By Bryn Zolty, PT
Pelvic organ prolapse is experienced by many women as heaviness in the vagina. For some women this experience is painful, dull, aching. For others it feels as if there is something in the vagina or sliding out. This can occur when a woman has pelvic floor muscle injury and in the presence of increased tissue mobility such as hypermobility disorders. It is commonly seen after a vaginal delivery.
Different images of two different pessary shapes used with permission from Pelvic Guru®, LLC | www.pelvicglobal.com
Although these conditions all sound like weakness and lengthened muscles, as clinicians we often see an increase in pelvic muscle tension and activity. What appears to happen is when a woman stands up, the feeling of heaviness and falling out increases, and either knowingly or unknowingly, she increases the pelvic floor muscle that tries to hold the organs in. This can be seen on biofeedback as pelvic muscle overactivity.
A pessary is a device fitted for a woman that helps reduce the symptoms of heaviness by insertion into the vagina and providing support that your body is not able to provide. New research suggests it may also improve muscle function. One hypothesis is that the muscle will stop contracting all day in attempts to decrease the symptoms of the pelvic organ prolapse. This hypothesis states that the muscles, specifically the puborectalis, will now assume a more normal resting position/tension and therefore allow for better muscle function.
If you are experiencing symptoms of pelvic organ prolapse and other pelvic muscle dysfunctions, talk to your providers about the use of pessaries to not only improve the symptoms of the heaviness, but improve the way the muscles work. These muscles have important functions for urination, defecation, continence, movement, core strength, and sexual function.
Every pregnant woman has an abdominal diastasis, or diastasis recti, at the end of their pregnancy. It's a massive stretch on the abdominal wall that makes the connective tissue at the center very thin. Some heal in the first six weeks postpartum, but many need more time. We're here to help women that need help strengthening their belly after baby.
Watch Bryn Zolty, PT demonstrate the criss-cross method with kinesiotape to support the diastasis and help activate your abdominal muscles correctly.
By Bryn Zolty, PT
Planks are one of the most well-known core exercises. Doing a plank incorporates many muscles to make us strong and support our joints. Typically an individual starting off with planks would try a modified plank and build up to a full plank. A modified plank means less difficulty when you are starting out so you can maintain a nice neutral spine, avoid holding your breath, and build strength. Two common modifications would be starting on your knees or placing your elbows on a higher surface than your feet as seen below in the Common Progression. After this position becomes easier, you can hold longer or perform more repetitions. Next you could try a full plank. Planks can continue to be progressed to have your feet above your elbows, your elbows on exercise balls, use exercise bands and more.
Now let's add prolapse to the situation. Pelvic organ prolapse can feel like heaviness in the vagina and even progress to the organs (bladder, uterus, vagina, rectum) coming out of the body. These symptoms increase with gravity. The more upright you are, the more symptoms you may have. So with a prolapse, we may consider reversing the progression. We may start with your body inverted - check out the picture with the feet on a chair and elbows on the ground in step 1 of the Prolapse Progression. We also encourage you to monitor your breathing. Holding your breath can increase symptoms. Consider what happens when you breathe in and fill your system with air, and then hold your breath and strain in a position. This can push these organs down. In addition, you could consider adding a kegel, or pelvic floor squeeze, to help support the organs. Your progression might look like the reverse of the Common Progression! As you gain better control of the pelvic muscles and breathing, you may be able to progress to being more upright with less symptoms. Good Luck! Contact us if you need help modifying your exercises, breathing, or help with pelvic muscle strengthening so you can exercise with confidence.
Written by Michelle Dela Rosa, PT
It takes time to strengthen pelvic muscles, but our therapists often see muscle training instrumental in avoiding corrective surgery and in other cases, helpful in preparing for surgery. If you've been diagnosed with prolapse, speak to your doctor about physical therapy for pelvic muscle training. If you've had therapy in the past, we're here for you too for "refresher" sessions or ways to improve your current program.
Patient: 66-year- old female with mesh repair of rectal and bladder prolapse 10 years ago.
Chief Complaint: “Knife-like” pelvic pain 10/10 with physical activity the following year, pelvic pain with urinary urgency, 6 voids at night.
Past Medical History: Diagnosis of interstitial cystitis 2 years ago, lumbar arthritis, thyroid condition.
Physical Therapy Treatment: Education on lifestyle modification for prolapse; breathing exercises; bladder retraining; manual release to pelvic floor and restricted internal scars; stretches for pelvis, hips, and low back; gentle core strengthening exercises.
Results: Pelvic pain 1/10 with physical activity, 0 discomfort with 2-hour drive, and 3 voids at night in 17 visits!