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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’.

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