Understanding Pelvic Organ Prolapse: An In-Depth Look - Episode 24

In this podcast episode, Dr. Kari Roberts explains the condition of pelvic organ prolapse (POP), a health issue that affects women's pelvic organs, including the vagina, bladder, uterus, and rectum. She discusses various cause factors like age, connective tissue weakness, obesity, and hormone changes that result in these organs shifting from their original positions. In this podcast episode, Dr. Kari Roberts explains the condition of pelvic organ prolapse (POP), a health issue that affects women's pelvic organs, including the vagina, bladder, uterus, and rectum. She discusses various cause factors like age, connective tissue weakness, obesity, and hormone changes that result in these organs shifting from their original positions. Dr. Roberts highlights the possible physical symptoms women could experience, such as discomfort, bowel changes, or urinary issues, and the treatment options readily available.

Book a call with Dr. Kari Roberts today.

• Episode Transcript

  Dr. Kari: Have you ever wondered what pelvic organ prolapse is? If you have, then stay tuned because I'm going to get into that right now.

  Welcome to the Marrone Pelvic Health Podcast. Hi, I'm your host, Dr. Carrie Roberts. On this show, we will be discussing a variety of things regarding your pelvic health. These conversations will be a mix of education, personal experiences, and a blend of tips you can apply to have a healthier pelvis.

  The goal of the show is to normalize conversations around pelvic health and help women stop suffering in silence.

  So we're getting into pelvic organ prolapse today. What is it? Have you heard of it? Pelvic organ prolapse, AKA prolapse, AKA pop. It's all the same thing. But what exactly is it?

  To understand what pelvic organ prolapse is, you first have to understand the anatomy of a woman. If you are looking at someone, if you cut them in half left and right and looked at them straight from the side, you would see the bladder in the front, you would see the vagina in the middle, and then you would see the rectum in the back in the pelvic region.

  And so with pelvic organ prolapse, it means that one of those organs, the vagina, the bladder, the uterus, or the rectum, could have shifted into a space that it's not supposed to be in.

  That could be due to a variety of things. That could be due to weakness. That could be due to an injury that is. There's also a correlation with age. There is a correlation with connective tissue.

  If it runs in your family, there is a.

  A correlation with your weight, your. If you're obese or not. And also, of course, as a woman, hormone changes, because it seems like everything can be related to hormone changes when you're a woman.

  So those are the. Some of the things that it causes. And I. Sorry. So those are some of the things that can cause pelvic organ prolapse. But like I said, there are four different structures that can prolapse, three different organs that could prolapse, and each one of those has a different name.

  So. So if the bladder shifts.

  Let me back up. So we've got the vaginal canal or the vagina in the center. The vagina is flexible, it can stretch. Things can go inside of it, things can go out of it.

  And so it's a real pliable part of the body, but it does have structure.

  And so when you have the bladder and it starts to cave into that front wall of the vagina, I.e. bladder prolapse, or cystocele. Cyst is a medical term for bladder.

  If you have the rectum on the backside, and if it starts to bulge forward and make kind of an extra pocket and leans into the back end of the vaginal wall, then that is called a rectal prolapse or a rectocele.

  If you have the uterus at the top of the vagina and it starts to hang low, then that is called uterine prolapse. If you no longer have a uterus and you've had a hysterectomy and the whole structure of the vagina kind of collapses on itself, then that's called a vaginal vault prolapse.

  So basically, prolapse really involves when there are different structures and pressures that move onto the vaginal wall, be it the front side from the bladder, the back wall from the rectum, the top from the uterus, or the vault, where it just kind of collapses on itself.

  So there are a variety of symptoms that can come with pelvic organ prolapse.

  The primary one is pressure. If women feel pressure down there, then that's kind of an indicator. There might be something displaced. There might be something where it's not supposed to be.

  Other things are related to the organs that are impacted. So if it's a bladder prolapse or a cystocele, then there might be changes. Actually, I shouldn't even say that because those structures are all in the pelvic bowl together and the pelvic floor, or, sorry, the pelvic bowl is so tight and so small, you could have a rectocele that gives you urinary symptoms.

  You could have a cystocele that gives you rectal symptoms. So I shouldn't say that if, depending on the organ, it's not necessarily the case. It could be, but not always.

  So you can have changes with your bowel habits. You could feel a bulge, you could feel straining, you could feel that your bowels are not completely emptying. Some women even say they feel like they have to kind of split the bowels or put pressure inside the vagina and put pressure on that back wall so that the body can evacuate that fecal matter.

  Other women might have urinary changes. Urgency, frequency, going to the bathroom multiple times, not being able to hold it like they used to.

  Generalize, Discomfort down there, pain with intercourse, discomfort with sex. That can also play a part. And if you see it, some women will actually look down and see something hanging.

  And that is a sign of prolapse.

  Now, it is a lot. It has a lot to do with tissue elasticity. So things are a little bit more flexible than what we would like. And so now let's talk about treatments.

  What can you do to reduce or fix a prolapse? There are four different degrees of prolapse, depending on how far into that vaginal canal that prolapse is moving. If it's just a little bit, it might be a 1, and it goes all the way up to a 4, which is where the organ is really pronounced.

  And you can see it on the outside. You can see it coming out of the vagina.

  Generally speaking, as a rule, physical therapy cannot. Pelvic physical therapy cannot really help you cure if you have stage four. Stage four is usually when you're talking about having surgery to repair that.

  Now, if it's stage one, two, or three, then pelvic physical therapy is actually a great option. And something else that's pretty interesting about pelvic organ prolapse, the degree, whether it's 1, 2, or 3 does not have any correlation to your symptoms.

  So someone could have a grade four or grade three and barely even notice it, where someone else can have a stage a grade one and have a laundry list of symptoms that she's dealing with.

  So there are times when women will come into the clinic and they want to know how bad is it? Because they're thinking the worse it is, the worse that they are going to feel or the harder it is for improvement to come, and it's just not the case.

  It's just not the case at all. I've had patients that have had grade four and are able to manage it virtually with no symptoms. Where I've had patients with grade one or grade two, and we've done all kinds of conservative things, and it just wasn't enough and they had to go back to the doctor for more advanced treatment.

  Now, speaking of treatment, what can you do in pelvic physical therapy? We're specialists with bones and joints and connective tissue and tendons and all of that good stuff. You could definitely find a pelvic physical therapist and do pelvic physical therapy.

  Let him or her do a full assessment on you, create a personalized plan and get those structures on board and see can the body respond to that and resolve that prolapse.

  The other option is it's kind of the intermediary. It's a little more advanced than pelvic pt, but it's still not invasive. And that is when you have A pessary. A pessary is an external device that you put inside of the vagina, the vaginal canal, and that device gives your vaginal canal structure.

  They have over the counter pesteries. Poise came out with an over the counter one about a year ago, and the name escapes me right now.

  But they're out there. And then you can also get more permanent reusable pessaries. And those come in a variety of shapes and sizes. Some are large, some are small, some are long, some are short, some are a little more flexible, some are a little bit more firm.

  Some are designed to go in there and stay in there for hours. Others are designed to go in there and stay in there for days. It all just kind of depends on what is.

  What fits your anatomy, what fits your symptoms? Is it the anterior wall from the bladder that's caving in? Is it the posterior wall from the rectum that's caving in? Is it the top from a vault prolapse or uterine prolapse?

  All of those things play a part into getting you the right device for a pessary.

  A lot of women do very well with a pessary. When you've got that structure back around the vaginal wall, that can help resolve that constipation and that fecal pocketing that happen in the rectum, that can help take that kink out of the uterus or, excuse me, out of the urethra and help your bladder be more supported.

  So then that way you don't have to have as much leakage and frequency as much to void. It can also help with that pressure that you're feeling if things are kind of hanging down.

  So a pessary is a really great option. Now, if pelvic physical therapy doesn't work, if pessary doesn't work, or you just already know out of the gate, got a grade four, then that's when surgery is indicated.

  And obviously, surgery is a lot more invasive, it's a lot more advanced, and anything that shifted or out of place is mechanically fixed with surgery. But as a pelvic physical therapist, I do recommend, yes, you've had surgery, so that particular structure has been recovered.

  But what about all of those other structures? Remember, the pelvic bowl is not that large. It's a very small space. So if something is out of whack with the vaginal wall, nine times out of 10, the connective tissue and the muscles around it might also be out of wh.

  So I've said this ever since I graduated physical therapy. School. I think every single person that undergoes their surgery in any capacity could benefit from at least a consultation with a physical therapist because there are so many things with regard to your movement that we're thinking about that the average person doesn't think about.

  And so I would say that as well with the if you did have to have surgery, that doesn't mean you don't need pelvic physical therapy. Yeah, pelvic physical therapy may not resolve or cure the pelvic organ prolapse, but it can definitely help you to maintain, not to maintain, to develop other strategies for the success of that surgery and also to make sure that those other structures are doing what they're supposed to.

  Just as a review, pelvic organ prolapse is when one of those pelvic organs has shifted into the vaginal wall and is causing pressure or discomfort when it's not supposed to be.

  And some of the treatments most conservative treatment is pelvic physical therapy. The nexus is an external device with a pessary which could be a one time use or multiple use.

  And then the third more advanced type of treatment is having surgical repair.

  Thank you so much for listening to this episode. If you're on YouTube, thank you so much for watching and I will be back soon with another episode. Thanks.

  Thank you for listening to this episode of the Marrone Pelvic Health Podcast. Please do me a favor and leave a review so that more people can find this content and make sure you like and subscribe yourself so you never miss another episode.