Dirty POP: Say “Bye, Bye, Bye” to Pelvic Organ Prolapse

If you’ve read my post on pelvic floor anatomy, you’ll remember that our lovely pelvic floor muscles perform a variety of functions including support of our pelvic organs. So What happens when those pelvic organs aren’t getting the support they need? Enter, pelvic organ prolapse or POP.

As much as I wish I could say this was somehow related to N’SYNC’s classic pop anthem, alas the descent of the pelvic organs (bladder, urethra, uterus, rectum, small intestine, and/or the cervix) into the vaginal canal is not quite as delightful as Justin Timberlake’s beatboxing. 

Risk Factors and Symptoms of Pelvic Organ Prolapse

Risk factors for POP include childbirth (especially with vaginal delivery), pelvic or abdominal surgery (such as a hysterectomy), joint hypermobility (check out the Beighton scale below), chronic constipation, chronic coughing, or chronic straining like with heavy weight lifting.

 

 

But a lot of women fit one or many of those criteria. So how can women know whether they may or may not be experiencing POP? While many women are actually asymptomatic, there are a few common symptoms. These include:

• A feeling of pressure or heaviness in the pelvis
• Feeling a bulge with wiping
• Dull low backache or pelvic pain, often that worsens as the day goes
• Symptoms that increase with straining, standing, walking, or other physical activity
• Symptoms that improve with gravity reduced positions, such as lying down
• Urinary urgency or incontinence
• A feeling of incomplete emptying with bowel movements
• Pain or discomfort with intercourse

Many women have some level of POP and have few if any symptoms.

Before you panic, checking for POP is fairly simple for your OBGYN or pelvic floor physical therapist via vaginal exam (yep, I know some of you just cringed). Keep in mind, however, that signs of POP may increase throughout the day as you are up on your feet, or change based on the phase of your menstrual cycle. This means that you may hear different levels of prolapse from different professionals with exams.

***If you think you might have pelvic organ prolapse, please take a break from high impact activities like running, jumping, and heavy lifting. Until you’ve built up the support you need, you could potentially make the prolapse worse.

Treating Pelvic Organ Prolapse

So what can we do for POP if this problem is found? A lot! – depending on the level of the prolapse. There are 4 stages of POP, with stage 4 being the worst and meaning the organ has completely left the party. Now, these lower stages are not something to mess around with. If you feel like your organ(s) are not staying in your body, please go see your medical professional. (I know some of you are like, “Duh!,” but you’d be surprised)

But really at any stage, awareness of whether POP may be a problem for you is important. Because if you know you’re already showing signs, you can do things to prevent a continuation of the prolapse.

“Okay, what things?” Glad you asked

Kegel’s

As I’ve discussed on this here blog, Kegel’s are the queen of direct pelvic floor strengthening. If you need some help figuring out whether you’re performing a kegel correctly, check out this post.

But Kegel’s are not the only exercise we need to address the root of the problem. In fact, for some women, they may be counterproductive. At the end of the day, pelvic organ prolapse is about more than pelvic floors that can’t generate the required force to hold up our organs. It’s also about the pressures we put through our body, via breathing, alignment, and muscle balance. If all you do is work on the pelvic floor muscles, it’s kind of like walking around all day trying to hold something above your head without any help. A little assistance from above makes things much easier to carry, and much less likely to fall.

Breathing

As for breathing, people have written entire books about how to breathe in a way that helps with mental and physical health. If you have an interest in breathwork, it is definitely worth looking into because the average person takes up to 23,040 breaths A DAY. That’s over 8.4 MILLION breaths a year. So if you want to change something that will have a BIG impact on your health, even apart from your pelvic floor, breathing is a good place to start.

Concerning pelvic organ prolapse, we want to breathe in such a way that doesn’t cause undue downward pressure.

Namely, let’s stop sucking in ladies. When you suck in your stomach, and in some cases, even use those waist shapers, you’re forcing all your organs either up towards your head or down towards… you guessed it, your pelvic floor. Add pressure through inhaling and you get even more force where we don’t want it.

Secondly, don’t just belly breathe. Gasp! I know that this has been the way that people in fitness have talked about breathing optimally for a long time. But if we’re trying to keep the forces on our pelvic floor within a more ideal range, we don’t want to constantly be bearing down on them with our breath. (Side note – this can be a good way to work on the relaxation of the pelvic floor if needed, though.)

Instead, think about breathing in as if you’re rib cage is expanding on all 4 sides. I like to think of a compass. Looking from the top down, your rib cage is like the circle of the compass. You want to try and move the ribs out in all directions, (N, NE, E, SE, S, SW, W)

 

Also did anyone else just hear their elementary school teacher in their ear. Because I definitely just said “Never eat soggy waffles” in my head to remember the directions in their order. 

Alignment

Alignment is another part of the prolapse puzzle, and good alignment will also help with breathing patterns. I’m not talking about the kind of alignment that means each bone is perfectly lined up with the other (though this could help with some of those issues.) I’m talking about positioning your body in such a way that supports optimal function.

In my opinion, the queen of explaining alignment is Katy Bowman. Yet again this is an entire topic one could write a whole book on – and in fact, Katy did just that (you can check it out here).

She would also tell you that the alignment of your feet and legs is as important to POP as your trunk. Among her many recommendations, perhaps the most heart-breaking for many is the directive, “NO MORE HEELS.” Yep, those drool-worthy shoes that look so beautiful you tell yourself they will be worth the pain at the end of the day and the gradual draining of your bank account.

Actually, Ms. Bowman would point out that any amount of heel (even a little one) alters our optimal alignment and function. If you wear heels of any kind, it might be worth thinking about gradually making your way to a flatter sole.

Full disclosure here, while I wear flats most of the time, I do don the occasional pair of high heels for church or date night because I just feel pretty in them! And yes, I also understand it’s a social construct, but it’s still true.

Moving up the body a bit, the muscle and bones connecting to the pelvis in the body play a big role in prolapse too.

Meaning all the muscles that pull on the pelvis can alter the forces on it (and we already know that we don’t want to have forces pulling us in every which way from our overly filled schedules – amiright?)

So if your hamstrings, hip flexors, and/or hip rotators are tight, your pelvis is going to be pulled in different directions that create more strain. And you won’t be able to attain a neutral pelvis, the keystone to this discussion.

“The Hip Bone’s Connected to the Back Bone”

Let’s turn our attention to our pelvis and rib cage and their alignment over one another. Ideally, your pelvis would be in a neutral position with the rib cage stacked over it (don’t worry I’m not leaving you with such vague directions). Finding the neutral position for your pelvis comes down to lining up 3 points on your pelvis (and 2 of them are the same point just on different sides of the body – we’re making this easier already!)

The 3 points we’re talking about are the Anterior Superior Iliac Spine (ASIS) and the pubic symphysis. The ASIS are on each side of the pelvis and are the pointy parts at the top of the front of the pelvis (see below).

The pubic symphysis is in the front middle, where the 2 sides of the pubic bones join together (go straight down from the belly button until you hit bone). 

 

Got ‘em? Great. You want these three points to line up in such a way that if you were to walk into a wall, they would hit the wall at the same time. (This is usually the part where someone tells me that they have a bunch of stuff in the way of hitting a wall. Girl, show yourself some love! You’re working on improving your health here already!)

Depending on the tightness of your various muscle groups, this may be quite a stretch (pun intended) for some of you!

Calling All Rib Thrusters

Now that your pelvis is in a neutral position (or as close as you can get at this point), take a look at those ribs. If you’re anything like me, the front points of your ribs are sticking out to high heaven. We call this a rib thrust. And rib thrusting is not where we want to hang out (it puts extra pressure on our low back for starters).

We want to draw our ribs down so that they also end up in the same plane as the 3 points of the pelvis.  At this point, your head may be facing more toward the ground than the wall/mirror/whatever is in front of you. If so, you’ve got some extra curve in your upper back (join the club!). But there’s hope for that too.

 

To improve this excess thoracic kyphosis (or that hump that makes you start wondering if you’re going to go the way of some of our older friends that your mother would point to when warning you to stand up straight!), we want to drop our chin and pull our head back over our shoulders.

The best way to think about this (in my humble opinion) is to imagine someone pulling your hair straight back from the crown of your head. You should feel the muscles in front of your neck and the middle of the upper back working, as well as the muscles in the back of the neck stretching (fun side note, this is also great for tension headaches). Your chin should be parallel to the world in front of you, pointing straight down to the ground, not tilting toward your chest or up toward the ceiling.

Ahhh, enjoy these new bodily sensations…even if you’re sweating 😀

Uhm, It’s Not Working…

But let’s say that you’ve tried Kegel’s, have worked on correcting alignment and breathing patterns, strengthened your deep muscular stabilizers (psst – if you’d like to learn more about these, what I call The Body Basics, head on over here to get the short e-book I wrote on it, and you’ve seen a pelvic floor physical therapist, but you’re still dealing with prolapse. What then?

Sometimes, while we work on improving prolapse, we still need some support. For example, let’s say that you’d like to do some heavy weight lifting or some jumping or running, but your pelvic floor is not ready. These activities can put a heck of a lot of pressure through the pelvic floor (particularly if you haven’t worked on breathing and alignment – see above).

While continuing to work on the above-listed changes, there are some options to help. The most invasive is surgery for POP, but for many women, surgery is unnecessary (and prolapse can return if all the other factors aren’t addressed). Option number 2: we can use a pessary.

Pessaries

Pessaries insert into the vagina and allow the pelvic organs to maintain their proper place somewhat. These babies come in a lot of different types and support levels (kind of like a bra, but without all the cute patterns or lace). And some are more easily inserted and removed than others.

Finding a pessary that fits is a trial and error process and it may take some time to find the best one for you. Talking to a pelvic floor physio or more likely your OBGYN can set you on the right track. To give you a taste of the multitude of available options, check out this pic from the journal for the American Family Physician (and if you want to read a more in-depth, albeit older article on pessaries, look here)

Pelvic organ prolapse is certainly multifactorial and the best approach is multi-pronged. Pelvic floor strengthening, breathing, and alignment and can help restore and prevent POP, but it takes time. So keep up the good work sister!

Which of these exercises is the most challenging for you?

 

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