Pelvic organ prolapse Q&A with Janette O'Toole

As a trainer who works with new and expecting mums, I get a lot of questions about Pelvic Floor and its function (or dysfunction!)...
"what is it?" "How do I activate it?" "I think something is going on down there, how do I know if it's normal?" "I wee went I cough, is that ok?" 

So to leave no stone unturned, I interviewed the amazing Women's Health Physiotherapist, Janette O'Toole from Better Health Physiotherapy on Pelvic Organ Prolapse, one type of Pelvic Floor Dysfunction which can occur. I hope this Q&A helps all you mummas out there who have questions but might be a little hesitant to ask. So here it goes...

​What are the most common types of pelvic floor dysfunction that you help women with at Better Health Physio?
I see women of all ages with a large array of pelvic floor issues. These include

• Leaking with coughing, sneezing or during exercise
• Rushing to toilet (urinary urgency) 
• Needing to go to toilet many times a day (frequency)
• Difficulty emptying the bowels or straining
• Poor wind control and/ or urgency with bowel movements
• Prolapse
• Reduced sensation during sexual intercourse
• Trapping of wind in the vagina
• Difficulty using tampons
• Pain with gynaecological procedures or sexual intercourse
• Hip and back pain
• Chronic pelvic pain- for example endometriosis
• Vaginal/ vulvar pain

 
What are the symptoms of Pelvic Organ Prolapse?
Women with pelvic organ prolapse usually describe a feeling of a ‘bulge’ or something sitting inside the vagina. They may also describe a feeling something has ‘dropped’ or an awareness of a lump inside the vagina.
It is not normally painful, just a feeling of discomfort or awareness of something not feeling quite right.
This may be a constant feeling or may come and go, particularly at the end of the day, when they are tired or if they have been on their feet all day.
Some women may also report some bladder symptoms (such as urgency, frequency or a change in urine flow) or bowel symptoms (such as difficulty emptying the bowel).
Some women will have no symptoms at all.
 
How is a Pelvic Organ Prolapse diagnosed?
A prolapse is diagnosed with a vaginal examination. 
A pelvic floor physio will usually use a single clean gloved finger and ask the person to cough or strain so that they can feel for any descent or laxity in the vaginal tissues. This can be done in lying and sometimes in standing (when the prolapse is usually more evident).
A gynaecologist will usually use a speculum to do this.
 
How can Women’s Health Physiotherapists like yourself help treat Pelvic Organ Prolapse?
An initial physiotherapy appointment is usually 1 hour and will include:

• A comprehensive assessment including questions on general health, bladder and bowel health as well as obstetric and gynaecology history.
• Screening for any risk factors for pelvic floor dysfunction
• Provide a vaginal examination to assess pelvic floor including prolapse
• Pelvic floor muscle exercises- specific guidance and progression
• Manage any avoidable factors such as constipation and straining
• Bladder, bowel advice to reduce symptoms
• Graduated exercise program to help the person achieve their fitness goals.

In your opinion, are there any exercises that a new mum with POP should avoid?
Regardless of if you have had a vaginal or caesarian delivery, ALL mums have some degree of pelvic floor (and abdominal) weakness. Therefore all exercises need to be introduced gradually.
Try to avoid:

• any exercise which causes symptoms as this is a sign of pelvic floor weakness. This includes symptoms of leakage, abdominal bulging or vaginal pressure.
• Sit ups, planking and heavy lifting as these all place increased load on the pelvic floor, therefore it is best to avoid these at first.
• Running should be avoided for at least 3 months. It is best to have a pelvic floor check at this time, prior to starting this.

With pelvic floor strengthening, these exercises can be safely and gradually introduced.

​Thanks Janette, you are a wealth of information!!
For more information about the services Janette provides and to book in with her, click here 

For additional Pelvic Floor resources and information, visit Pelvic Floor First here