I recently received this question in my DMs, and it’s one I get often, so I thought it might be helpful to share it with you as well!
“I was told I had prolapse by my OBGYN at my annual appointment. Is there any way to fix this beyond surgery?”
The short answer is absolutely yes. It’s possible to “fix” most prolapses without surgery, but I want to explain it a little further so you have a better idea of WHAT prolapse is and how physical therapy can help.
Prolapse occurs when we have a weakening along the vaginal wall, causing an organ (most commonly, the bladder, rectum, or uterus, respectively) to bulge down/into the vagina. Externally upon vaginal examination, the prolapse can be graded from 1-4, one being the least and 4 being the worst (basically a bulge that is coming out of the vaginal opening at rest). Severe prolapses are most likely surgical situations, but Grades 1-3 (which is most common) are treatable with pelvic floor physical therapy, and research has also shown pelvic PT to be the very best treatment option for mild to moderate prolapse.
What a lot of women don’t know is that prolapse grade doesn’t necessarily correlate with symptoms. Symptoms of prolapse include (but are not limited to) vaginal heaviness, pressure, low back or pelvic pain, leaking, difficulties with peeing or pooping, and pain or feeling a “blockage” with penetrative intercourse. Symptoms often worsen as the day goes on or with increased activity like walking, exercising, or being on your feet for long periods. Some women may have a Grade 2-3 prolapse and have NO symptoms, while others can have a Grade 1 prolapse and have significant symptoms.
The goal of pelvic floor physical therapy is to strengthen the pelvic floor to provide better support to the pelvic bowl and vaginal wall, decrease symptoms of prolapse, and work through various exercises and techniques that can be helpful to prevent worsening of prolapse in the future.
Symptomatic improvement does not always correlate with visual improvement, meaning you can improve symptoms without necessarily seeing a difference in prolapse grade. Grade is also pretty subjective, meaning you can have 2 different providers look at it and give different grades depending on how they assess it.
My biggest concern when a provider diagnoses prolapse is that often, surgery is the first (and only) treatment option, regardless of grade and even if patients have not had ANY symptoms! Considering research shows pelvic floor PT to be the very best treatment option for Grades 1-3 (which are most common), surgery should be the very last treatment option after conservative measures have failed.
The good news is that almost ALL the patients I’ve seen with Grade 1-3 prolapse have had great success with pelvic floor PT! It can take some time, and yes, you will have to do some level of maintenance afterward, but this is a FAR better option than surgery. Surgery is invasive, has trauma to the body, requires at least a 6-week recovery period, and, unfortunately, has a high failure rate and high need for recurrent surgeries in the future. Sometimes, it is necessary, but it’s utilized far too often b/c women aren’t aware they have other options.
If YOU are wondering if you have prolapse (most women who have had at least 2 babies have some degree of prolapse) or would like to consider pelvic floor PT, here are some options for you:
- You can work with me one-on-one, in person, or virtually, and we can create an individualized plan for you! Most of my patients average 3-4 visits for prolapse.
- You can take Pelvic Core, my 4-week online course that addresses prolapse and will help strengthen your pelvic floor and inner core. I have had numerous patients take my course for prolapse and see success! You’ll join a small, exclusive coaching group where you’ll get 1-1 help from me to reach your goals.
I’d LOVE to help you and offer you HOPE! You don’t have to settle for issues, AND most likely, you don’t have to put up with surgery! If you’d like a first step, learn more about your pelvic floor and inner core with my free E-guide! And if you’re ready to start healing, please reach out! I’d love to help you determine what treatment option is best for you.