Postpartum

Pelvic Prolapse

Pelvic floor prolapse refers to a condition in which organs such as the bladder, uterus, or rectum drops or descends into the vaginal wall.

Many different factors can cause a pelvic prolapse to occur. Some of the more common causes included:

  • Child birth/vaginal delivery
  • Increased abdominal pressure
  • COPD – chronic obstructive pulmonary disease
  • Constipation or prolonged straining when having a bowel movement
  • Heavy, prolonged lifting
  • Menopause
  • History of pelvic surgery

 

Depending on the type of prolapse, one can experience a variety of symptoms. Common symptoms of a pelvic prolapse include:

  • A feeling of a bulge or protrusion from the vaginal region
  • Poor or prolonged urinary stream
  • Feeling of incomplete emptying of the bladder after urination
  • Having to reposition self when urinating to start or complete urination
  • Stress urinary incontinence or the loss of urine with physical exertion
  • Urinary retention or lack of the ability to urinate
  • Having to reposition when having a bowel movement
  • Having difficulties evacuating the rectum
  • Requiring the use of fingers as a splint to defecate

 

Physicians label prolapses by indicating which organ is prolapsing or descending into the vaginal wall and by the stage of the descent. Stages of prolapse range from 0 (no prolapse) to 4 (complete eversion of the organ).

 

Cystocele:  Bladder is descending into vaginal wall

Common symptoms include:

  • A  feeling of a bulge or protrusion from the vaginal wall
  • Poor or prolonged urinary stream
  • Feeling of incomplete emptying when urinating
  • Positional changes to start or complete emptying when urinating
  • Stress urinary incontinence
  • Urinary retention

 

Urethrocele:  Urethra is descending into the vaginal wall

Common symptoms include:

  • Pelvic or vaginal pressure
  • Difficulty evacuating the rectum and emptying the bladder
  • Lower back pain/discomfort which increases as the day progresses
  • Lower back pain/discomfort that increases with prolonged standing and is relieved by lying down

 

Urethrocystocele:  Both the bladder and urethra are descending into the vaginal wall

Common symptoms include:

  • A  feeling of a bulge or protrusion from the vaginal wall
  • Poor or prolonged urinary stream
  • Feeling of incomplete emptying when urinating
  • Positional changes to start or complete emptying when urinating
  • Stress urinary incontinence
  • Urinary retention

 

Rectocele:  Rectum is descending into the vaginal wall  

Common symptoms include:

  • Pelvic or vaginal pressure
  • Difficulty evacuating the rectum and emptying the bladder
  • Lower back pain/discomfort which increases as the day progresses
  • Lower back pain/discomfort that increases with prolonged standing and is relieved by lying down

 

Rectal prolapse:  Rectum is descending into the vaginal wall

Common symptoms include:

  • Pelvic or vaginal pressure
  • Difficulty evacuating the rectum and emptying the bladder
  • Lower back pain/discomfort which increases as the day progresses
  • Lower back pain/discomfort that increases with prolonged standing and is relieved by lying down

 

Enterocele:  Small intestine is descending into the vaginal wall

Common symptoms include:

  • Pelvic or vaginal pressure
  • Difficulty emptying the rectum and bladder
  • Lower back pain/discomfort which worsens as the day progresses
  • Increased pain/discomfort with prolonged standing which is relieved by lying down

 

Vaginal vault prolapse:   Upper portion of the vagina is descending into the vaginal wall

Common symptoms include:

  • Pelvic or vaginal pressure
  • Difficulty evacuating the rectum and emptying the bladder
  • Lower back pain/discomfort which increases as the day progresses
  • Lower back pain/discomfort that increases with prolonged standing and is relieved by lying down

 

If an individual is diagnosed with a prolapse a physician may recommend a pessary, physical therapy, or in some cases surgery.

Physical therapy is considered conservative management and is often preferred by both physicians and patients as a method of treatment for individuals who have a pelvic prolapse. A physical therapist can address symptoms such as pain, urinary incontinence, and/or urinary urgency. A trained physical therapist in pelvic floor rehab is recommended to treat patients who have pelvic floor dysfunction such as prolapse.

Physical therapy includes the following:

Evaluation:

  • Musculoskeletal evaluation, which includes assessment of an individual’s function, posture, manual muscle test, and  joint mobility
  • A pelvic floor assessment, which includes both a manual muscle test of the pelvic floor muscles and prolapse examination

 

Treatment can consist of the following:

  • Patient education on pelvic floor anatomy, bladder and bowel health, and ADL training
  • Trunk, abdominal, pelvic floor, and lower extremity strengthening
  • Neuromuscular re-education to improve functional use of pelvic floor in daily activities that causes symptoms
  • Instruction on home exercise program
  • Biofeedback