I see this all too often. A client comes into the clinic and she’s been diagnosed by a health care practitioner with a pelvic organ prolapse. And then she googles it. And rightfully, gets very upset. Whether that client is of child bearing age or post menopausal, the diagnosis can be terrifying. In this first post I hope to clarify what a pelvic organ prolapse is and some common signs and symptoms.
What exactly is a pelvic organ prolapse?
A pelvic organ prolapse is when one of the pelvic organs, the bladder, uterus and/or rectum push against the wall of the vagina and move into the vaginal canal. Weakness of the front of the wall can cause a bladder to prolapse, also called a cystocele. Weakness in the back wall of the vagina can cause the rectum to prolapse, also called a rectocele. Weakness at the top of the pelvic floor can cause the uterus to prolapse. A good analogy is to imagine a balloon filled with air. If you were to punch the balloon, the balloon would encase your hand. Your hand is now “prolapsed” into the balloon.
Grading a prolpase
There are 4 grades to a prolapse:
Grade 1: this is described as slight movement of the pelvic organ into the vaginal canal
Grade 2: this is described as the pelvic organ moving into the vaginal canal towards the opening of the vagina
Grade 3: this is described as the pelvic organ moving in and out of the vaginal opening
Grade 4: this is when the pelvic organ comes out of the vaginal opening
Grades 1 and 2 typically respond well to physiotherapy. Grades 3 and 4 are most likely going to be referred for surgery.
It is also important to note that this grading system is subjective. You may be graded a grade 1 by one healthcare practitioner and a grade 2 by another. Time of day and activity level can also affect the grading.
Common signs and symptoms
There are some common signs and symptoms I see in the clinic for this. A lot of times women describe heaviness and pressure. Almost like a tampon is falling out. Typically these sensations get worse with weight bearing activity (ie. standing, walking, running) and as the day goes on. A lot of women describe the first incidence of this occurring after an increase in workload that they were accustom to. For example, working in the garden all day, shovelling snow, doing a lot of housework, doing a lot of lifting, etc. A lot of times, women will say their symptoms get better when they lay down. Other things commonly described is going pee and having to go again soon, as if they didn’t fully empty as well as a lot of pressure with bowel movements.
In the follow up to this post I will be discussing what you can do help prevent and treat a pelvic organ prolapse as well as the way I look at this clinically. Thanks for reading!