Prolapse: 3 Ways To Heal Beyond Kegels
Authored by the Bodyful Team
Are you looking for how to fix a prolapse without surgery?
Are you newly postpartum and have been diagnosed with prolapse?
Have you heard of the term pelvic organ prolapse (POP) but want to understand it better?
Do you have a mild pelvic organ prolapse?
Are you interested in pelvic floor exercises for prolapse?
Have you had surgery and you want to know prolapse surgery recovery time?
There is so much information on the internet nowadays and oftentimes it can be confusing or inaccurate. Hopefully you will find some of your answers in the blog. We also have a page about pelvic organ prolapse here.
There are many claims that there are “right” things to do and “wrong” things to do when it comes to prolapse. The reality is that there is much more nuance and individualization that needs to be applied to this diagnosis.
Some folks can manage their pelvic organ prolapse without surgery. Others may benefit from pelvic physical therapy rehabilitation after a prolapse surgery.
What is pelvic organ prolapse?
Prolapse, in its most simple definition, is when an organ housed in the pelvic bowl (bladder, uterus, rectum) begins to descend downward from its normal resting place.
This is most commonly seen during and after pregnancy, but can also be seen in folks over time who strain during abdominal pressure management, like breath holding patterns during effort, chronic constipation, heavy weight lifting, or connective tissue dysfunction in their history.
Prolapse can be scary if you have heard about “organs falling out” and you may have heard “your pelvic floor is too weak.” POP is more complex than that.
Think of prolapse like a ship on water with ropes holding it to a dock. The ship in this metaphor is the organ, the water is the pelvic floor, and the ropes are the ligaments that hold the organ in place. The water (pelvic floor) plays an important role in keeping the ship (organs) up, but the ropes (ligaments) play a very important role in keeping it in place as well.
This is why doing 100 kegels for prolapse may not be the whole story. If the tensile strength of the ligaments and the pressure above the organs is not managed, prolapse can persist.
Aspects such as posture, core coordination, and breathing patterns can have just as much, if not a stronger, effect on prolapse and the potential recovery.
Here are 3 ways, beyond kegels, to begin managing your prolapse:
Consider using an estrogen cream.
If you are newly postpartum and currently breastfeeding/chest-feeding, or if your estrogen levels are known to be low from long term hormonal birth control or perimenopause, you may want to talk to your MD about a topical estrogen cream.
Estrogen levels remain decreased during breastfeeding/chest-feeding and this directly affects the ligaments that hold the pelvic organs up by keeping them a little more relaxed. While you wait to wean when it is right for you, using a topical cream directly in the area can promote healthier local tissue and ligaments that may decrease laxity and decrease uncomfortable sensations associated with prolapse.
Note that it takes at least 6 months after you stop lactating for your hormonal levels to return to baseline.
Manage your constipation.
Because prolapse is also an abdominal pressure management issue, if you have bowel movements that are hard to eliminate and you are straining, this can significantly contribute to excessive pressure downwards.
Consider how much fiber you are getting in your diet as well as water. If your stools are hard and dry they will be difficult to eliminate. It is recommended that you eat 25-30 grams of fiber a day from food, not supplements.
You may consider adding psyllium husk to your diet as this is a natural and sustainable way to promote better bowel movements.
Consider purchasing a squatty potty, or using a footstool, so that you can have ideal biomechanics when pooping.
Always breathe when pushing to have a bowel movement. If you feel this is difficult to do or you are not sure how to coordinate this, pelvic floor physical therapy can help train you.
Decrease pelvic floor muscle tightness.
Since the common assumption with prolapse is a weak pelvic floor, many people walk around with a pelvic floor that is too tight and over-recruited. This can make prolapse worse because of a concept called “biotensegrity.”
To understand this, grab a piece of clothing you are currently wearing and pull on it from a corner. You will see how some parts of the fabric get tight and other parts actually look more slackened. The tension of the fabric is no longer evenly distributed. This is essentially what can happen in your pelvic floor at the fascia when certain areas are held more tightly than others. The uneven tension creates laxity somewhere else, which can result in a worsening of the prolapse.
Internal pelvic floor work can be helpful in targeting the specific areas that are held and helping them to soften. This, in combination with very specific coordination training at the pelvic floor, can ensure that pressure is more evenly distributed and can reduce symptoms of prolapse.
Prolapse is very common, and a low grade or mild prolapse will likely not cause symptoms if you have healthy pelvic floor muscles.
Many people are walking around with low grade prolapse and have no symptoms at all.
If you are only mildly bothered by your symptoms, watch for the following:
Urinary retention
Severe bowel dysfunction
Hydronephrosis
Whether you have mild pelvic organ prolapse, or advanced prolapse, communicate with your doctor if any of the above develop, to avoid risk of complications.
Prolapse does not mean you are damaged.
Prolapse does not always mean you need surgery.
Mild prolapse symptoms can be reduced with the appropriate treatment.
Tailored postural muscle strengthening exercises, pelvic diaphragm coordination training, and good bowel and bladder habits, can significantly improve your function, even if you have a prolapse or after prolapse surgery.
If you have had a prolapse surgery, pelvic physical therapy can help with symptoms including, but not limited to, pelvic, low back, or hip pain, urinary incontinence, overactive bladder, pain with sex, and constipation. It is important to start physical therapy as soon as you can, after your surgeon has cleared you for return to exercise.
