HELP… my insides are falling out!

Amy Ready, MPT

JULY 17, 2017

Have you experienced abnormal tissue coming out of your vagina, like a lump or a bulge? Pressure or heaviness in the vaginal area at the end of the day? Painful intercourse? Constant ache in tailbone or lower back? Urination problems such as urinary incontinence or frequent UTIs? Fecal incontinence? Do I have your attention yet?

These are symptoms of pelvic organ prolapse. Prolapse is defined as "to fall out of place." Of course not all of these symptoms mean you have a prolapse, but pelvic organ prolapse doesn't "just happen" after prolonged vaginal labor and it is not a "normal part of aging." It can happen in women of any age, not just over 50! Hard intense workouts such as improper squats or deadlifts, estrogen deficiency, obesity, chronic coughing, straining due to constipation, pregnancy and hysterectomies are some of the causes of prolapse. These factors can cause an increase in intra- abdominal pressure. Increased abdominal pressure + improper pelvic floor/ abdominal muscle activation = risk of pelvic organ prolapse.

What is Pelvic Organ Prolapse (POP)?

drawing of internal organs in prolapse

If the pelvic floor muscles become injured or stretched, a pelvic organ prolapse can happen. This can be a descent of the rectum (rectocele), uterus (uterine), bladder (cystocele), intestines/bowel (enterocele) or vaginal vault prolapse (most common after hysterectomy when the uterus is removed and the vagina descends). There are different severities of prolapse. Mild (or 1st degree) is when the prolapse is within the vagina. Moderate (or 2nd degree) is when the prolapse is just outside the vagina. Severe (or 3rd/4th degree) is when the entire prolapse protrudes out of the vagina.

How do I know if I have this?

Your doctor will diagnose and perform a pelvic exam. To do so appropriately, your treatment may include standing up, bearing down or coughing to cause more pressure on the pelvis. It is very important to tell your doctor about any symptoms. Yes, it can be embarrassing but knowing that there is help can prevent a prolapse from getting worse and possibly prevent a surgery!

Here are some statistics:

  • In 2010 there were 3.3 million women in the US alone with POP, however it is difficult to know exactly how many are affected since many females fail to mention this to their doctor.
  • 40-70% of women with POP have urinary incontinence
  • 1/3 women with POP will have multiple POP surgeries
  • Research has showed effectiveness in pelvic floor muscle training to prevent prolapse (Hagen et al 2017). Pilates has also demonstrated increased strength in the pelvic floor muscles (Culligan et al 2010).
  • 50% of females that have children develop prolapse but only 10-20% seek treatment.
  • Half of all women over 50 have at least one type of prolapse.

How can PT help?

In mild to moderate cases of prolapses, specialized physical therapists can help with correct activation of the pelvic floor and abdominal muscles. This is done with a manual vaginal exam to make sure the muscles are firing appropriately. Many women do not activate the pelvic floor correctly with just written instructions. Dunn PT can use abdominal ultrasound or biofeedback so patients are able to see how to use the muscles correctly. Electrical stimulation is sometimes used to help activate the muscles and for patients to feel how to use the muscles correctly. More importantly, you will learn how to use these muscles in functional situations of everyday life. We don't have patients "just Kegel"; we look at the entire patient, addressing posture, breathing, bowel/bladder habits and develop a Pilates based pelvic floor muscle training program. Did you know there is a right way breathe, get out of bed, or even have a bowel movement? Again, intra-abdominal pressure + improper pelvic floor/abdominal activation= risk of pelvic organ prolapse.

A pelvic physical therapist can treat postoperative patients that have had severe prolapses or work with patients that have been fitted with pessaries, which is a removable medical devise inserted into the vagina for structural support and is used as another treatment option for prolapse vs. surgery. This option can also be discussed with your doctor.

Remember, the pelvic floor is muscle. Like any other muscle in your body, it can become weak. The pelvic floor muscles help support the pelvic viscera and are vital for continence and intra- abdominal pressure. Women that have symptoms of a prolapse should not just "live with it", since these symptoms can get worse with poor habits and weak muscles. This can affect women physically, emotionally, socially, sexually, financially, and impact relationships. Many pelvic organ prolapses can be successfully treated, maintained and even prevented with education and pelvic floor physical therapy.


Association for Pelvic Organ Prolapse Support

Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial; The Lancet, Volume 389, No. 10067, p393–402, 28 January 2017

Mayo Clinic

Pelvic Organ Prolapse: The Silent Epidemic; Sherrie J. Palm

SHORE for Women

Women's Health in Physical Therapy; Jean M. Irion and Glenn L. Irion

We accept most major insurances in the Louisville area including Medicare and Passport.