Exercise key to a healthy ‘‘floor’’
Do you get a pain or dragging sensation in the pelvic region? Do you have problems holding in your urine when you cough or sneeze, or find it hard to pass a bowel motion as easily as you used to?
If so, you could well be suffering from a prolapse – and you’re not alone.
It is thought that about half of all women who have ever had babies have a degree of prolapse, though sadly most will suffer in silence and never ask for help.
A prolapse occurs when one or more of the organs in the pelvic region drops down lower into the pelvis, because of lack of support from the pelvic floor muscles and ligaments.
It is almost always, though not exclusively, related to pregnancy and childbirth but often occurs many years or even decades later, especially around the time of menopause when body tissues in general become a bit slacker.
When working correctly, the muscles and ligaments around the pelvic floor create a supportive sling that holds up the bladder, womb (uterus) and bowel.
If this sling is damaged or weakened, some or all of these organs can drop down, leading to the symptoms of a prolapse.
There are different types of prolapse, depending which part is affected:
❚ Anterior prolapse (affecting the front part of the pelvic area): when this type of prolapse occurs, either the bladder itself or the urethra (the tube leading from the bladder to the outside) are affected. This is known as either a ‘‘cystocele’’ if it affects the bladder or a ‘‘urethrocele’’ if it affects the urethra. The most common type of prolapse actually involves both the bladder and urethra.
❚ Prolapse of the middle part of the pelvic area: when this occurs, the uterus or womb can descend into the vagina. This type of prolapse can be so severe that the cervix (the neck or entrance to the womb) can protrude out of the vaginal entrance.
❚ Posterior prolapse (affecting the back part of the pelvic area): when this occurs, part of the bowel or bowel wall protrudes into the vagina, interfering with bowel function. This is known as a rectocele or enterocele.
Although most forms of prolapse are related to pregnancy and childbirth, we don’t fully understand why some women will be affected, while others won’t. Factors that make a prolapse more likely to occur include:
❚ Multiple pregnancies.
❚ Vaginal deliveries as opposed to caesarean sections.
❚ Very large babies, or difficult births (like forceps or ventouse extractions).
❚ Increasing age – as mentioned, once levels of oestrogen decrease with the menopause, tissues in general become looser, increasing your chance of being affected by a prolapse.
❚ Aside from pregnancy, anything that increases pressure on the pelvic floor can lead to a prolapse – this can include obesity, constipation because of the constant straining to pass a bowel motion, or a long-term cough.
❚ Family history – it is thought that you are more likely to get a prolapse if your mother or sister had one, though the exact reason for this isn’t fully understood.
Many women will never get any symptoms from their prolapse, and it may just be picked up when they have a smear test or sexual health check-up with their doctor. If this is the case, there is no need to panic but it would be worth doing some of the basic exercises discussed below to try to prevent things getting any worse.
However, for other women symptoms can be really troublesome and have a major impact on their life. These might include:
❚ Urinary symptoms – such as needing to pass urine all the time (a symptom known as frequency); having difficulty holding on to your
Most women won’t require surgery, and can manage their symptoms conservatively.
urine especially if coughing, laughing, running or jumping; leaking without any warning; incomplete emptying of your bladder; or difficulty passing urine unless you are sitting in a certain position.
❚ Bowel symptoms –this can include leaking from the back passage, incomplete emptying of the rectum or difficulty passing a bowel motion, or passing lots of wind compared to normal.
❚ Symptoms occurring during sex – prolapses can affect sexual function and also enjoyment of sex. For some women, it will be difficult to have sex due to the degree of prolapse (for example, they may have a large lump or swelling in the vagina itself), while for others sex may be physically possible but not pleasurable. Lots of women with a prolapse may be too embarrassed to have sex at all. ❚ Vaginal symptoms – the pressure of the prolapse itself can cause pain; for some women this can be really uncomfortable, while for others it may be more of a dull, dragging or pulling sensation. Women can experience pain in the vagina itself, or the lower tummy or back area,
depending which part of the pelvis is affected. Many women with a prolapse will be able to feel a lump or swelling ‘‘coming down’’ into their vagina, or even out of the vaginal entrance in extreme cases – this is often worse after prolonged periods of standing, and tends to improve with lying down.
Occasionally, there can be new vaginal discharge which may be blood-stained. As many of these symptoms can also be associated with more serious conditions such as cancers of the cervix, ovary or womb, it is really important to get examined by a doctor, rather than attempting selfdiagnosis.
Although there has been heaps of media coverage of late about the surgical management of prolapses (especially those involving ‘‘meshes’’), there is no need to feel anxious – most women won’t require surgery, and can manage their symptoms conservatively.
For everyone with any prolapse symptoms (and even those who don’t), I encourage you to be as proactive as you can about doing good, regular pelvic floor exercises – the sooner you start them in life, the more likely they are to work. There are lots of good websites you can look at to give you ideas, but the one I refer to is continence.org.nz.
If you are struggling to see any improvement in your symptoms, ask your GP to refer you to a local physio who specialises in pelvic floor exercises – they will be able to help design an exercise programme specifically for you and ensure you are doing them correctly.
Aside from exercises, trying to lose weight, avoiding constipation and reducing the amount of standing and heavy lifting you do can all minimise your symptoms.
Some women will require other management such as insertion of a pessary (a device that sits at the top of the vagina and works as a ‘‘support’’ to hold things in place). Once all of these have been trialled properly, referral for surgery may be considered if things aren’t improving.
For more information, visit healthnavigator.org.nz