Women who have had children are often advised to do exercises to tighten their pelvic floor muscles. The muscles run from the pubic bone at the front of your body towards the back and help support your bladder and control when you urinate.
As you get older, these muscles can also weaken, and pelvic organ prolapse is a common disorder. This is when the bladder, womb or bowel moves downwards from its normal position because the muscles or ligaments aren’t supporting it as they should. It can lead to pain, discomfort and less enjoyment in life. Problems with the bladder – both difficulty passing urine or incontinence – the bowel and having sex can be embarrassing and debilitating. Prolapse and bladder problems often co-exist but they aren’t always related.
We don’t know the exact number of women with prolapse. This is because women don’t always come forward because they are embarrassed, but also because studies measure prolapse in different ways – some record symptoms, others actually measure how far your anatomy has dropped from its normal position but which may not always be accompanied by symptoms.
According to one large study about 40% of women older than 50 had some degree of prolapse when examined. About 11% of women undergo surgery for urinary incontinence or prolapse in their lifetime, and 7% for prolapse alone. In England, about 29,000 prolapse repairs were done between 2010 and 2011, at a cost of around £60m.
All of this suggests that the problem is common – but there are things that can be done to help. Pelvic floor exercises have been recommended but evidence of their effectiveness has been limited. But a study we carried out with 447 women suggested that women reported fewer symptoms at six and 12 months if they had been involved in a personalised programme of pelvic floor muscle training than if they had been in the control group.
Pelvic floor muscles exercises
You can pull in your pelvic floor muscles by pretending to hold in your wee or stop yourself passing wind. Once located, the muscles can be trained by regularly doing a series of long and short holds. For example, you might squeeze these muscles slowly ten times in a row, then do ten fast squeezes.
The exercises can be built up over time, and in our study we aimed for women to achieve ten long muscle holds for ten seconds, and up to 50 fast contractions three times per day. It does take some time to start to see the effect, but after a couple of months they did start to feel a difference.
Consulting a professional, such as a pelvic floor physiotherapist, as well as giving you the correct exercises, can also help you understand more about the anatomy and function of pelvic floor muscles and the types of prolapse, and offer support. They will perform an internal assessment of the muscles to ensure correct exercise technique and provide an individualised exercise programme.
There are a number of reasons why women develop a pelvic organ prolapse. The main one is childbirth, which is associated with a higher risk of prolapse in later life. The more children you deliver, the greater the risk. Other obstetric factors could also play a part. Caesarean sections, for example, might be protective compared to vaginal delivery, while the use of instruments such as forceps during the delivery may increase risk.
Women can also have a genetic predisposition to prolapse, and heavy lifting or a physically strenuous occupation can contribute.
Treatments for prolapse include surgery and conservative (non-surgical) management, which includes the pelvic floor exercises, lifestyle changes (such as weight loss), and vaginal pessaries (a support device worn inside the vagina to push the prolapse up to restore normal anatomy).
Choice of treatment depends on the severity of the prolapse and its symptoms, and the woman’s general health and preferences. Conservative treatment is generally considered for women with a mild degree of prolapse, those who wish to have more children, the frail or those unwilling to undergo surgery. These therapies are less expensive, carry lower risk and don’t stop you having further treatment such as surgery later on. It is also the main form of management used to help women with this condition.
While we reported better results for women who’d done exercises in a follow up after a year, we still don’t know whether in the longer term it prevents women from having to go on to surgical procedures. What we do know is how common prolapse is and what could help. It really is nothing to be embarrassed about.