Pelvic Organ Prolapse – Finding the Sweet Spot with the Right Plan, Support and Progressive Loading

Ever get the feeling you are swinging on Miley Cyrus’ wrecking ball through a hailstorm of terrifying pelvic organ prolapse blogs and are left clutching your vagina for fear it’s falling out? My patients must be because I have a tsunami of women in my office terrified that they have truly stuffed their vagina and it’s all downhill from here. However, when we examine their pelvic organ prolapse, their ability to hold or empty their urine or their bowels, it seems that often their pelvic organ health and vaginal wall movement is within normal or only mildly prolapsed. Yet, their vaginal tissues FEEL SO BAD. It feels like something is falling out, aching, dragging and ‘it must mean there’s a pelvic organ prolapse that’s only going to get worse’. This is becoming such an issue that there are universities right now trying to develop questionnaires that work out why things might feel so bad when the measurements are ok¹. 

What’s going on with Pelvic Organ Prolapse?

Do not for one second tell me that these women are hysterical, or it’s all in their head. No way, we have done that dance and that’s how women’s health was so ignored and botched in the past. Women put up with stuff, they don’t invent it!

I’ll tell you what it is, it’s Well-Meaning Health Practitioner syndrome. Yep, I’m making up a syndrome and I don’t care. I’ve been guilty of this, so many doctors and physios have meant well but said life altering stuff that’s accidentally for the worse. We say something to a patient, or a community group at a health talk, with noble intentions, but we leave every woman so terrified of ‘what could happen’ that they grip those pelvic floor muscles like ants on smarties. Forever! We try to validate someone’s symptoms or see the cost of pelvic organ prolapse get minimised and so campaign through education and blogs for others to realise JUST HOW BAD prolapse can be, but then don’t notice that all the conversation about pelvic organ prolapse is negative and alarming. The future for pelvic organ prolapse feels dangerous because we know prolapse surgery is often repeated. Combine all this with media coverage of the ‘mesh mayhem’ and it feels like pelvic organ prolapse is the actual end of a meaningful life.

There are some amazing studies out there showing that the things physios and doctors say to patients can set them up for worse symptoms². They accidentally create a sense of vulnerability in the tissues and mental images of crumbling joints (or vaginas). And here’s the kicker, it actually changes the sensitivity of nerves and ‘crampiness’ of muscles. Sound crazy? Not at all. If an ‘expert’ has told you a body part is vulnerable, your clever immune system will make sure you have more sensitive nerves and more high alert muscles in order to protect that area. You can actually change your DNA recipes for that body part. 

So a moderate degree of stretchiness in the vaginal walls, and a slightly constipated day of the week, can become a feeling of an inflamed wombat hanging out in your pants. It’s the nerves and muscles trying to protect you from what you have been told is a terrifying possibility.

If you are one of those women out there with a vagina that’s holding you hostage, and your physiotherapist or gynaecologist has a furrowed brow saying, ‘it’s not too bad actually’, then please hear me: You are not alone, this is not in your head, your body is trying to protect you and it can change for the better.

Here’s what ‘Well-Meaning Health Practitioner Syndrome’ always fails to communicate; you dear human, are resilient and your body is plastic. Sure there’s a few things we kiss goodbye forever if we blow it; dentine on our teeth, the fat pads under our toes and I’m not going to lie about youthful skin disappearing. But we change, we gain, and we grow tissues as we load them in a smart way. Yet our culture continues to get the story wrong. Take spinal discs and running for example, the prevailing story is that it will squish your discs, so you know, you better be cautious especially if you have had a back injury! But research shows that regular runners have thicker spine discs than their age matched peers³! Loading is good for tissues, including vaginal walls and pelvic floors, when we do it regularly and we gradually progress the load in a good range. Our language around injury and pelvic organ prolapse needs to change, it needs to hit the sweet spot of celebrating our resilience that matches research.

Progressive Loading for Pelvic Floor

There is a flurry of studies being done on women doing weightlifting in the presence of pelvic organ prolapse⁴. And the early results are trending to say; women’s pelvic organ prolapse symptoms and measurements do better rather than worse when they load up! Our bodies like controlled, progressive load and doing things that feel satisfying to conquer.

Don’t run out and start snatching 60kg overhead tomorrow, but know that there is a lot you can do to encourage your body’s plasticity:

1)    Look after yourself with sleep as soon as kids permit, and supply your body with healthy fuel for your energy tank

2)    Get to know your vagina and decide to love it. Your pelvic health physiotherapist can tell you how stretchy it is, how thin, strong, tight, soft or coordinated the muscles are. They can measure how much the vaginal walls move at the moment; how healthy the mucosa is. They can form a plan with you for any muscle tightness or weakness holding you back from the things you love. You can learn all the tricks that reduce pressure on pelvic organs as you get through your workload and family care.

3)    Feel more confident about your vagina by using external supports. SRC Restore shorts and pessaries are just a couple of great options to help you feel confident about your vaginal tissues and to feel less bouncing while coughing and exercising. This can help muscles in the area to spasm less and reduce the amount of discomfort in the pelvic floor.

4)    Get involved in exercise you enjoy! Load the pelvic floor by getting involved in satisfying exercise with the guidance of a pelvic floor physiotherapist that can monitor your measurements.

One of my most joyful consults last year was a check up with a woman who had horrific birth management 40 years earlier. She was terrified that her new ‘bone health’ exercise program would cause pelvic organ prolapse to worsen. The reverse was true. Six months into her training she had a thicker, stronger, healthier pelvic floor and better pelvic organ prolapse measurements. Golden oldies, they are hard workers and reap the benefits!

If the activities that make life meaningful to you involve a fair bit of load on the pelvic organs, then it will likely take one or two supporting professionals plus the ‘slower path’ up the mountain of training. I confess I’m the first person to moan when I have a flare up of symptoms and you will have a few along the way. But you can find and train towards satisfying goals. If pelvic organ prolapse is making your world shrink, you need to find the right support to get you back into the things you love.

1. Drage KJ, Aghera M, MacKellar P, Twentyman R, Jacques A, Chalmers KJ, Neumann P, Nurkic I, Thompson J. The relationship between symptom severity, bother and psychological factors in women with pelvic organ pelvic organ prolapse: A cross-sectional observational study. Neurourol Urodyn. 2022 Jan;41(1):423-431. doi: 10.1002/nau.24842. Epub 2021 Dec 10. PMID: 34888916.
2. Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med. 2013 Nov-Dec;11(6):527-34. doi: 10.1370/afm.1518. PMID: 24218376; PMCID: PMC3823723.
3. https://www.painscience.com/biblio/thicker-juicier-spinal-discs-in-slow-runners-and-fast-walkers.html
4. Forner LB, Beckman EM, Smith MD. Symptoms of pelvic organ pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey. Int Urogynecol J. 2020 Aug;31(8):1551-1558. doi: 10.1007/s00192-019-04163-w. Epub 2019 Dec 7. PMID: 31813038.

The Author - Liz Lush is a mother of 4, Senior Clinical Educator at All Women's Health Physiotherapy and Clinical Educator for Pelvic Pain Foundation of Australia. She loves her husband who constantly sings to their dog, her kids that drive her up the wall and the privilege of working with women.