If you have ever heard the word prolapse or have been diagnosed with a prolapse you are probably asking yourself: Why does prolapse happen?

Let's set the scene.

You are on the toilet, go to wipe and notice a new and weird feeling when you wipe. You grab a mirror Okay let’s be real, you likely grab your phone camera, and you see something that looks like it is falling out of your vagina. Yikes! 

Or maybe you go for a long hike and about half way through you start to notice something rubbing against your underwear and think ‘What in the world is that?!’

In these scenarios it sounds like you may be experiencing a prolapse. The good news is that

1. You are not alone.
2. There is help for prolapse!
   

Now you may be asking 'what exactly is prolapse?'



Pelvic organ prolapse (POP) is a condition in which the pelvic organs shift in a downward or outward direction leading to a protrusion into the vaginal canal. This is likely due to weakening of the connective tissues and musculature in the pelvic floor area that are there to support these pelvic organs. It’s estimated that around 1 in 3 women will experience some form of pelvic organ prolapse in their lifetime.

To get a better understanding of prolapse, it is important to understand the anatomy involved in a prolapse which can help us better understand why prolapse happens.

Pelvic organ prolapse may involve the:

• bladder (cystocele)
• rectum (rectocele)
• uterus (uterine prolapse)
• intestines (enterocele)
• vaginal vault (seen when the bladder & rectum prolapse after removal of the uterus)
• anus (anal prolapse - not pictured)
  

Now that we have a better understanding of what structures may be involved in prolapse, we can dive into our primary question of ‘Why does prolapse happen?’

While it is commonly believed that prolapse is only an issue for pregnant folx, this is not true. Anyone can experience prolapse, even those who have never been pregnant or experienced childbirth. The most common causes of POP include:

• Genetics - Those with a family history of prolapse do have an increased likelihood of developing POP.
• Hormonal Shifts - changes in our bodies hormones during perimenopause and menopause result in decreased estrogen levels. Estrogen is a key hormone in vaginal tissue health, so as your estrogen level drops and the vaginal tissues weaken, prolapse becomes more likely.
• Chronic Cough - Due to the relationship of the diaphragm, the pelvic floor, and the pelvic organs, chronic cough can place increased, repetitive pressure on the pelvic floor. Over time, a chronic cough in conditions like COPD or emphysema can lead to POP.
• High Impact or Heavy Lifting Activities - With high impact or heavy lifting exercises, it is common for individuals to struggle with managing their intra-abdominal pressure. By straining to lift heavy, or failing to breathe properly as we exercise, we set ourselves up for a higher risk of prolapse. 
• Pelvic Surgery - Surgical procedures in the pelvic region or involving the pelvic organs can increase the risk of POP due to the effects on the structural integrity of the pelvis or the removal of space occupying structures (as seen in vaginal vault prolapse)
• Pregnancy - Individuals who have had multiple pregnancies, delivered larger babies (>8.8 lbs), or undergone lengthy labor (>3 hours of pushing) may be at heightened risk for POP due to the repetitive or prolonged stresses on the pelvic floor muscles and structures.
  

So, what can be done about prolapse?

Luckily there is a spectrum of care available to those who are dealing with prolapse, which ranges from conservative management to surgical correction. Common treatments include:

• movement modifications and focused breathing for intra-abdominal pressure management 
• wearing garments that provide perineal body support, especially with prolonged activities or exercise
• pelvic floor therapy to gain a better understanding of how your whole body impacts your prolapse symptoms & identify/treat underlying pelvic floor issues including tension, weakness, or discoordination
• utilizing a pessary for internal support
• And finally, surgery can be utilized to provide permanent support of the pelvic organs
  

What you can expect at Pelvic Pride.

In pelvic floor therapy we will perform an evaluation from head to toe to ensure we are looking at every system that may be involved in your prolapse symptoms. This means we are looking at things like how your collapsed arches can impact up the chain to your knee, hip, and pelvic floor. We will take a look at your breathing pattern to determine its impact on your ability to manage intra-abdominal pressure. 

And of course, with enthusiastic consent, we will assess your pelvic floor to ensure we are addressing any tightness, tension, weakness, or discoordination that may be impacting your prolapse symptoms. We want you to leave with a better understanding of how each part of your musculoskeletal system is impacting your POP as well as the knowledge of tangible changes you can make immediately to help minimize POP symptoms when they happen.