Well on this special day for women, I thought I’d write a blog about a problem that women mostly keep quiet about- ‘Prolapse’.
I had a patient recently who had had significant improvement with the FEELING and LOOK of her prolapse and was so excited that she would be able to postpone surgery for a few years that she demanded that I write a blog about the options for women with this condition.
Before I outline the key strategies that can minimise the effects of vaginal prolapse or as it is known in the literature – Pelvic Organ Prolapse (POP) – I would like to share some of the comments that patients have said to me when they are diagnosed with prolapse. Some use words like shattered; they feel like they are ‘damaged goods’; they feel like a failure; some have even said they were ashamed; sometimes they were angry…..why is childbirth so glorified in education classes with no real mention of the potential consequences such as prolapse. They have often described prolapse as like a secret and this is where Jenny (my delightful and delighted patient) has asked for there to be a “conversation about prolapse.”
There is a big conversation about prolapse on Twitter. There are many of us pelvic floor physios who have bumped into each other on Twitter and are now sharing many conversations about the latest research articles; sharing information on topics such as different sorts of pessaries and other products such as a Femmeze – a device to help with defecation with women who have a posterior wall prolapse called a rectocoele. But Jenny wants the conversation to be for women and amongst women so much more easy, preventative interventions can happen earlier to reduce the severity of prolapse.
So what are these easy strategies that all girls/ women should be implementing as soon as really the period/ birds and bees conversation takes place.
1. Pelvic floor muscles
Well the fact that they exist is a good start- how they work and like any striated, voluntary muscle in the body -they need to be exercised regularly to keep them well activated, able to hold for 10-15 seconds and if possible maintain good strength (sometimes damage from straining at stool or vaginal deliveries can cause nerve damage or levator avulsion and therefore affect strength). Doing 30 repetitions per day in lying, sitting and standing will help maximize the potential of these muscles. (lying on the bed, not the floor) if you are unsure about how to contract them correctly then see your local Continence and Women’s Health Physiotherapist.(Google Find a Physio section of the APA website)
2. Engaging these muscles with ALL increases in intra-abdominal pressure.
When you cough, sneeze, lift, bend (as mothers we do heaps of bending), push, blow your nose, jump etc etc, you must tighten your low tummy (just above the pubic hairline), tighten your urethra-vagina, pull in with your anus and then do the activity. In my book Pelvic Floor Recovery I use the term bracing – now I do this because I like the concept that bracing is like a structural support to help hold things up and that is, after all, what we are aiming to do when women have prolapse. (Bracing is not to be confused with a concept used about 50 years ago in Physiotherapy literature for any physios reading this.)
3. Correct Defaecation position and dynamics.
We are never really taught how to defaecate – we are just plonked on the toilet and much clapping and reward-giving occurs if something disgusting and smelly appears in the potty. There really is a much more effective way to go which minimizes downward forces on the vagina and therefore helps minimize further prolapse.
It involves leaning forward, and depending on the height of your toilet, popping a set of 2 toilet rolls under each foot to give some nice elevation – sort of mimicking squatting – and then gently bulging your abdominal wall forward instead of pushing down into your bottom (which constitutes straining). See page 50 of my book.
4. Pessaries
There are a wide range of pessaries which you can talk about with your Urogynaecologist or Gynaecologist -and some Continence and Women’s Health Physiotherapists also fit them. These devices used to be considered an interim device but increasingly are being used as a viable solution to prolapse management.
Well Happy International Women’s Day to everyone out there and may some of our conversations now involve the word ‘Prolapse’.
International Women’s Day
Dear Friends, My Femmeze just arrived and I am having trouble, as the stool is too big. I live on Ducolax and MiraLAX. I do the correct exercises. Thank you for your invention. Not many practitioners in America even know about this, but my new lady PT did. Thank you for any advice you may give.
Another thing to try is to discuss the use of adult glycerol suppositories with your GP. In Australia these are an over the counter product.
Thanks Sherrie for your comments. You are such a great advocate for women world wide who have prolapse.
Top shelf blog entry Sue! Passing these basic and significant pieces of information along to women is pivotal to shifting the POP dynamic. We all need to work together to estabish recognition and understanding of pelvic organ prolapse. Insights like these truly help!
Sherrie Palm, Founder/CEO
Association for Pelvic Organ Prolapse Support
Hi Sue, great blog thanks! Yes it’s true that I feel better about myself because I have delayed surgery and am managing prolapse with greater confidence. One of the main reasons is that a very good friend of mine who is a nurse, warned me against prolapse surgery. She said that her nurse friends said “this is the last surgery you ever want to have…because of the risks etc’ This really worried me and I went right to the web to research the issue. This is when I discovered the FDA alert on surgical mesh. I immediately delayed the surgery and stated my concerns to my surgeon. He was open about the risks of surgery and asked me to return in 6 months for a review. In the meantime he prescribed a local oestrogen called vagifem, which has assisted my improvement.
I decided to seek another medical opinion. I went to a female specialist, who examined me and recommended that surgery was not warranted at this stage. She was very matter-of-fact, and gave me the impression that this was not a big deal – just another step along the road of putting my body through two childbirths. So I left feeling that prolapse was not a personal failure, just a consequence of living a full life as a wife and mother. Could I have done things in my life to prevent it? – yes of course, if I had been aware of the very real danger of it. But as I said to Sue there is the great silence about prolapse. We celebrate everything about pregnancy and childbirth but the discussion about prolapse is simply avoided.
So what am I doing now? I am going to pilates twice a week with very supportive practitioners. I am on review with my woman surgeon who will decide at some stage to do surgery. When will that be? I have no idea. But in the meantime I feel a sense of achievement that I have delayed surgery. This was due to the support of a range of women – my nurse friend, Sue who provided invaluable management information/techniques and my very practical female surgeon. I am very relieved that I looked beyond my first doctor’s recommendations for immediate surgery. I really believe in everyone’s right to shop around for a medical opinion and to become fully informed about their options.
Hi Jennifer
Thanks for your comments. Very comprehensive answer- very helpful for other ladies. Keep up the active, productive, fulfilled life!
Thank You Sue! Appreciate you furthering the conversation and shedding additional light on these very real issues women experience globally.
Well done. Keep them coming.