We need significant resistance exercise and strength training to improve prolapse symptoms.
3. Are Kegels enough to fix prolapse?
Kegels are not enough to fix prolapse. Core, hip and strength training are required in order to help build the endurance needed for improved pressure management.
4. How do I sleep with prolapse?
Most individuals feel better laying down with prolapse as they are not standing or sitting up against gravity. Some patients may feel better with pillow support under their hips or knees.
5. Is walking good for prolapse?
Walking as exercise can be helpful for prolapse. Some patients may need to shorten the time they spend walking initially in order to decrease symptoms. One goal of physical therapy is to increase the time with walking without symptoms.
Final Thoughts: Fixing Your Prolapse Without Surgery Is Possible
You can improve the symptoms of a prolapse with pelvic floor physical therapy. It is best to work with a skilled pelvic floor therapist and to seek an urogynecology consult in order to get the best picture of what treatment looks like for you.
If you are experiencing prolapse symptoms, help is available! Pelvic floor physical therapy is the gold standard treatment for this condition. If you are in the Forest Hills, Queens, NYC area and you are looking for help today, reach out to us! Give us a call or fill out our contact form today!
