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Prolapse

Pelvic organ prolapse is where any of the pelvic organs (bladder/urethra, uterus/cervix, or rectum/bowel) can drop into the vaginal (or sometimes, rectal) space. It is due to excessive stretch of the fascia and ligaments that normally suspend these organs in a mostly vertical alignment. Your Sydney Pelvic Clinic physiotherapist has expertise in diagnosing what type and grade of prolapse you may have. They will then provide evidence based management, which may involve education and lifestyle advice, pelvic floor exercises and discuss the use of a pessary.

The most common reason for pelvic organ prolapse is vaginal delivery, but it can also be secondary to chronic straining of this area, i.e. chronic constipation, coughing or excessive weight lifting. Symptoms of pelvic organ prolapse is a feeling of heaviness, dragging or something dropping in the vaginal region. Pelvic organ prolapse can also affect sexual function and contribute to bladder dysfunction, i.e. incomplete emptying. Pelvic organ prolapse symptoms often fluctuate and can be worse with heavy lifting, post-defecation, pre and during menstruation or prolonged standing.

Research has shown conservative management of pelvic organ prolapse is very effective in reducing the symptoms, or amount of bother of the pelvic organ prolapse. Such management included pelvic floor muscle training, optimising bladder and bowel habits, correct use of core and pelvic floor muscles. In some cases, using a pessary may be very beneficial.

If there is a need for surgical intervention, we have a wonderful network of specialists we work with. Even if surgery is required, it is essential you have your pelvic floor muscles in optimal form, and you understand how to protect your pelvic organ prolapse in the longer-term and to avoid repeat surgery.

What is a Pessary?

A pessary is a soft plastic or rubber ring or cube that fits into the vagina to help support minor or moderate pelvic organ prolapse. It is useful to see wearing a pessary akin to wearing a knee guard for ligament injuries. The pessary supports the pelvic organ prolapse into a more optimal position and stops the pelvic organ prolapse dropping further. It is a safe long-term management option for pelvic organ prolapse, and sexual function will not necessarily be affected, as you can be taught to insert and remove your pessary (just like you can manage a tampon). Your Sydney Pelvic Clinic physiotherapist will help determine if a pessary will be a good option to manage your pelvic organ prolapse, and which pessary will work the best.

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