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Prolapse and Pessaries

Pelvic organ prolapse is when one or more of the organs that sits in the pelvis descend.
The organs that often do so are the bladder, bowel and uterus. This is a common condition with 40-50% of women over the age of 50 experiencing some degree of prolapse.



Why it happens


It happens for many different reasons.
Generally, the organs are held up high by two things - both the pelvic floor muscles from below and the connective tissue from above.


The reason the organs can start to descend is due to lack of support from these two things. The pelvic floor and/or the connective tissue can get lengthened, weakened or torn after a vaginal delivery. Occasionally prolapse can also occur from something that creates too much pressure from above down onto the organs, like from years of straining at the toilet, years of coughing or even from a tight thorax and/or rib cage.



The symptoms


  • Heaviness or a dragging feeling vaginally, usually worse at the end of the day or after exercise

  • A bulge at the entrance of the vagina, again usually at the end of the day

  • Difficulty emptying your bladder completely, sometimes a slow flow initially

  • Low back ache

  • Painful intercourse

  • Difficulty emptying your bowels


How is it assessed?


  • It is assessed via an internal examination. Your physiotherapist will be able to tell you if you have a prolapse, what type and to what grade (mild, moderate, severe). She will also assess your pelvic floor at the same time and search through the rest of your body to see if there are any contributing factors.

  • It is also sometimes assessed using transperineal ultrasound, where the ultrasound transducer is placed over the vulva. It is a great way to visualise the organs and form a treatment plan.



Treatment


Treatment options are different for each and every person.

Sometimes we:


  • Optimise your pelvic floor. We will make sure it moves correctly, and we will release the muscles if they need it and of course give you pelvic floor exercises if required to not only make it strong but the appropriate length in order to support your pelvic organs.

  • Optimise the way you breathe

  • Release and retrain your ribcage

  • Retrain the way you use your abdominal wall

  • Advice about exercise – what you can and can’t do

  • Advice on lifestyle (ideal weight, when to rest, how to effectively empty your bladder, defecation dynamics, etc.)

  • Pessaries: Pessaries are devices that we insert up into the vagina in order to help hold the organs up. There are many different types of pessaries that are available and we use all of them including rings, cubes, gellhorns, shatz, and doughnuts. There is an art to a good pessary insertion and we are proud to say they we have a lot of experience in this field. For more information on pessaries see our Pessary information Sheet.

  • Refer and liase if we think necessary to gynaecologists, urogynaecologist, colorectal surgeons, etc.

  • Advice and rehabilitation post surgery (if it is required to support your prolapse)

Pessary Information Sheet