I’m so excited to announce that “Lift,” my new 5-week series for pelvic organ support, has arrived! This 5 week, 5 video series is designed to help women with mild to moderate prolapse manage their symptoms; it’s also great if you have mild incontinence, or if you’re a new mama. You can learn more about the series by watching the short 5-minute intro video below:
The best way to follow along with “Lift” is to subscribe to my special Lift email list. When you sign up, I’ll send weekly emails with the video links and downloadable PDF handouts that you can print out. This makes it easy to do the daily exercises WITHOUT having to constantly re-watch the weekly Lift videos!
Let’s talk about pelvic organ prolapse.
The topic of pelvic organ prolapse is HUGE and far too much to cover in a simple blog post. I’m going to keep the following brief, and in list form. I want to provide some basic information, because knowledge is power and pelvic health is something that EVERY WOMAN should strive to understand! However, I also want to make clear that while self-exploration is important, you should always get confirmation of your self-evaluation from a trusted healthcare provider. I recommend seeing a gynecologist or urogynecologist, and/or a women’s health physical therapist.
What is pelvic organ prolapse?
Put simply, pelvic organ prolapse is when one (or more) of your pelvic organs descend from their rightful position(s). This can occur due to stretching, weakness, or laxity in the connective tissues that hold the organ(s) in place, or due to lack of support from underneath (i.e. the pelvic floor muscles).
Types of pelvic organ prolapse:
- Cystocele: bladder descends and pushes into the anterior vaginal wall
- Rectocele: rectum descends and pushes into the posterior vaginal wall
- Enterocele: a herniation of the peritoneal sac (containing the small bowel or sigmoid colon); it descends into the area between the vagina and the rectum
- Uterine prolapse: uterus descends and the cervix is more clearly seen/felt
- Vaginal vault prolapse: the top of the vagina descends down into the vaginal canal; can occur after hysterectomy
Stages of pelvic organ prolapse:
- Stage 0 = no prolapse
- Stage 1 = most distal portion of the prolapsed organ is more than 1 cm above the level of the hymen (it almost reaches the opening of the vagina)
- Stage 2 = most distal portion of the prolapsed organ is less than 1 cm above the level of the hymen or less than 1 cm below the level of the hymen (it reaches the opening of the vagina)
- Stage 3 = organ is more than 1 cm below the plane of the hymen (it protrudes through the vaginal opening)
- Stage 4 = complete eversion, organ is at least 2 cm below the plane of the hymen (it protrudes completely outside the vagina)
*Note that stages 1 and 2 are considered mild to moderate. These stages are often TREATABLE without surgical intervention! Here are three studies with outcomes that suggest that conservative management is worth considering, if the prolapse is mild to moderate: study one, study two, study three.
Surgery is typically required to correct more advanced stages of prolapse (i.e. stage 3 and 4). It might even be indicated (for various reasons) at earlier stages; however, if you’re diagnosed with a grade 1 or 2 prolapse and are not exactly “excited” about the idea of going under the knife, then I encourage you to request to explore conservative options first.
The take-home message: Reversing symptoms of stages 1 and 2 prolapse is possible, and preventing progression is ABSOLUTELY POSSIBLE. Follow the “Lift” video series, and seek guidance from a pelvic health expert who can provide a physical examination to best determine your condition.
Physical examination technique to determine stage:
While exams are often done lying down in supine, a standing exam is ideal to confirm the full extent of prolapse since standing is a functional position in which we (humans) spend most of our normal daily lives. Don’t just test on an exam table. Stand!!!
The best part? You can try this at home, on your own.
- Empty your bladder
- Stand with feet apart (option: stand with one foot up on a stepstool)
- Separate your labia (the “lips” that surround your vaginal opening) and hold a handheld mirror under your vagina
- What do you see? Take note. Then try gently bearing down, and observe. Then try coughing, and observe.
- Gently insert 1-2 finger(s) into your vagina. What do you feel? Take note. Is the bulge/movement coming from the anterior/front vaginal wall, or the posterior/back vaginal wall? Or from the top? Try gently bearing down, and observe. Then try coughing, and observe.
*Note: you can also examine yourself while sitting on a toilet, or while sitting on the edge of a bathtub or the edge of a bench. In my personal opinion this is a “step up” from a supine examination (i.e. an exam done lying on your back).
Things to avoid if you have prolapse:
- Poor posture (slouching/slumping when sitting, standing, or walking)
- Holding your breath
- Most heavy lifting… at least for now!
- Most high impact activities… at least for now!
All of these topics (and more) will be covered, in-depth, in my new “Lift” series. Click here to get weekly Lift emails with video links and printable handouts.
Conclusion and prognosis:
The best way to discover YOUR personal needs and staging is to self-evaluate (so that you KNOW YOURSELF) and then to FOLLOW UP with a women’s health physical therapist. There are also some promising new imaging techniques that may be helpful when it comes to proper evaluation (and then developing the perfect treatment plan for you):
There is SO MUCH you can do conservatively (i.e. through exercise and lifestyle) to help manage your symptoms — and to help prevent progression of your condition — if you do, in fact, have prolapse! My “Lift” series is a great place to start, particularly when coupled with an individualized treatment program from a women’s health physical therapist you see in-person.
If you think you have prolapse, then schedule a consultation with your gynecologist or with a women’s health physical therapist. Here’s a link to a women’s health PT locator to help you find a provider in your area. Your provider will give you a solid diagnosis (including exactly how far advanced your prolapse is), and can provide you PERSONALIZED recommendations re: the next best steps.
Last word of caution/advice:
Please know that just like every person is different, so too is every HEALTHCARE PROVIDER different. If you are not satisfied with the evaluation or examination you receive from one provider, then don’t be afraid to seek a second opinion.
Advocate for yourself!
If you feel like something is “off” in your body, then LISTEN.
If you feel like you can (at least attempt to) heal yourself naturally, then LISTEN.
You’re probably right.
Sending light and love!