Understanding your prolapse with Clare Bourne

Many women experience a prolapse, it’s time we sat down and had a good old chat with an expert. Squeeze those pelvic floors, ladies, we’re in for a wild ride.

What is prolapse? You may have heard tales about prolapse from your aunties or gal pals, but all too often we get freaked out by the concept and forget to ask “what the fuck actually is prolapse and how can you manage it?”

Let’s open up our conversations about prolapse, so we all feel less alone. Expert physio, Clare Bourne gives you all the info your aunty missed out.

What is prolapse?

A pelvic organ prolapse (POP) is the downward movement of one or more walls of the vagina, including descent of one of the pelvic organs. The pelvic organs are supported by the pelvic floor muscles and connective tissues. 

This support system is impacted by different lifestyle factors. Pregnancy and childbirth are often most discussed but other factors include chronic constipation, a family history of prolapse, being overweight, age, menopausal changes, and chronic cough.

A prolapse can be mild where women are not even aware of it, or more severe causing significant symptoms and impacting quality of life.

What are the symptoms of prolapse?

Most commonly, women experience a dragging or heaviness sensation within the vagina or seeing/feeling a bulge. ⠀

Other symptoms include:

  •  Incomplete emptying of bladder or bowels & needing to strain ⠀
  •  Incontinence ⠀
  •  Frequency of urination ⠀
  • Urgency of bladder or bowels ⠀
  • Needing to apply pressure on perineum to open bowels⠀
  • Difficulty inserting tampons⠀
  • Pain with sex, or feeling something in the way⠀
  • Backache or abdominal discomfort ⠀

These symptoms may be there all the time or vary depending on the time of day, your monthly cycle or your activity level.⠀


How to seek help for a prolapse

If you have symptoms of a prolapse it can be difficult to reach out for help, but there are two compulsory steps to support.

Step 1: 🚫 DO NOT GOOGLE PROLAPSE! 🚫
Step 2: Speak to your GP. They will be able to help you.

As well as seeking medical help from your doctor, you can improve prolapse symptoms by taking care of each area of concern:

Bowel care:

The NICE guidelines state that preventing or treating any existing constipation is essential in treating prolapse. ⠀

    • Don't strain to open bowels.

    • Get a @squattypotty to help sit in optimum position to open bowels. This helps the pelvic floor to relax and bowels to open.


  • Keep tummy relaxed and breathe into your tummy.

  • Allow gentle support to the perineum with your hand. You may want to use a pad to support or wrap your fingers in toilet paper.

  • Take your time ladies: no need to rush! ⠀

Bladder care: 

  • Sit on the toilet rather than hovering.

  • Where you feel you struggle to empty your bladder properly you can use 'double voiding' where after you do your initial wee, do a little stand, sit back down and try going again.

Weight:

The NICE guidelines recommend losing weight if BMI is over 30 k/m2 as increased weight, especially around the abdomen, as this can place increased pressure onto the pelvic floor.⠀

Lifting:

Now we are not here to say avoid lifting...that isn't life, but during rehab just question 'do I need to be doing this lifting?' - if you have an option to opt out of heavy repeated lifting then it will probably help your symptoms. However, mum life involves lifting and that is ok. Just try and engage your pelvic floor on the lift. It's a great way to get your exercises in.⠀

Vaginal pessaries:

These are recommended in the NICE guidelines for use either alone or in conjunction with pelvic floor muscle training. There are many different types and this is normally fitted by a urogynaecology nurse or gynaecologist.⠀

Topical oestrogen:

This is a tablet or cream that women use to provide more oestrogen to the vaginal tissues. This can help breastfeeding mums or menopausal women with a prolapse, as we are more oestrogen deficient. It isn't used for all women as it depends on how the vaginal tissues appear. ⠀

Pelvic stability exercises:

Working on strength around the pelvic floor (i.e. abdominals and glutes) can help provide support to the pelvic floor. Pilates can be helpful with this, especially in the postnatal period.

Exercising with a prolapse

It is very understandable if you have a prolapse to be afraid of exercise or be unsure what you can do, and advice can often be mixed. You may also find that certain exercise aggravates your symptoms. Essentially, nothing should be taken off the table forever. However, like all exercise through life it needs to be right for your body at that stage with the right guidance.

Here are my top tips for exercise:

1️: Exercise carried out in the right way can actually help your rehabilitation and prolapse symptoms.⠀

2: It’s best to start with low impact exercise, with gradual introduction of impact (best under physio guidance). ⠀

3: Introducing impact is important for your pelvic floor and bone density so we don't want to avoid it forever.⠀

4️: Progressive loading (ie gradual and graded over weeks and months) with weights and impact is the best approach, how that looks for you, unfortunately I cannot say without assessment, therefore individual help is a necessity.⠀

5️: Being aware of symptoms during exercise is key. Tune into your symptoms and if the exercise you are performing is causing those symptoms during or after, this indicates that it is not the right exercise for right now.⠀

6️: Courses like the Holistic Core Restore programme from @burrell_education can be a really helpful place to start. There are trainers all over the country which look at pelvic floor strengthening through functional movements (e.g. squats), and so much more. ⠀


7️: We MUST be doing pelvic floor exercises in standing, if we want to help our symptoms during exercise when most of us are upright.⠀

8️: Please, please, please: if you are avoiding exercise due to prolapse symptoms speak to your GP, or find a pelvic health physio who can guide you through back to what you love. ⠀

Sex with a prolapse

Being diagnosed with a prolapse or feeling prolapse symptoms can have a huge impact on a womens libido, body confidence and comfort.
Here are my top tips for anyone concerned about having sex with a prolapse.

  • First and foremost it is important to say that it is safe to have sex with a prolapse, it will not make the prolapse worse or cause any damage.
  • Using a lubricant is really helpful. @yes_organics is a great brand to check out. This is really important for any breastfeeding mums who may have dryer vaginal tissues due to reduced oestrogen levels.⠀
  • You may need to try different positions to work out what is comfortable for you. 

  • Working on your pelvic floor exercises will help with the prolapse as well as sexual pleasure. However, if sex is painful for you please do try and access assessment of your pelvic floor to work out if actually your pelvic floor has gotten too tight and is contributing to symptoms. ⠀

  • Be totally honest with your partner about how you are feeling and your fears so you feel understood and supported. Some women will benefit from speaking to a psychosexual counsellor as well.⠀

If a prolapse is putting you off having sex please don't let that be the end, please reach out for help, because it is out there. You are not alone and we are here to listen and support you. ❤

Prolapse is not the end of the road, for lots of us it is just the beginning of understanding our bodies better and using exercise as a power for changing our symptoms. 💪


Love, Clare Bourne, and Nessa. X

Want to hear more from the experts? Check out our our Nesspert series 

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