04 Jul 2023

Pelvic Prolapse: How to prevent and manage a prolapse during menopause

*Disclosure: Some of the links in this post are affiliate links (marked with an *). This means that, at zero cost to you, we will earn an affiliate commission if you click through the link and finalise a purchase.

Does your pelvic floor get the attention it deserves? 

We care for the skin on our face, and yet we often neglect a part of the body that deserves equal, if not more, care. 

Many of the issues caused by poor pelvic floor health are not only treatable but preventable, and yet still aren’t openly discussed, causing many women to suffer unnecessarily.

Katie welcomed author and pelvic floor specialist Kim Vopni to the podcast to talk us through probably one of the most uncomfortable and awkward conditions that can affect a woman, pelvic organ prolapse. 

Kim explains exactly what a pelvic prolapse is, the most common causes and how commonly they occur. She also gives advice on treatment options, including how to do pelvic floor exercises effectively and also when surgery might be the best option. 

Listen to the full conversation in The Latte Lounge podcast episode above.

Some of the key information from this episode:

What is a pelvic prolapse?

Statistically, incontinence occurs in 30 - 40% of women and pads are widely marketed, but pelvic prolapse affects 50%. It's more common, and yet there is no conversation around it, leaving women sidelined when they get this diagnosis. 

We are dynamic beings, so there is movement inside our pelvis. When the bladder, the uterus, and or the rectum start to shift out of their proper anatomical position, they start to bulge into the front wall or the back wall or, in the case of the uterus, descend into the vagina. That's essentially what a prolapse is.

RELATED: Is it too late to fix your pelvic floor?

What causes a pelvic prolapse?

There are lots of things that can contribute to the development of prolapse, and pregnancy and childbirth are definitely known contributors, as are chronic coughing and constipation. There are lots of different contributing factors, and it can sometimes take many years. 

During perimenopause and menopause, when we have a decline in oestrogen, the tissues in the vagina, around the urethra and around the bladder become thinner and drier. There's less resilience that can contribute to less support, and this can exacerbate an already existing prolapse or cause it to develop for the first time.

Hormonal changes can also influence our digestion, contributing to constipation, which can, as mentioned, can be another exacerbating factor.

RELATED: Pelvic Health - it's no laughing matter (or is it?)

Can we prevent or improve prolapse?

We absolutely can. We should be taught preventive strategies throughout our life. That's not yet happening, but we have the power to start today and pay attention to our pelvic health like we pay attention to the skin on our faces.

We invest in therapies and serums. We wash our faces. We put makeup on. We care for the skin on our face, and we need to show the same care for the part of our body that manages our continence, supports our organs and plays a role in our sexual response.

It’s also the foundation of our core. It supports our spine and pelvis. So we can step in with pelvic floor physical therapy. Kim would recommend that we see someone every single year, just like we go to the dentist, because early-stage pelvic prolapse can be asymptomatic. When it becomes a little bit more advanced, the symptoms can really be quite bothersome.

When symptoms interrupt our quality of life, we start to seek help, and it's never too late. But often, we're then prescribed medication or sent down the surgical path, which are great options to have, but they shouldn't be our first line of defence.

Pelvic floor exercise for ten minutes a day helps to keep our pelvic floor strong, and we should use vaginal oestrogen in the early postpartum and also as we're approaching menopause transition.

RELATED: How to strengthen your pelvic floor during the menopause

pelvic prolapse

What does a pelvic prolapse feel like?

There could be back pain, a sense of heaviness and dryness in the pelvis, especially as the day goes on, feeling like you have something stuck in your vagina. Maybe difficulty with insertive sex, in that the bulges might be uncomfortable.

There may be difficulty emptying the bladder; where that bladder bulges in, there's a little bit of a pocket where urine can get trapped, and in the same way with the backside, voiding can be harder. There may be difficulty inserting a tampon, or tampons can get pushed out.

Which treatments and lifestyle interventions can help improve prolapse?

If you have the capacity financially to see a pelvic floor physical therapist, that would be ideal. 

If you can see a physical therapist or a women's health physio to have your pelvic floor evaluated, they use gloved fingers to assess your pelvic floor.

That's the gold standard, but if that's not available to you, you have your own fingers or your partners, or if you happen to have a male partner, they could use their penis. Something inserted inside the vagina that gives you some feedback.

Avoid constipation. Work on improving your gut health and whatever you need to do to make sure you're pooping without straining every single day.

Kegels are a bit of an elusive exercise. They involve a voluntary contract and lift and let go of the pelvic floor muscle. What people interpret as being a kegel is a squeeze. And so they often use their inner thighs, their butt cheeks or their glutes and even hold their breath and bear down, which is the opposite of what we're trying to do. 

Pessaries are like an orthotic for your vagina. There are different shapes and sizes and are inserted so they open up inside and apply pressure and support to the walls of the vagina and any organs that are starting to shift out of their position.

Evidence absolutely supports the use of vaginal oestrogen. It's very safe, and this is inserted into the vagina, stays locally and affects the tissues there.

Being overweight affects all of the muscles in our body, but the pelvic floor, especially because it's so central and it is a bit like a supportive hammock that manages all of the load, which increases if we are putting more body mass on our body. 

Many smokers will have a cough, and coughing is a big contributor to pelvic floor dysfunction.

It’s about staying at an optimal weight, stopping smoking, and looking at inflammatory products we put on our bodies or consume. It's a much bigger conversation than simply doing some kegels. 

RELATED: Different ways to get fit in midlife

Want some extra help?

We recommend these pelvic floor trainers to help you strengthen your pelvic floor muscles.

(*Disclosure: These links are affiliate links. This means that, at zero cost to you, we will earn an affiliate commission if you click through the link and finalise a purchase.)

Elvie - App Controlled Women's Pelvic Floor Trainer

Elvie - App Controlled Women's Pelvic Floor Trainer

  • Connect the Perifit probe to the app by Bluetooth, and watch your pelvic floor contractions in real time. Bid goodbye boring and complicated exercises, and get quick results thanks to the app's fun exercises.
  • Perifit's 5D analysis diagram (strenght, endurance, contraction quality, relaxation, agility) allows you to focus on your own areas to improve. The app proposed 6 training programs to address your very own issues and symptoms.
  • Designed in partnership with physiotherapists and pelvic floor specialists. Now, many health professionals worldwide recommend Perifit to their patients for pelvic reinforcement.
  • As a multi-award-winning Kegel trainer, Elvie Trainer is recommended by hundreds of healthcare professionals, from physiotherapists and gynecologists to personal trainers. We’re also proud to work in partnership with the NHS.
  • Perifit - Pelvic Floor Exerciser with App

    Perifit - Pelvic Floor Exerciser with App

  • Connect the Perifit probe to the app by Bluetooth, and watch your pelvic floor contractions in real time. Bid goodbye boring and complicated exercises, and get quick results thanks to the app's fun exercises.
  • Perifit's 5D analysis diagram (strenght, endurance, contraction quality, relaxation, agility) allows you to focus on your own areas to improve. The app proposed 6 training programs to address your very own issues and symptoms.
  • Designed in partnership with physiotherapists and pelvic floor specialists. Now, many health professionals worldwide recommend Perifit to their patients for pelvic reinforcement.
  • Bodyotics Deluxe Kegel Weighted Exercise Trainers – Set of 6 for Beginners to Advanced with E-Book

    Bodyotics Deluxe Kegel Weighted Exercise Trainers – Set of 6 for Beginners to Advanced with E-Book

  • Connect the Perifit probe to the app by Bluetooth, and watch your pelvic floor contractions in real time. Bid goodbye boring and complicated exercises, and get quick results thanks to the app's fun exercises.
  • Perifit's 5D analysis diagram (strenght, endurance, contraction quality, relaxation, agility) allows you to focus on your own areas to improve. The app proposed 6 training programs to address your very own issues and symptoms.
  • pelvic prolapse model

    When does surgery become the only option?

    There isn't really a perfect time to have surgery. Surgery is not mandatory, people live with stage three and four prolapses with pessaries, estrogen and exercise, and that is absolutely possible. Kim was able to reverse her stage two uterine prolapse, having lived with and worked at it for nine years.

    If the symptoms are interfering with your life to such a degree that your quality of life has declined, and you have tried all of the conservative approaches without success, then that is absolutely a time when you could be considering surgery.

    Pelvic organ prolapse is like an ACL tear or like a rotator cuff like it's an injury, and there are things we can do to support it if you don't want to have surgery but having it is not an indication of failure or that you're giving up, it really, truly can be transformative.

    The conservative approaches to helping improve or manage prolapse become your prehab. So if you have tried all of those things and they get to the point where nothing is really changing, all of those things have helped put your body and your pelvic floor in a better position to undergo surgery. And all of those things are going to be part of your recovery and ongoing pelvic health. 

    Some people think that once they have surgery, the symptoms will be gone, and it won't bother them anymore. Arguably, we need pelvic floor exercise even more after surgery. 

    We have to appreciate that there were contributing factors that led to the development of that prolapse so you need to make sure that you continue to maintain resilience in those muscles now.

    As a side note for those who have had a hysterectomy or are considering a hysterectomy, the uterus and cervix play a role in helping keep the top of the vagina up in place and when it's removed, especially if it's because of prolapse, it can leave us at an increased risk of other types of prolapse. 

    We couldn't have a uterine prolapse anymore because the uterus is gone, but we are at a greater risk of a bladder prolapse or a recusal, or what's called a vaginal vault prolapse, where the top of the vagina starts to almost cave in on itself turn itself inside out.

    That's an important consideration, and you want to ask your surgeon how they will resecure the top of the vagina. 

    Kim has written a brilliant book: Your Pelvic Floor: A Practical Guide to Solving Your Most Intimate Problems*

    (*Disclosure: This link is an affiliate link (marked with an *). This means that, at zero cost to you, we will earn an affiliate commission if you click through the link and finalise a purchase.)

    Watch the video version of the podcast.

    Discover more: Listen to more of The Latte Lounge podcast episodes - and don't forget to subscribe / follow to be notified of future episodes!

    pelvic floor
    Health | Menopause

    How to strengthen your pelvic floor during the menopause

    Ageing and fluctuating hormones during menopause can have a significant impact on our pelvic health. Katie speaks to continence nurse specialist and author Jane Simpson, about the common problems we might experience with our pelvic floors, including weak bladders, that feeling of always needing to go to the loo as well as tightness and tension in our pelvis.

    Here, Jane shares a whole host of tips and guidance on how you can ease your symptoms.

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