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A Non-Surgical Approach For Prolapse

11/8/2012

19 Comments

 
Pelvic Health Physical Therapy can help pelvic organ prolapse
UNDER PRESSURE!!! Photo by Crystal Kwok
Recently I had the opportunity to work with a woman 7 weeks postpartum.  She had been experiencing heaviness and pressure in her vaginal area with walking, lifting, and prolonged standing.  At her 6 week check in with her midwife, the midwife said she had a mild prolapse.  Concerned about the discomfort and the inability to perform daily activities: lifting her 5 yr old and newborn, walking, standing...etc., and the potential further descent of her organs, she made an appointment with me.

My evaluation confirmed her midwife's diagnosis of prolapse: a mild rectocele and urethrocele .  
​
In our session we worked on making her aware of habits that increase downward pressures which can contribute to prolapse, with the ultimate goal of reducing or eliminating such patterns.
Picture
Poor alignment: anterior pelvic sway. Notice the hips in front of the ankles. The ribcage is lifted up and in front of the pelvis.
Treatment for Prolapse starts with good standing alignment
Improved alignment: pelvis is stacked over the ankles and the ribcage is stacked over the pelvis.

Habits that can affect the health of the pelvic floor

Standing alignment
My client stood as most of us do, with her pelvis out in front of her.  She also lifted her ribcage to bring her shoulders back.  Ideally we should stand with our pelvis stacked over our ankles and our ribcage stacked over our pelvis; think about our functional core connection here: diaphragm, transversus abdominis, pelvic floor and deep back muscles. (For an educational read, get the book, The Pelvic Girdle by Diane Lee.)  When the pelvis is out in front, we no longer have a neutral pelvis, which is important for the position of the pelvic organs (bladder, uterus) to have support of the pelvic ring below (notice in the pic above on the left, the bladder and uterus rest on the pubic bone).  This means more grativational load on the fascia and ligaments leading to tissue failure (and descent of the organs).  So my client learned how to stand.
Sucking in the stomach
Pulling in the gut to “look” slimmer freezes and shuts down the diaphragm, not to mention increases pressure in the cavities above and below.    Read more about sucking in here:  So my client learned how to breathe.

Tension in the pelvic floor
All muscles need to be able to contract and relax optimally.  When the pelvis is out in front, the muscles in the pelvic floor are held in a shortened position.  When there is increased pressure in the abdomen and pelvic cavities from sucking in, the pelvic floor muscles try to create balance by increasing contraction to maintain continence.  Chronic tension means decreased blood flow, decreased oxygen, decreased waste removal = potential for pain signals.  So, my client learned how to relax her pelvic floor.

Very shortly my client returned to the clinic with noticeable improvements:

Within a week she felt less heaviness and pressure in her vaginal area.  She felt pressure only with heavy lifting. She possessed the education to continue her home program from the initial visit and we added gluteal strengthening to her program.  

Two weeks later she returned to clinic reporting continued improvement.  She was able to walk and perform yard work without any discomfort!  She had a follow up visit with her midwife who reported upon exam significant reduction of prolapse!  She was given additional functional movement reeducation for her home program.  I will follow up with her in a month and more than likely discharge treatment.   

Moral of the story is this:  if you feel pressure or heaviness in your vaginal area postpartum (or at any time),  get it taken care of, go see a pelvic health physical therapist.  Or contact me for more information!


Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.
19 Comments
Tim Harris
11/8/2012 12:46:42 pm

Whole body alignment reduces site specific problems. Who'd a thunk it? You for one, Susan. Great job. I bet she is one happy client

Reply
Susan
11/18/2012 12:42:16 am

Tim,
Alignment has changed my life!

Reply
Katy Bowman link
11/15/2012 05:11:21 am

Ah, another success story. And, I like your use of "discharge" in this pelvic floor post. Ewwwwwwww.

Reply
susan
11/18/2012 12:45:46 am

Katy,
Thanks to your genious and Whole Body Alignment, when I work with clients I am able to address the cause and not just the symptoms!

Reply
Carmen
11/18/2012 06:02:03 am

I am six weeks post baby and have the exact same symptoms. I've just started to do these exercises and the symptoms have lessened. Does the prolapse actually reverse itself and move back up or do the symptoms just get better?

Reply
Carmen
11/18/2012 11:02:27 am

I am so excited to hear that! Yes, the exercises can actually reduce the prolapse because the downward pressures decrease, and the body is more aligned. Thank you for sharing! Susan

Reply
Carmen
11/18/2012 06:05:45 am

It's actually a mild prolapse of the cervix, I can see and feel it. Will these exercises help?

Reply
Jeannie link
3/2/2013 01:36:03 am

Can you tell me of anyone in Nebraska that understands this? I have PFD and SI joint dysfunction on both sides. I've tried so many drs and pts, to no avail!

Reply
Susan
3/17/2013 05:52:53 am

Jeannie,
Where are you in Nebraska? I can see if there is someone nearby.
Susan

Reply
Anne
4/22/2013 02:37:14 am

I'm not Jeannie, and I am not dealing with post-partum issues, but I am very eager for some alignment help in Nebraska (although Kansas City or Des Moines would work in a pinch). I'm in Lincoln, but Omaha is close--and I'm used to driving for things that matter. Any suggestions would be much appreciated. Also, it sounds like you can get people started on the right track in just a couple sessions--is this true? Thanks for your help!

Susan
4/22/2013 01:16:17 pm

Anne,
Are you needing pelvic health assistance as well as alignment help? I will put the word out and see who would be the best match for you. Susan

Reply
Angela Lowrey
6/9/2013 04:18:14 am

Great Post Susan! I am Egoscue Cert. PAS./ACE Health coach cert. and IYT yoga certified. I have just discovered Aligned and Well with Katy B. She has a passion and a gift of presenting the biomechanics in a way that we understand the connectiveness of it all!!!LOvely!! and I want to learn more!!AND I will at some point. I did order her complete set of DVD. I think they are a great compliment to my working knowledge and I am seeing good results with my clients in the Chiro office(I am the rehab room using Restorative exercises/egoscue/yoga.) I will be out for 4- 6 weeks because I just went to my annual pelvic exam(had been feeling bloated all the time). I have tennis/golfball size fibroids in my enlarged tilted(for many years DR.s have said tilted)uterus. I am 46 and I am scheduled for a Lap.hysterectomy on the 25TH of June!:(. I am fit and functional. I know how to squat!! I understand the importance of activating the transvers abd. to not allow pelvic pressure. Any other advice I will need to help with recovery and movement during that time would be great!!! I will pay for a consult if needed!! I had 8 lb babies in 1990 and 1992 both vaginally and big heads! I am 5'4"OUCH!!! Never been in hospital since!!!!Thank you so much for your time!!Angela

Reply
Susan
6/9/2013 10:11:49 am

Angela,
Thank you for your comment. The Egoscue Method is what got me interested in alignment. I completed the Egoscue PAS years ago and found it to be missing something for me. One thing that Katy B and the Whole Body Alignment program emphasizes is to pay attention to our biomechanical objective markers. Once the alignment markers are in place, the muscles are in a better position to "turn on" and be able to create force generation/blood flow.
I have a question for you? What does it mean for you to activate the transversus abdominis? My understanding is that we shouldn't be contracting it all of the time, it is part of our internal core that responds posturally/automatically. Conscious holding and contraction is a tension pattern. There are many things that we tend to do on a daily basis that shuts down our internal core. I am curious about your breathing patterns and what is happening with your pelvic floor. To me, fibroids are a sign of congestion. Tense muscles can create congestion. I would want to look at how you are using your body. What are your habits, or things that you do that impose on your system. I have lots of questions for you.
Are you in Salt Lake City? Might be good to have a consult.
Would love to hear from you, Susan

Reply
angela Lowrey
6/10/2013 01:29:25 am

Thank you for your response! Katy B. really does answer many of the why"s behind the dsyfunctional patterns in our clients on a much deeper level. That has been missing for me!!! And yes there is a LOT of tension in the pelvic area(holding on/not able to let go1/2nd chakra issues as for a energy goes. Oh ,and if you are into chinese healing tools, I am Earth, really an old oak tree. I like stability(too much though) BUT I really want to be more like a Chinese elm(grounded with the branches having a little more sway!!)So , yes there is (stuckness) there! :) Yes, let's schedule a consult(skype?)- Wed./12th around 1:00 central time(l live near Little Rock,AR) or Thursday/13th same time

Susan
6/10/2013 03:11:59 am

Angela,
I could do Wed the 12th at 12:30 Mountain which would be 1:30 central? Would that work for you? Can you email me and so I can give you my skype info: susanmclaughlin@xmission.com

Susan

Tiffany
2/19/2014 12:48:56 am

I have fourth degree cervical prolapse. I wear a pessary to workout and if I know I will be on my feet for a while.
I was wondering if you have worked with a client with stage four prolapse and if your methods have helped. I have seen multiple doctors and pelvic floor specialist and they honestly have been very discouraging. They don't seem to realize that this changes a persons life and one can't just "get over it"! I am 32, have two children and would love to start running again.
Thank you!

Reply
Tessa
2/20/2014 11:35:41 am

I am 27 weeks pregnant and feel like I might have some sort of prolapse. I will be discussing it with my midwife next week but I'm curious, if I do have it, what do I need to know about prolapse during pregnancy and childbirth?

Reply
debbie liddy
5/6/2017 06:20:50 am

If you have already had a hysterectomy can you still have a healthy pelvic floor by following your exercises ?

Reply
Susan
5/11/2017 12:54:46 pm

Hi Debbie,

Yes it is possible to have a healthy pelvic floor after hysterectomy!

Susan

Reply



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