Can you fix a prolapse without surgery?
If you’ve just been diagnosed with a prolapse, you might have been told (maybe by your doctor but sometimes by your mom or your friends) that surgery is your only treatment option.
Let me tell you that that couldn’t be further from the truth!
While surgery can be the best choice in some cases, it’s not always warranted and many patients experience a complete resolution of their symptoms with conservative management (also known as pelvic floor physical therapy) alone!
(A quick disclaimer to say that I am absolutely not against surgery if needed. I have a lot of respect for my surgical colleagues and I will not hesitate to tell a patient in my office if they would be better served by a surgeon. That being said, I do feel like a lot of messaging has painted a black-and-white picture that portrays surgery as the only correction for a prolapse and leaves my specialty out of the conversation completely. As I am very much an advocate for physical therapy, I wanted to write here about the times when you should absolutely seek PT before scheduling surgery.)
In this blog, I’ll go over what a prolapse is, common causes, some options for treatment for pelvic organ prolapse, who may benefit from pelvic floor physical therapy, and some tips to help you manage prolapse without surgery!
What is a prolapse?
A prolapse is simply when one of the organs that are situated within the pelvis (which would be the bladder, the uterus, and the rectum in a female body) begin to lower further down in the pelvis from where they originally were.
As you can imagine, this can cause symptoms such as an uncomfortable pressure or bulging sensation in the pelvis as well as bowel or bladder changes.
Prolapses come in many variations, both in terms of which organ is affected and also in how much the organ has dropped. The picture below shows some illustrations of the different types of prolapse.
Image used with permission from Pelvic Global, LLC.
What are the common causes of a prolapse?
A prolapse can develop for many reasons. Some common causes of a prolapse include:
Chronic constipation
Chronic coughing
Childbirth, especially with a longer second stage of labor
Repetitive heavy lifting, especially for those who have done so occupationally
If you look at the list above, you may notice a common theme: most of these reasons have to do with prolonged straining.
Whether it’s straining to have a bowel movement, straining to push a baby out, or straining when lifting, all that straining over and over again puts a lot of pressure on the pelvic floor!
Over time, that pressure can cause prolapse.
A quick note, some people say that aging can be a cause of prolapse and while that can be true, a big part of the reason why that is is because people tend to lose muscle mass as they age and since having strong pelvic floor and hip muscles help support the pelvic organs, less muscle mass equates to less inherent support.
So older people who have maintained their strength have a much less chance of developing prolapse.
And that’s good news because even if you’ve lost some strength over the years, it’s never too late to start strength training!
Who should see a pelvic floor physical therapist?
Now that you understand more about what a prolapse is and why it develops, let’s go over who would benefit from pelvic floor physical therapy vs. who needs to go directly to a surgeon.
Generally speaking, most people would benefit from an assessment with a pelvic floor physical therapist. I know you probably saw that coming, but hear me out.
As a pelvic floor physical therapist, I have been trained to identify who is an appropriate surgical candidate.
So if someone who really ought to be having surgery ends up in my office, I will recognize that, recommend that they speak to a surgeon, answer any questions they have, and then they’ll be on their way.
So in the worst case scenario, they took an hour to come to an appointment with a physical therapist. (And keep in mind that you are often able to make an appointment with a PT much sooner than you can a surgeon as they tend to have months-long waiting lists.)
Seeing a PT will certainly not make a prolapse worse and even if someone is more appropriate for surgery, there are often many tips we can review during a session that may help you feel better in the short-term.
On the flip side, if someone who has prolapse but does not need surgery is in my office, then they’re in the right place because pelvic floor physical therapy can help you resolve prolapse symptoms!
So we can get started on your treatment right away.
I’ve actually had skeptical patients come to my clinic just while they were waiting for their appointment with a surgeon then end up completely resolving their symptoms in the interim and end up canceling their surgical consult.
So hopefully you can see why I’d recommend seeing a PT first!
What are some tips to help manage prolapse without surgery?
So how do you treat a pelvic organ prolapse? If you recall the above section where I went over the common causes of prolapse, you’ll remember that I had mentioned prolapse being a result of too much pressure on the pelvic floor.
So we fix it by managing that pressure! Here are a few ways to do that.
Breathe
If you get nothing out of this post, please remember this: breathe!
Breathe whenever you’re lifting something heavy. Whether that’s lifting weights in the gym, lifting boxes on the job, or lifting your kiddo at home, breathe while you do so. Many people subconsciously hold their breath during physical effort and while that can make you feel stronger in the moment, it also puts a lot of pressure on your pelvic floor.
Also remember to breathe while you’re going about your day. In today’s hectic world, a lot of us subconsciously hold our breath as we rush to do something. (I know I definitely catch myself holding my breath in rush hour traffic!) Remind yourself to take a deep breath when you’re feeling stressed.
Improve your bowels
As I mentioned above, constipation can be a cause of prolapse so it makes sense that improving your bowel movements would help lighten the load! Some tips to help get things moving:
Hydrate well
Get regular, aerobic exercise (walks count!)
Use a squatty potty while on the toilet (or a regular stool works too)
Consider using a fiber or magnesium supplement (but be sure to check with your doctor before doing so)
Lay with your hips elevated
This is a little trick of the trade that uses gravity to our advantage.
Taking 5-10 minutes to lay with your hips lifted above your heart can really do wonders to help prolapse symptoms feel better. Just use some pillows, a yoga block, or a bolster to prop your hips up so that you can fully relax into the position.
You can do this whenever you feel your symptoms.
(Quick note: if you have any blood pressure issues, inversions may not be appropriate so use your best judgment when implementing this one and talk with your doctor first if you have any concerns.)
Notice that I did not say to “do your Kegels”. Kegels can be appropriate in some cases, but in others, they can actually worsen prolapse.
So I like to do a full pelvic floor muscle assessment before recommending them.
If you haven’t had a pelvic floor muscle assessment, I’d recommend holding off on kegels and working on your full body strength instead (while breathing of course).
Certainly, this is a short list of treatments and there’s a lot of nuance to prolapse so unfortunately, not everyone will have a quick fix.
There is so much more to prolapse that goes beyond a short blog post (I’ve actually taken multiple-day courses just about prolapse, there’s so much to discuss!)
Pelvic floor physical therapy in Durham, NC
If the above tips did not work for you and you’re local to Durham, NC or the surrounding areas, I’d highly recommend making an appointment so we can dive deeper into the potential causes (and solutions!) of your specific symptoms.
I’d love to help you live without pelvic pressure, heaviness, or discomfort! You can reach out by completing a contact form here or by scheduling a complimentary discovery call here or by clicking the button below.
