Menopause Prolapse Symptoms: What are they and how to manage them.
Prolapse can be a terrifying word for many women and leads to so many questions. Can it be fixed, why did this happen, will I need surgery, and more.
While prolapse can happen earlier in life due to pregnancy, childbirth, or heavy weight lifting, a common time for it to rear it’s ugly head is during or after the menopause transition.
Things I cover in this blog:
What is prolapse?
Pelvic organ prolapse is when our internal organs are no longer supported by pelvic floor muscles, ligaments and connective tissues. This causes them to ‘slip’ down and become a bit of an intruder into the vagina. How rude!
There are different types of prolapse:
Cystocele
Where the bladder moves down and back and presses into the front vaginal wall
Rectocele
When the bowel slips down and forward and presses into the rear vaginal wall
Uterine
Where the uterus slips down through the cervix into the vaginal cavity
It is also possible for the urethra, anus or vaginal walls themselves to prolapse.
There are 4 grades of prolapse depending on how far down the organ has descended with Grade 4 being the most severe.
What are menopause prolapse symptoms?
Symptoms can be quite subtle, or in lower grades, non-existent. You may only learn you have a prolapse during an examination such as a cervical smear.
Symptoms can also come and go, depending on your activities. Certain movements, or even lack of movement, can make things worse.
Prolapse symptoms:
A bulging sensation in the vagina. Like there’s a tampon in there
A feeling of heaviness or dragging in the pelvic area
Being able to feel protruding tissue out of the vagina
Difficulty fully emptying the bladder- you may leak when you stand off the toilet, or need a second pee soon after the first
Have difficulty started the flow of urine started and have to strain to empty bladder or bowels
Difficulty fully emptying bowels. Inserting a finger into the vagina to support the rectum can assist with emptying.
Have pain or decreased sensation during sex
Have lower back pain
Why do women experience prolapse in the menopause transition and beyond?
This can partly be attributed to aging and partly to the shifting hormones in menopause.
As we age our collagen within our connective tissues becomes weaker and provides less support. Gravity then plays its part and our organs can begin moving.
However, our muscles, ligaments and fascia (all components of the pelvic floor) are also sensitive to hormone levels, including estrogen, progesterone and follicle stimulating hormone whose levels change during the menopause transition.
So, when our hormones are fluctuating during the menopause transition it can reduce the support provided by the pelvic floor to the internal organs.
Who is at risk or prolapse?
If we all go through menopause, why do some women get it and some don’t?
Prolapse is actually more common than you might think with up to 50% of women experiencing prolapse.
However, several factors can increase your risk.
Birthing (vaginally) large babies
Instrumental assisted delivery (forceps, suction)
Experiencing perineal tears or episiotomy
Experiencing a Levator ani avulsion during birth
Obesity
Chronic cough
Chronic constipation
Heavy strength training with inability to safely manage intra-abdominal pressure
Family history
Lifestyle (e.g. sitting a lot can weaken pelvic floor tissue)
Medical conditions
Hysterectomy (removing the uterus creates space for other organs to move into)
Hypermobility which is due to connective tissue laxity (you may not know you are hypermobile)
Can prolapse be prevented?
Yes! I believe at any age prolapse can (mostly) be prevented.
Things you can do to minimise your risk:
Improve your breathing patterns and rib mobility (to help manage intra-abdominal pressure)
Learn how to contract AND relax your pelvic floor muscles for optimal function
Strengthen your deep abdominals
Improve coordination of pelvic floor, abdominals and whole body mechanics
Strengthen the muscle groups that support the pelvis so your pelvic floor is not doing all the work (glutes, hamstrings, adductors, abdominals)
Optimise your posture so your muscles have the best chance at sharing the load to provide support. The position of your pelvis can also provide some bony support to your internal organs.
If you know you are at an increased risk, modify your strength training to reduce the amount of intra-abdominal pressure and force on the pelvic floor.
Can prolapse be fixed?
Maybe??? That depends on your definition of fixed.
Will tissues completely return to their ‘pre-injury’ state? Not likely.
However, lots can be done to improve symptoms and prevent it from getting worse.
One of the first steps is to see your doctor, OB/GYN or pelvic health physiotherapist if your circumstances allow. But I know, they can be EXPENSIVE.
Rehabilitation exercises are just the start however, as you need to progress from the corrective exercises to exercises incorporating strength training, coordination and connective tissue training. That’s where exercise physiologists- especially ones with a strong understanding of pelvic floor function (like me) come in.
How to manage menopause prolapse symptoms?
The best place to start is to reduce load on your pelvic floor. This doesn’t mean stop exercising.
If you have constipation, consider seeing a dietician or nutritionist to help you improve your bowel movements. Constipation is not always due to diet though and can be due to a tight back pelvic floor. Access my checklist here: Is your pelvic floor tight or weak or both
If your symptoms increase at the end of the day or after certain activities, spend some time elevating your pelvis to use gravity to help unload the pelvic floor and internal organs. To do this, lie on your back with your feet on a wall with a pillow under your hips.
Learn to perform a 360 degree breath and spend time working on developing a flexible rib cage that can absorb some of that pressure. Women often have narrow rib cages and as we age our posture becomes less optimal causing area of compression in our rib cages. Think of the effect of squeezing a tube of toothpaste at the top. All the pressure goes down.
Learn about your pelvic floor. Pelvic floor can be tight, weak, or both tight and weak. They are in fact commonly tight at the back and weak at the front. These imbalances can increase prolapse risk and symptoms. Access my pelvic floor checklist: How to know if your pelvic floor is weak, or tight, or both here.
See a pelvic floor physiotherapist or an exercise physiologist with a good understanding of pelvic floor function (like me). Kegels (pelvic floor strengthening exercises) are not always the answer and can sometimes make things worse.
A quick word about surgery. Surgery is sometimes unavoidable, however research has found that up to 40% of prolapse surgeries fail. This is a big percentage. So if you choose (or need) to have surgery it can be really beneficial to perform prehabilitation (pre-surgery exercise) and rehabilitation post surgery to improve your chances of success.
Conclusion
Pelvic organ prolapse does not have to be a terrifying diagnosis. There is much that can be done to improve or manage symptoms including improving daily habits, increasing overall strength and improving movement patterns.
Seeking help from an exercise physiologist with a special interest in pelvic floor health (like me) can be a great place to start. If you live in the Toowoomba, Queensland area, I offer in-person exercise physiology services at my clinic Ebb & Flow Exercise Physiology.
Where to next?
Read my blog posts:
Read more about my pelvic health Toowoomba services
Disclaimer:The information provided in this blog is intended for educational purposes only and is not a substitute for professional medical advice. Always consult with a qualified healthcare professional before starting any exercise or health program. By using this content, you agree that EBB & FLOW EXERCISE PHYSIOLOGY is not responsible for any injuries or health issues that may arise from your use of the exercises or advice provided.