If you’ve been diagnosed with pelvic organ prolapse or suspect you have it and are unsure about what to do, fear not – we are here to help! 

Some common statements I hear: 

“I stopped working out because I was scared to make things worse” 

“I feel insecure about having intercourse” 

“I don’t feel aware of what is ‘down there’” 

“I am really scared and confused” 

Dealing with prolapse can be intimidating, especially if you’re uncertain about how to treat or manage the diagnosis.  To learn more about what pelvic organ prolapse and treatment options for prolapse are, check out my other blog post on the ‘Low down on Pelvic Organ Prolapse” 

There is hope, and pelvic floor physical therapy can provide guidance for non-surgical prolapse management.  Today, you can read about my top strategies for living with prolapse! 

1) Pelvic Floor Exercises (a.k.a Kegels) 

It’s time to stop putting these off and get to work!  The pelvic floor muscles serve as a support system for your pelvic organs (bladder, uterus and rectum).  If they are weaker, the organs may shift to the path of least resistance - the vaginal opening. Work with a physical therapist to ensure you are performing kegels correctly.  For visual feedback, consider using the Perifit.  Most importantly, start incorporating pelvic floor exercises into your routine!. 

Disclaimer: if you experience pain while performing kegels, consult with a physical therapist, as kegels may not be suitable for you. 

2) Stop holding your breath to prevent progression of prolapse

While there is a time and place for holding one’s breath, generally, we aim to minimize the pressure exerted on the pelvic floor during breathing.  When we increase intra-abdominal pressure, directing it into the belly, and keep our mouths closed, that pressure has only one way to go - DOWN! 

Use the exhale technique with exercise when you are lifting your baby, car seat, dog food or during exercise.  Remember the mantra ‘Blow before you go’ (credit: Julie Wiebe, PT, DPT), this will assist in engaging your trunk and pelvic floor, preventing downward pressure of your pelvic organs. 

3) Non-Surgical Management of Prolapse with Position Changes

4) Stop the straining

One of the primary reasons for the advancement of prolapse is constipation, particularly straining during bowel movements.  Several factors influence the bowel system, including our diet, colon motility, anxiety levels, stool consistency and muscle function.  For individuals with prolapse, stools may become more challenging to empty.  

One trick to improve passing a bowel movement is splinting.  Splinting is an effective method to assist stools out during a bowel movement.  You apply pressure at the perineum area (the area between the vaginal opening and anus), insert a finger into the vaginal canal and push back towards the tailbone or use an external tool like the Femmeze®Vaginal Trainer for a rectocele.  The images below correspond to the examples mentioned above.  

Image used with permission from Pelvic Guru®, LLC www.pelvicglobal.com

5) Experience Relief with a Pessary

A pessary may sound intimidating, but when it works, it works!  It is a device placed inside the vaginal canal to provide support to the urethra, bladder, and/or uterus.  Pessaries can be used during everyday activities or exercise.  You can choose to be fitted for a pessary by a urogynecologist, OB/GYN, and in some areas, a physical therapist.  If you are unsure about using a pessary, you can start with over-the-counter options like Impressa®  and/or Revive®.

Feel free to comment or ask questions about any of the strategies above.  If you need additional pelvic health tips or tricks, reach out to a pelvic floor physical therapist. 

Dr. Susan Miller PT, DPT, is a licensed pelvic floor physical therapist and the owner of Lotus Core Physical Therapy in Colorado. She welcomes both in-person and telehealth appointments for Colorado residents, as well as coaching calls for clients residing out of state.  

Book at www.lotuscorept.com