Episode #13: All Things Prolapse
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In this episode, Dayna and Rhonda talk about all things prolapse such as…
What is it?
What do the grades of prolapse mean?
Do symptoms match up with severity/grade?
Things to be mindful of when managing prolapse
Will exercise make it worse?
Can I have sex with a prolapse?
…Plus so much more!
We’re excited for you to hear this episode as Dayna and I both manage prolapse, so this was an important one for us to do for you all!We hope you find this helpful!
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Episode #13: All Things Prolapse
We're excited to have you join us for this episode of Pelvic Health and Fitness. I'm Dayna Morellato, Mom, Orthopedic and Pelvic Health Physiotherapist. And I'm Rhonda Chamberlain, Mom, Orthopedic Physiotherapist and Pre Postnatal Fitness Coach. On this show, we have open and honest conversations about all phases of motherhood, including fertility, pregnancy, birth, postpartum, menopause, and everything in between.
We also provide helpful education and information on fitness, the pelvic floor, and many aspects of women's health, including physical, mental, and emotional wellness. Please remember as you listen to this podcast that this is not meant to treat or diagnose any medical conditions. Please contact your medical provider if you have specific questions or concerns.
Thanks so much for joining us. Grab a cup of coffee. Or wine. And enjoy!
Hey everyone. Welcome to episode 13 of Pelvic Health and Fitness. Today, Dayna and I are actually recording in person together at my house in the same room, which is super cool. And today we are chatting about prolapse and both Dayna and I have shared already on the podcast that we experienced prolapse, um, did so postpartum and still managing some symptoms even two, three years postpartum and something that definitely has a lot of fear surrounding it, similar to other topics we've already discussed.
So, how about Dayna, do you want to start us off talking about what is prolapse and how they're graded? Yes, absolutely. I love that you said manage because I hope that's what listeners will take away today is that we're just hoping to decrease fear around prolapse and how it really is more of a management.
So, pelvic organ prolapse, or you might see it shortened to POP basically is the descent of the pelvic organ. So the pelvic organs are your bladder, your uterus or your rectum. So the descent of those pelvic organs down into the vaginal canal. So from my perspective as an internal therapist, when I am assessing somebody internally and you will see the anterior vaginal wall, the vaginal opening, and that would be a cystic or a bladder prolapse.
You can feel or sometimes see the cervix coming down, and your cervix kind of feels like the tip of your nose. So if you were to, like, push into the tip of your nose, that would be what your cervix kind of feels like, or, and kind of almost look like if you push into your nose, that, like, Interesting. I don't know what the description of that shape is, but that's kind of what it feels like.
And then, if you see the back wall kind of bulging in, that would be a rectocele or a rectal prolapse. Obviously prolapse can be alarming to people. Um, I think everybody kind of goes right to everything is falling out. Like the world. This is the worst thing ever. This is the worst thing ever. Um, and I always just start explaining prolapse as existing on a continuum from all the way to no symptoms to yes coming out of the body. So, um, there is a grade one where when there's a little bit of internal pressure, so think breath hold or a little bit of squat and we see a little bit of those bulges coming down like a change in position.
A grade 2 would be, yeah, it's there, we can see it, it's covering less than half of the vaginal opening. A grade 3 is it's at the opening, we can see it kind of covering that whole, um, if you were to look into the vaginal canal, you can see it covering the whole opening, and a grade 4 is it's exiting the body.
Um, Um, most common question I get about grades is, or prolapse in general, is can we get rid of it and can we change the grade? And the easy answer is not really. Um, I think that's hard for people to hear, but at the same time I have had plenty of clients who are grades threes, so not coming out of the body, but right at the opening that are symptom free.
Right. So it doesn't necessarily mean that those uncomfortable prolapse symptoms are always there. Right. Um, and it really is, like you said, about managing pressure from above. And I think that's the biggest thing that I learned is that. Symptoms don't always correlate with the severity of the grade of it, right?
So it's easy to assume if you're a grade 3 or grade 4 that must be terribly symptomatic, right? But that's not necessarily true and the opposite can be true that you can have a grade 1 Barely there prolapse and have immense symptoms that are detracting from your quality of life. So all that to say that Whatever you're feeling is valid, right?
So you might have an assessment and you're only in quotes a grade one and think am I crazy? Why is this bothering me so much? It's totally normal that you're gonna feel that way. Yeah, and I run this constant in my head. If someone, if I'm assessing somebody and they're coming in, let's just say for a standard six week check, they've been told it's something that they should do.
They don't necessarily have any pelvic floor symptoms. And I notice a bladder prolapse. I've gone back and forth with whether or not. I should say something because it definitely has in the past, I've had a handful of clients where that fear is so strong, maybe they've got moms and aunts and grandmas that are talking about surgeries and things falling out and pessaries, which I will come back to.
Um, and so they went from having no symptoms to being symptomatic. Now suddenly they're, they're like, Oh yeah, maybe I do feel that or I didn't know that that's what I'm feeling. And that fear response can be really tricky to settle. But at the same time, I really believe we should just know our bodies.
For sure. And know what's happening because I worry that if we don't tell clients what we see. Yeah. That they won't manage. the pressures well, and what does that mean? We'll get into it for sure, and then they could make it worse. Right. Right? Or they could become symptomatic, and then down the road, you diagnose them, and they say, well, why didn't you tell me that, right?
And then a bit of trust might be lost. Yeah. Yeah. So I think I agree with you. It's, yeah, you walk that line of kind of making someone fearful, and, uh, potentially. Um, sort of like bringing something to mind that they didn't even realize. But I do think it's so empowering to just learn about our bodies and know what's going on in our bodies and then it's not necessarily our job to like withhold that information from someone because we don't know how they're going to react, right?
For sure. Yeah. Absolutely. And something that's super interesting too is Yes, a vaginal delivery is the number, I believe, the number one risk factor for prolapse, at least in a certain age group. But people have prolapse before they ever have children as well. And we, unless you see a pelvic physio prior to having babies or even during your pregnancy, although the pressures are a little bit changed with the baby sitting on top for sure, we don't know.
We don't know. Yeah, and I suspect that there are quite a few people with grade ones at least. Yeah Walking around Symptomatic likely and didn't know that they had that before they they Had children. Yeah. Yeah, and I think I you know thinking back to my history I've talked on the podcast before about my history as a gymnast.
I Exhibited a lot of high pressure strategies, which again will kind of get into that when we talk about symptom management. I never got, I did get assessed, uh, when I was pregnant. But that doesn't, that wasn't necessarily something I was getting assessed for. But I for sure had all the strategies or all the, you know, habits that could have made me symptomatic of a prolapse before even having kids.
One thing I thought was interesting too when I got into this world and this can hopefully help to mitigate some of the fear is how common it is too. And again, it's not, we just said, it's not necessarily just in pregnant and postpartum, uh, people. It can be in anyone before they have kids too. And, yeah, I think, I think stats are skewed because we were just saying how symptoms don't necessarily correlate with severity.
So some people who have a high level of prolapse might never get assessed because why would they if they don't have symptoms? So I think they probably even miss some of those people. But I think it's like 50 something percent of women at some point in their lives will experience some type of prolapse.
Which is, yeah, so fascinating. And that's what I see clinically, I have to say. Like prolapse is so common and I always say that to people. Again, hoping to decrease the fear. That people just aren't telling you they have a prolapse. Yeah, they're not in the realm being like, oh, yeah I totally have a bladder prolapse like if they were hanging out with you or I um, but it's happening and it's It's not just in an old person's in quotes condition, right?
And again, I you know, sometimes i'll bring it up with clients and That's the first thing they think. Oh, like, isn't that just for grandmas? Yeah. No, it's not. It's very common in all ages. Yes, yes. Oh, absolutely. So when you're meeting with your clients, what are some of the flags or symptoms that you're listening for that might indicate that someone has a prolapse?
Yeah. So I'd say the common ones, and you can kind of add to this too. So what I experienced is sort of the typical, like a tampon feeling of coming out feeling. So it just felt like there was something down there, you know, it just felt like something was stuck there. Um, a lot of clients will describe pressure.
So just a feeling of heaviness, like a dragging feeling. I find one that comes up a lot too, and this was my experience as well, is like a gaping feeling. So feeling like Your tissues are kind of gaped open there, and then yeah, like a vulnerable kind of feeling like things are coming out. That was my experience, especially trying to get back into exercise.
So anytime I tried to do like a squat or any movement like that, I just felt very vulnerable. It's just a very... bizarre feeling and over time and I will say I still have that feeling sometimes but now that I know more and I'm Decreasing the fear associated with it It doesn't bother me because I you know, it feels like stuff is gonna fall out of you, but that's not what's happening right, so once you kind of Wrap that around your head then that helps you feel better any other any other ones.
Um, no, those are the typical ones Yeah, the gaping one is an interesting one. Yeah, because I do hear that one for sure It can be pain or like a feeling of fatigue in the pelvic floor too. I would say Those are the common ones. The tampon one is for sure the most Common. Yeah, I get burning sometimes too, like a stinging I have had a couple people, uh, report, especially if they're, you know, a grade four and it's coming out, like a stinging, the most recent one I had was, um, what'd she say, it felt like slivers.
Oh, okay. So a little bit more acute, right? This was an acute prolapse. So anything from like no bother at all to that sounds awful, right? Yes. And, and I think that's typical of any... Dysfunction we'll say in the body. Yep There's a range of symptoms and a range of what people will report and it doesn't always necessarily mean or correlate with severity for sure Yeah, yeah.
So along those lines a huge question I get and I'm curious to hear how you respond to this. So Again, so when we talk about prolapse again, the severity doesn't correlate with the symptoms, but the symptoms are what? Sort of take away from our quality of life, right? It's very distracting. It's very uncomfortable kind of awkward feeling Again, I was nervous to work out because I just thought I was gonna make it worse And I just remembered feeling like hopeless and feeling like is this my life?
and am I gonna feel like this forever and was this the price I paid to have kids and Not to sound dramatic, but honestly, I went through like a phase where I was like, this sucks. Yeah, absolutely. And I just, again, with my clients, I just reassure them, like, I felt the same way you're feeling right now, and it's scary, and it feels like, again, this is gonna last forever.
Um, but is it possible to become symptom free with prolapse? Yes. Yeah. I think so. Yeah. Um, yes. All the way from, Yes to yes. Most of the time I would say. Uh, and that's the category I would say I fall into. Like I definitely know there are some movements, like when I do a deadlift, for example, I feel that sensation, that tampon y type feeling.
Um, but it doesn't linger. Yeah. Uh, and I'm okay with it. I do the movement and it's done and I just know that about myself. Yes. Uh, I, plenty of clients will get them. I think most people think that it only happens with running, it certainly can, um, but any sort of like hopping, jumping, running, it's a little bit more, um, could be flared up a little bit more easily, but those things are definitely, you can do those activities and be symptom free with a prolapse a hundred percent.
That's yeah. I think too, I always have clients look at their cycle as well and start tracking it on their cycle. And we chatted about this a bit with Kathleen and running. Yep. And, and it may mean that part of your management strategy is working out around your cycle. So it's very common, for example, to have more symptoms around mid month, like ovulation, or perhaps right around when your period is going to start, like the first several days, even a couple days before, depending on your own body, but You know, your uterus swells a little bit right before your period.
And so that just puts a little bit of extra pressure down on the pelvic floor overall. So if you're someone who's like, I don't understand. You know, every, my period comes and I get my symptoms, but I've done all my homework. Yeah. It might just be hormonal. Yep. And maybe that's the day you don't do deadlifts.
For sure. Right? And so just starting to time. And I, I think, and I hope that that just feels like, you know, your body well, as opposed to a restriction. Totally. Yeah. Yeah. No, I agree. I think, kind of coming back to the symptom free thing too. So what I always say to my clients, um, I might not get you to the point of symptom free, but getting to that point of learning to manage your symptoms, and also again, decreasing the fear that when those symptoms arise, not blaming yourself.
And we've talked about this in previous episodes of, there's multiple reasons your symptoms might have increased, right? So the hormonal piece, stress, lack of sleep. You know, there's a multitude of layers as to why your symptoms might have gotten worse. So then take away that fear. So when you are sym having symptoms and say you just did a workout, you don't have to right away say, I must've done something wrong.
Yeah, I must've been my workout. You know, I just made it worse. Mm-hmm. poor me. Like, why did I do that? So, starting to get to a point of again, like, getting rid of that self blame, losing that fear that everything you're doing is making your symptoms worse, right? So, coming to a point where, yes, we obviously want the symptoms to kind of taper off so that they're not as bothersome, but understanding that they might still arise and Kind of be okay with that knowing that there's ways you can do to minimize them.
Yeah, I always say to clients get curious What was it like you might not know what exactly it was, but it's often especially as moms Accumulation of things we're stressed young children. You didn't you know went out for an extra run You're in the middle of your cycle who knows what it is. It's likely an accumulation of things I used an example with somebody that seemed to land the other day and you know, people often have chronic injuries So in this case, it was a shoulder injury and she was experiencing prolapse symptoms and was struggling with kind of wrapping her mind around the fact that symptoms didn't necessarily mean she had pushed herself too hard in her workout.
So I said to her, she'd had a long history of the shoulder injury, kind of flared up and down on her every now and then. And I said, you know, you have certain things that you just do a little bit differently probably you're a little bit more mindful of with your shoulder and she said, yep, absolutely. And I said, and when it flares up on you, do you go into a shame spiral of what did I do wrong?
How did I mess up my shoulder? And she said, no, I just kind of take it easy. Yeah. I ice it, I rest. I said, that's the exact same thing. I know. And it's, that's, yeah, that's an interesting question to kind of dig deeper. Like why? Why are we so hard on ourselves when it comes to our vagina, right? Like, that could probably be a whole, like, other layer.
Yeah, that's, oh gosh, I think we need a mental health professional for that one, but, um. Yeah, so it really truly is. I think sometimes we think about these structures and these systems like they are different, different kinds of muscles and different kinds of ligaments and the truth is they aren't. And they just require the same management when there is a change in position or a little bit of dysfunction happening there.
For sure, yeah. Yeah, and actually I remember back to a post I posted on Instagram. This was a while back, but something about that it is possible to get to symptom free. I don't think I necessarily was even talking about prolapse, just pain in general. That as a physio, I'd love to get you to a point of being symptom free.
And a colleague actually responded, um, in a very helpful way that I was like, thank you. She's like, but what if that's not possible? Like what if, because she then brought in like the prolapse piece and she's like, I still have symptoms of a prolapse. but I can do every single thing I want to do and it's not taking away from my life.
And I was like, thank you for that perspective. So that's what I try to sort of communicate with clients now too. I can't guarantee any tip for any injury, for any pain or symptom. that I'm going to get you to zero out of 10. I can't guarantee that life, right? Like symptoms are going to arise. But again, can we get you to a point where you know how to manage symptoms?
You're not afraid of them. You can be curious about them. To me, that's the goal and getting you back to all the things that you love. Yeah, absolutely. And I, I, I like this kind of example too. I say this to people all the time because it is hard to wrap your head around the fact that if you have no symptoms, You're booting around.
Maybe it's been weeks or months or maybe even a year since you've had any symptoms and Suddenly you feel that again. You feel that tampon. You feel that heaviness and It's really hard to wrap your head around the fact that that doesn't mean it got worse Yeah But I often will say to clients, you know If you put a lot of pressure on your forearm and you can't see what I'm doing, but if you push on your forearm with your finger, even with your nail.
Maybe it kind of aches a little bit. You're very aware that you're doing that. But if you were to walk around all day like that, eventually, you know, you're talking to your friends, you go in and pick up your kids, you go to the groceries, not paying attention to that sensation anymore. Right? You get, your body gets used to it.
Your brain gets used to it. If something changes in your arm though, if you pick up groceries on that side or you tense the other side, you know, the, the So I'm pushing my right finger into my left forearm for those, this is not a visual. Um, I can feel my finger more now. Right. So if you tense up your pelvic floor or you have a cough that plagues you for a week or so and the muscles get tired or maybe you had a fussy baby at home that just was teething and needed to be on you and you had more load on your body.
Something has changed in that system that brings more awareness to that system now. For sure. And now you're paying attention to it. Yes. There's no change to where my finger is on my arm. Yes. But the amount of load on my other hand is higher. My arm is working harder. I like that. I like that example. Yeah.
And I think that makes me think also, and we can talk about again, just symptom management strategies. But honestly, one of the things that helped me the most is to just stop thinking about it. And I know that sounds like impossible. Yeah. Because, again, it's such a scary diagnosis and you think this is your life forever and ever.
But similar to what you were just saying, it's like, if You're just, you know, pushing and focusing on it. Yeah, your mind is gonna go where that focus is So, of course, you're gonna feel it if that's what you're thinking about So I remember I had one postpartum client and she again went through the whole spiral of fear When she got diagnosed and thinking like this is horrible and I'm never gonna get back to the things I love she is a very active person and On her mat leave she started her own business.
So she started getting busy with this online business And we kept working together and then, you know, a few weeks went by and I asked how she was doing and she's like, I haven't thought about my vagina for two weeks and I feel amazing. And I'm like, what's changed? And she's like, I'm distracted. I haven't thought about my vagina.
I'm distracted. I'm like, I'm focusing on something that's bringing me joy. Yeah. And you've helped me, you know, coach me through the fear piece and yeah, I feel great. Yeah. I'm like, that's amazing. Absolutely. Yeah. Absolutely. Distraction is a beautiful technique. Uh, for a number of things. It brings it to another client to, uh, very symptomatic, very fearful of movement, very active job and lifestyle.
So having prolapse symptoms really through her, understandably through a bit of a tail spin. Um, and go running 10 kilometers was her thing. She needed to get back to that. And, you know, we had done a lot of education of waiting until 12 weeks. And, you know, you want to be maybe a little bit more symptom free, but we'll see.
And she got to the 12 weeks and was very focused on the running and not being able to run because she still had symptoms every now and then. And honestly, as a therapist, my advice was, I think it is better for you to attempt to run and see what happens, even though you're not symptom free. Let's just see what happens.
And she went for her run and wasn't symptomatic and the amount of, uh, relief that she had from that took her symptoms away from the rest, from a lot of the rest of the things that were causing her symptoms. You're not going to break your body. You're not going to break it. No. Your body is so resilient.
It's so strong. symptoms. We've talked about this before in other episodes. It's just our body's way of talking to us, right? It's not telling you you've done irreversible damage, right? Yeah. So we've been talking about management strategy. Yes. So what would you say are the things that you're coaching your clients for?
Let's start with maybe risk factors to making a prolapse worse because we're talking about how like, We can manage it. It's going to be fine. You can certainly make anything worse. Yes. So if you didn't know any of this information, what are some of the things that could potentially make a prolapse worse?
So some of the things that I ask about, and we've said before, we both do pretty thorough histories and kind of get a background on clients. Um, a big one I find is history of constipation and Um, like straining to have a bowel movement. So then we talk about, you know, water intake, fiber intake, using Squatty Potty.
We talk about Squatty Potty all the time. This is not sponsored, but it should be. I love a Squatty Potty. Yes, because if you think about it, again, like all, it all goes back to pressure, right? So we have this, you know, core canister. Pressure has to go somewhere, right? So if you're pushing and straining to take a bowel movement, it makes sense that it's pushing and straining on the other parts of the, those organs, right?
And potentially making that symptom worse. So even just going back, we talk about breathing all the time, right? So just different breath habits, right? So, Holding your breath all the time, which can, so if breath is not coming out from up above, that can potentially put pressure down into, um, into that prolapse.
Um, different things, uh, like a bearing down strategy too, like I know a few of my clients, we talk about that and Um, just doing day to day tasks. They would catch themselves, like, pushing like they're taking a poop. Just when they're, like, wiping the counter. Yeah. Right? Just simple things that you don't realize you're doing until someone points it out.
Oh yeah, I do do that. I do do that. Yeah. Absolutely. What else do you add? Uh, sucking your tummy in. All the time. And again, pressurizing that canister. And I don't mean if you do that for 24 hours, we're going to prolapse ourselves. But I think over, I have a lot of clients who are, let's, like in menopause.
who will say, I didn't have any prolapse symptoms. You get this hormonal change. They suddenly have prolapse symptoms and I asked them if they're clenching their tongue and they're like, Oh, I've done that since I was, you know, 15 years old. Right. Yeah. So these things are cumulative. This isn't like a, you know, they're going to, it's going to happen tomorrow.
You're going to make yourself worse, but they could be aggravating if you're someone who does have symptoms. But then over time, Going unchecked, they could potentially cause a prolapse if they're worse than one. So, belly gripping, um, you have the bearing, I think constipation is probably one of my biggest ones, yeah.
And then with the belly gripping too, like glute, glute gripping. Glute gripping, squeezing your bum all the time. So, if you're listening right now, check in. Yeah. Are you sucking your tummy in? Squeezing your bum? If you happen to be a client of mine, you know I ask you that every single time you're in my clinic because they laugh and they're like, yeah, totally.
These habits die hard. It's not an easy thing to change. And I think just taking breaks throughout the day, checking in, letting off tension throughout your body can make a big difference if you're symptomatic for sure. And then in preventing anything longterm. Yeah. And then with that, so I always say, I don't know if you, say that the glutes and the pelvic floor are kind of buddies, right?
So, typically if you're clenching and holding a tension in your glutes, might be doing that in your pelvic floor as well. And, kind of going back to that example of you pushing your forearm, I read somewhere, and it makes perfect sense, if you have a tight hypertonic pelvic floor, it's not necessarily the feeling of the organs descending.
It's the pelvic floor, like, always being lifted that's causing you then to feel your organs against your pelvic floor. Like, that's what's causing symptoms. That was a huge lightbulb moment for me because that's something I'm still working on, I'll probably work on forever, is relaxing and releasing tension in my pelvic floor.
And honestly, I think when I become symptomatic, I, yeah. I tend to get it around my period and I've noticed with myself, I wear a diva cup and I tend to like clench around it. Mm-hmm. and those when my, that's when my symptoms arise again. Yeah. Surprise, surprise. That makes perfect sense. Right? Absolutely.
I'm clenching, holding tension. Of course. I feel those organs. Mm-hmm. when the pelvic floor is lifted. A hundred percent. And we talked about this in the incontinence or the leaking episode as well. Mm-hmm. , it is a hard sell. Yeah. As I'm sure you find. Yeah. When you. You know, I feel like you see the look in your client's eyes, right?
You're like, I just told you that it feels like everything's falling out and you want me to let go of attention. Are you kidding? I get it, right? Yeah, a hundred percent. It's a great example. I think we all could err on the side of letting go of tension before we try any strengthening because it's, it's just always going to balance us, but absolutely.
Yeah. Hypertonic. I actually did just have a client, a newly postpartum client, um, diagnosed with an internal assessment with a prolapse, wants to get back into exercise. And yeah, we basically spent the whole session talking about breathing strategies and relaxing and releasing tension. So, one thing I do give clients, and we've talked about this before, is like, Z Line, so laying on your back with your legs up.
Because then, if we think of just the effect of gravity, right? Like, the effect of gravity itself is going to feel like it's pulling those organs down, which can, again, be a vulnerable feeling. So, when you're laying on your back, it's going to feel maybe a little safer to relax and release tension, because gravity's not also tugging down on your organs.
So we did that with her and she again like lightbulb moment. She's like, oh my goodness that feels so much better Yes, right coming back to common symptoms. That's a good one It's getting worse towards the end of the day right or the end of the week if you work on your feet That's a common symptom. Yeah, I wake up in the morning and I don't have anything but but the end of the day I've got X Y or Zed.
Yes, that's an accumulation of load on the pelvic floor, especially with baby carrying I find like women that you know, wear their babies all day And again, not to, not, I'm not saying that to say like, don't do that, but just again, that's just an example of hmm I wonder why I'm feeling this today. I just have my baby attached to me all day.
You didn't do damage too. That's the thing too. Like don't panic. It's like, and this is temporary. You're not gonna be wearing your baby forever. And honestly, zed lying is magic. Yes. It's magic. I think, I have most of my clients get in that position at least at some point, um, and depending if you, it could even be tilting your pelvis backwards a little bit, which is then literally bringing those organs up and into the body a little bit more, taking all of the load, body weight, gravity, pelvic organs off the floor.
So now you can completely relax. Does it have the added benefit of actually repositioning those organs up a little bit higher? Yeah, for sure. Yeah, it does, for sure. Yeah. A common question about, uh, that I get asked a lot too about prolapse is, can I have sex? Hmm. Yeah. And I always say, well, I mean, there's a multitude of factors here, but there's nothing about prolapse that should prevent you from having sex.
For some people, they actually find it relieves their symptoms. Yeah. For lack of a better. description. It basically pushes everything back where it should be, right? So, um, if that's good for you, good news for you, I mean, run with that. But you can also use that kind of tilted back pelvic position as well.
So if you're on your back or in the missionary position and you have a pillow underneath your hips to tilt your pelvis back into that position, that can help reposition those organs a little bit. So if you are someone who is having discomfort with it, which is not pelvic floor tension, Cause as we just said, you know, it's not uncommon to have pelvic floor symptoms or pelvic organ prolapse, pardon me, verbal diarrhea symptoms with a tight pelvic floor.
If that's, you don't think that's the case, try tilting your pelvis backwards and repositioning those organs a little bit. Yeah. Move them out of the way essentially a little bit and try that. See if that feels better. Yeah. Cause that's a common fear. Yeah. Of clients. Having sex with a prolapse. Yeah, makes sense.
Um, you touched on this a little bit earlier but I know this is a common question that I get with pelvic floor physio internal therapy. Can you reverse the grade of a prolapse with pelvic floor physio? The research says no. Yeah. So I think, I mean, and I'm happy to, any discussion or feedback. I don't think there's been any solid concrete evidence that we can change a grade.
We can't go backwards. Will, I mean, clinically have I, I, I believe that we do have a little bit of play in that though. Like, and I, I think that there's, you know, there's ligaments that hold these structures as well. Muscle fatigue. I think we probably get a little bit of play in a position within a day. Um, and I think, you know, if you're someone I see you at six weeks, have I, would I say that I see a little bit of improvement?
Sure. Yeah, I think so. Um, that doesn't mean it goes from being a prolapse to not at all, though. I think that's important to know, but no, I don't think we can, we can change that position. Right. And yeah, not to say that to panic people, but just to be realistic, right? So Absolutely. If, if you're seeing someone and they guarantee that they're going to reverse your prolapse, I would say, uh, that's probably not the truth, but again, we can get to a point, even if you still have a grade two, three prolapse of doing everything you want to do with.
So, we've done our own mental work about our own bodies here. So, like, we've been there, we still, you know, it's not always easy to kind of work through these things. But I think a lot of it is rooted in fear of stories we've been told. Um, that it means surgery, everything's falling out. So I, I think it's important to know that surgery is an option if there is a grade for prolapse.
I truthfully don't know what the cutoff is. I'm sure that they will operate even if it's not fully out of your body. But at one point when I was taking my pelvic health certifications, uh, five years ago, gosh, probably almost six. I believe the failure rate for a mesh surgery for a bladder was somewhere close to 70%.
Oh my goodness. So and I did have a client who I've had one client who I saw post op who had re prolapsed within two weeks. And We chatted about all these things that we've talked about already. Managing pressure, um, you know, what are some good lifting techniques. Constipation management was huge for this client.
Nobody had said, hey, drink more water, you know, try squatty potty. Squatty potty if you're listening. Um, but she was symptom free within a few sessions. Yeah. So. Surgery, I think, is an option if you have exhausted all of your resources. You've done pelvic physio, you've tried to strengthen the area, maybe you've even tried a pessary, which we should touch on next, and it's still just a quality of life issue for you.
Maybe it's affecting how you're fully emptying your bowel or something like that, your bladder, but... Then come back to all of these pieces post op as well. Right. Right. But surgery is at the far end of the spectrum one way. We've got like pelvic floor physio or exercise retraining on the other end. And then in the middle I'd say there's pessaries.
Yeah. Yeah. So what is a pessary? I believe they're massively underutilized. They are essentially a sports bra for your vagina. They are, there are a variety of different shapes, but for simplicity they are silicone structures, usually a ring that gets inserted into the vagina. Um, and they give structure to that vaginal canal.
So they reposition or push back for lack of a better description, the organs where they should be. So they're offering support. So you don't have symptoms. And even with the pessary, it can be a wide range. I have. clients who are elderly who have them inserted by a gynecologist and then they go back every three months to have it Taken out cleaned and reinserted which again coming back to this idea of it being an old lady condition Yeah, that is what women think of when they think of pessaries.
They think of their grandmas getting them All the way to I have a couple clients who have one that they just the one client it's running She just puts it in when she goes for a run because she always got symptoms when she ran didn't matter what she did And it also just gave her a sense of security and support during her run.
Great. Yeah. Cool. So she comes home from a run, she takes it out, she goes about her day. Um, another client, uh, she has it and she just feels better with it in. She wears it all day. Yeah. She puts it in in the morning, she wears it for her day when she's got her two young kids and she takes it out at night.
Um, but still doing all of the pelvic floor physio. Right. And I think it's important to do both the strengthening and the relaxation. Um, with it in and with it without it in. Yeah, so it's not like a brace that you rely on. Yeah, because that is a big hurdle for some clients. They'll say to me, well, is it like going to mask all these symptoms and I'm just going to be secretly making it worse in, in the background?
And I say, well, it's a tool. Yeah. Um, but I think we still, we still have to manage constipation. We still don't want to be bearing down every single time you wipe the counter, you know, things like that. So changing our habits and our strategies, um, but I think they are fantastic tools. Yeah. I love that.
Yeah. And so I think we should touch on, you know, our pelvic health and fitness. So let's talk about a bit of like the exercise component to it too. So, um, again, we, we've sort of already said that we can't necessarily reverse a prolapse. So. But there's so many ways that we can manage it, and I think, you know, I'm biased, but I think just working on pelvic floor strengthening, yes, but just whole body strengthening can be so beneficial to help with symptoms.
And honestly, I think a lot of it is just the confidence piece and the learning to trust your body again, right? And realizing you're not broken, you're not damaged, you are, you know, a strong, resilient human being. And yeah, let's get you back to the things you want to do. So similar to rehabbing from other things we've chatted about, it doesn't mean I would recommend right away someone diving right back into, you know, heavy lifting or right back into high level CrossFit.
Let's, you know, ease back in, but 100 percent we can get to, to where you want to go. Um, and again, I think just working on, reconnecting the breath, you know, working on breath strategies through your workouts can make such a difference with symptoms as well. Oh gosh. Yes. Exercise is so important. I love that you said confidence cause that's my runner, right?
She was so nervous about not being able to run so much fear about not being able to return to it. Go for a run. Just try it. Go for a run. Worst case scenario, you get symptoms, but it's not worse. You're not going to, you're not going to go from a grade two to a grade four after one run. Yeah. So go for a run.
Worst case scenario, you get symptoms and we'll manage it from there. And with exercise, it's so important for all of those benefits. Strength, confidence, flexibility, um, distraction. All of those things, right? We want to be strong. We're so much more than just a pelvic floor. So we talk about like reconnecting with the breath and all like getting, you know, if Kegels are appropriate for you.
But we don't want you to be picking up blueberries with every rep of every exercise until the end of time, right? We want to make sure that you're strong and you have just good management strategies and something you and I have chatted about before too is Yes, good management, good game plan for symptoms during exercise sessions But my opinion is that a prolapse more at risk from the other, like you said, 23 hours in a day.
Yeah, you're kind of habits throughout the rest of your life. Yes. That are more likely to flare you up than the exercise that you love to do. Yes. Agreed. Yeah. And I think again, that goes back to the whole, like don't get obsessed about focusing on it. And this was my experience. When I was managing symptoms early postpartum, trying to get back to exercise, I became so hypervigilant of like, what is my pelvic floor doing?
You know, exhale and exertion, and lift, pick up the blueberry, and I got so frustrated because my symptoms were just either getting worse or staying the same, and we talk about Antonilo all the time, so I started really getting into his stuff, and his big thing is, you know, yes, maybe you want to work on that reconnection piece initially.
You want to drop that pretty quickly though, because your body, you want to rely on your body, that automaticity. It knows what to do, right? So, you know, I started learning more about his approach and gave myself permission essentially to like stop thinking about my pelvic floor and I started to feel so much better.
My confidence went up. Started to add more load, just started to, again, just experiment and be curious about, like, what can my body do? And again, yes, sometimes I would push it a bit too far and my symptoms would arise. But that was just a marker, and again, just like, uh, that symptom that I got curious about.
Okay, maybe my body's not quite ready for that yet, right? So, I always talk about with my clients, like, symptoms, think of it, think of it like, uh, like a ceiling, right? So, we want to kind of nudge up against that ceiling. Not necessarily like break through the ceiling, but keep kind of nudging it and then over time that ceiling of what your body can tolerate will just keep going up, right?
Yeah, that's fantastic. That's essentially what we're doing. Yeah, for sure. Yeah. Hopefully. Hopefully, yeah. This means less fear. Yes, that's the biggest thing again with all of our episodes. Yeah. Decrease that fear. Yeah. Get you back to the things that you love to do with hopefully less symptoms. Yes, absolutely.
Yeah. Good chat. Good chat. Thanks for listening to today's podcast. We hope you enjoyed the conversation. If you liked what you heard, we would love if you could share this with a friend, leave us a review, or subscribe to anywhere that you listen to your podcasts. Thanks for being here.
