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Prolapse Page

First, a rant… Prolapse care for women and the narratives around it, quite frankly, frustrate me. I got into this work after significant damage from a birth, and I was given so many scary stories about the future of my pelvis. Women are told to stop strengthening their abs, stop their fitness programs, not given excellent evaluations that really tell them what happened and how to care for their pelvis in particular (not the same kegels for all), and then so many women stop exercising and limit their activity out of fear of further damage or leakage. I’m saying enough! ENOUGH!!! Yes, that’s me lifting a heck of a lot of weight, and I want you to feel that fearless doing the bada** activities you love also!!!!! You can bet I strengthen my abs!

Ok, but back to education….let’s understand prolapse…

Pelvic organ prolapse is common in women who have had vaginal births or patients who have had chronic constipation. No, that doesn’t mean you are destined for a life of sitting around.

True vaginal vault prolapse is a shortening of the vagina, and uterine prolapse is the uterus moving downward, towards the vaginal opening.

In addition, there can be conditions where another organ starts intruding into the vaginal canal. A cystocele is the bladder sagging backward and down into the vaginal space. A rectocele is the rectum pressing forward into the vaginal space. An enterocele is the small intestine moving downward into the vaginal space.

Patients describe this condition as feeling like something is, “falling out”. Other patients report a low back heaviness or pressure that increases as the day goes on. Sometimes they can see a bulge coming out from the vaginal or anal canal. Sometimes birthing a big baby or some other birth trauma has changed positioning of organs, and the patient reports feeling something soft moving into the vaginal canal.

Part of conservative non-surgical management for includes pelvic therapy to support the involved organs and to restore normal mobility and function to related structures. We also educate on how to prevent future damage and treat whatever symptoms the prolapse is causing. 

It all starts with an incredibly detailed eval. 

  • Did you have muscle tearing?

  • What is your current fascial support? 

  • Do you have equal strength on both sides? 

  • Are you weak by the bladder but overcompensating by the rectum (creating eventual constipation issues), what can we expect from your muscles? 

  • How can we strengthen the muscles that are not strong enough to contract? 

  • What position is best for you? 

  • How deep did you tear? 

  • What is the integrity of the perineum and anal sphincter?? 

From there we make a plan. We do manual therapy on the scarring and organ positioning (visceral manipulation), we apply external support or strengthening assistance in graded progression, until we have you living your fullest life, without symptoms, once again.

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