Pelvic Organ Prolapse

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How Can I Help Myself?

Pelvic organ prolapse is not a life threatening condition, and many women do not know that they have a prolapse until it is noticed at a routine check-up or smear test. Many women have very minor bladder or bowel involvement.

You have several options as to what to do next:

• You can do nothing and wait and see how your symptoms change over time
•  Manage the symptoms yourself by adopting lifestyle changes and improving your pelvic floor muscle support. This is generally the preferred option as research suggests that this can control your symptoms and prevent your prolapse from worsening over time. Physiotherapy focuses on this stage. Please see below for more details.
• Speak to your GP about a vaginal pessary which supports the vaginal walls. A pessary is a device that a gynaecologist, GP, or specialist nurse inserts into the vagina. It stays in place and is changed approximately every 6 months. This is often, but not always, accompanied by vaginal oestrogen.
• Speak to a gynaecologist about surgery. Many gynaecologists may prefer you to have tried all the above options before surgery is considered. 

Information on pessaries and surgery is on the “help with your diagnosed condition” section. There are links to patient information leaflets from other organisations.

Lifestyle Changes

All recommended lifestyle changes have one goal: to reduce the downward pressures through your pelvis.

If you are overweight then consider losing weight. Extra weight causes a continuous pressure on any prolapse present.

Consider reducing the amount of heavy lifting you do. Heavy lifting increases pressure in your abdomen which pushes down on your pelvic floor.  If you have to lift, then tighten your pelvic floor muscles before and during the lift, and remember to breathe.

If you spend long periods of time on your feet, and find that your prolapse symptoms are worse at the end of the day, consider adding regular seated breaks to your day. This will give your pelvic support structures a chance to recover.

High-impact exercise, such as weight-lifting and very vigorous gym activities can overload your pelvic support structures. If your exercise causes symptoms then change them for a less demanding type of exercise (e.g. yoga, swimming, pilates). If you are currently exercising at a high level and have no prolapse symptoms then you are safe to continue but monitor how your body feels. If you have any increase in symptoms then it is wiser to change or modify your activity type sooner rather than later.  Make strengthening the pelvic floor muscles an essential part of your exercise regime.

Persistent coughing or sneezing increases the downward pressure on your pelvis, puts pressure on the pelvic floor muscles, weakening them over time. In addition, nicotine is a bladder irritant and is strongly associated with bladder symptoms (especially urinating very frequently, or experiencing a sudden desperate urge to urinate). If your cough is due to smoking then consider stopping.  If your chronic coughing or sneezing is due to a medical condition then consider reviewing your treatment and medication with your GP. 

During the menopause, the level of oestrogen in your blood decreases. Decreased oestrogen is associated with weakness of the pelvic floor muscles, and supporting tissues. This can lead to worsening symptoms.  Many women find that HRT is useful. If, after discussing with your GP, you find that HRT tablets/ patches/ gel are not suitable for you, then a very low dose of oestrogen can also be taken instead. This is in the form of a tablet (or cream) that is inserted into the vagina on a regular basis. Taken like this, it can directly help the tissues that need it.

Avoid straining to open your bowels, due to constipation as this puts pressure on the prolapse and worsens your symptoms. If your stool type is hard then consider increasing your fluid intake and ensuring a healthy diet high in fibre. It is important to stay hydrated to minimise constipation further or discuss this with your GP if you are still struggling. In the meantime, you may find it beneficial to alter your position on the toilet seat. 

• Stick your bottom out when you go to sit down on the toilet. Sit fully on the toilet (do not ‘hover’). Try to relax as this helps the anus open more fully.
• Place your feet apart and raised-up on a stool/ support. Experiment with how far apart you need to have your feet. Most people prefer to have them quite far apart, depending on their height and build. To achieve this, it might be useful to take your underwear down past your knees – or even take them off entirely.
• Bend forwards and rest your arms comfortably on your legs. Try not to slump entirely, keep your head facing forward rather than down. This maintains a gentle curve in the base of your spine.
• Keep your tummy and abdominal muscles relaxed. Avoid holding your breath and work on breathing naturally.
• Relax your mouth and jaw muscles.
• A slight bearing down will help the stool to open the back passage for the bowel movement. Many women may find it helpful to use their fingers to apply pressure to empty the bowels more fully and effectively. Some women support the perineum (the area of skin between the anus and the vagina). Other women find it more useful to apply pressure just inside the vagina, pushing towards the back passage. Either one of these areas can work well, but some women find one position more effective than the other. Putting a finger inside the rectum to hook out a stool is not generally recommended.

Pelvic Floor Exercises

The pelvic floor muscles are at the base of your pelvis and are important for supporting your pelvic organs, bladder and bowel continence, and sexual enjoyment.

To exercise these muscles, imagine that you are trying to stop yourself from passing wind at the same time as trying to stop passing urine. You should feel a squeeze and a lift inside the vagina. Do not hold your breath. Do not clench your buttocks or hold your breath. If you find this difficult or feel a vaginal bulging when you try to tighten your pelvic floor muscles – get help from a specialist physiotherapist.

Long Squeezes

• Tighten your pelvic floor, hold, and then relax fully. How long can you hold the squeeze?
• Repeat until the muscles tire. How many times can you repeat the squeezes?

Short Squeezes

• Quickly tighten your pelvic floor muscles, then immediately let them go again. How many times can you do this quick squeeze before the muscles tire?

This level becomes your baseline level of exercise. For example, you might be able to hold for 5 seconds, repeat 4 times and do 8 quick squeezes. This is your individual exercise program. It reflects how strong you are right now and the level to which you should be working. This program should be attempted three times a day. Over time, see if you can do a little more. Eventually, aim to do 10 long squeezes, holding each for 10 seconds, followed by 10 short squeezes.

Remembering to do your exercises daily is a challenge. Try to associate it with another activity so you will remember. Or there are apps which help to remind you and chart your progress. Squeezy is an app that has been developed by physiotherapists working in the NHS.

You may find it takes time to be able to do the exercise properly. It may take 6-8 weeks to get the technique right. You may struggle with relaxing other muscles at the same time, or you may struggle with breathing normally. You may also find that you are able to do the exercises correctly in one position (e.g. lying on your side) but if you change position then you can’t get the muscles to work in quite the same way. All this is very common at this stage. Women will often be frustrated in this time period as you may not see any improvement in symptoms despite doing exercises every day. But it is important to persevere. Build up your exercise regime over time. If your muscles were weak, you should notice an improvement in your symptoms in 3-5 months.