14 questions about pelvic floor prolapse

Incorrect lifting is one of the causes of uterine or bladder prolapse. One in four women will have to deal with this in her life. 14 frequently asked questions about these so-called vaginal prolapse.
Incorrect lifting is one of the causes of prolapse of the uterus or bladder. One in four women will experience this in her life. 14 frequently asked questions about these so-called vaginal prolapse.

1. Where are your pelvic floor muscles?

The pelvis is a kind of funnel that is closed at the bottom by a supporting plate of muscles and supporting tissue. There are three openings in the middle: the vagina, the urethra and the anus.
The pelvis is a kind of funnel that is closed at the bottom by a supporting plate of muscles and supporting tissue. There are three openings in the center: the vagina, the urethra and the anus.

They are normally slightly contracted and thus ensure that the organs at the bottom of the abdomen (the uterus, the intestines, the bladder, the urethra and the vagina) remain in place and you do not accidentally lose urine or stool.

Prolapse occurs when the pelvic floor muscles stretch or become damaged. They are no longer able to do their job properly. The uterus, bladder and / or intestines then sink into the vagina and may even come out.

Such a weakening or damage to the pelvic floor muscles can have various causes. The most important are pregnancy and (vaginal) delivery. Overload due to standing or heavy work also plays a role, as do years of incorrect urination and defecation behavior (for example due to constipation), a lot of coughing and serious obesity. In short: anything that causes excessive pressure on the pelvic floor. Prolapse complaints often arise during menopause. And if your mother has had a prolapse, you have an extra high chance of getting it too.
Such relaxation or damage to the pelvic floor muscles can have various causes. The most important are pregnancy and (vaginal) delivery. Overload due to standing or heavy work also plays a role, as do years of incorrect urination and defecation behavior (for example due to constipation), a lot of coughing and serious obesity. In short: anything that causes excessive pressure on the pelvic floor. Prolapse complaints often arise during menopause. And if your mother has had a prolapse, you have an extra high chance of getting it too.

Women are the first to feel or see a bulge in their vagina or between their legs. Other complaints are a nagging pain in the lower back and stomach, and an uncomfortable feeling or pain when cycling or having sex. Sometimes problems with holding up urine, passing urine or having a bowel movement (constipation) also develop. The complaints worsen during the day. Lying down often reduces discomfort. Incidentally, a prolapse does not always cause complaints. Most of the women who have given birth have some degree of prolapse without noticing it.
Women are the first to feel or see a bulge in their vagina or between their legs. Other complaints are a nagging pain in the lower back and stomach, and an uncomfortable feeling or pain when cycling or having sex. Sometimes problems with holding up urine, passing urine or bowel movements (constipation) also arise. The complaints worsen during the day. Lying down for a while often reduces discomfort. Incidentally, a prolapse does not always cause complaints. Most women who have given birth have some degree of prolapse without noticing it.

Yes, although this is much less common. In men, it is usually the bowel that prolapses and ends up in the anus.

Prolapse is not a health hazard. In very rare cases, the tubes that carry urine from the kidney to the bladder can become pinched. The complaints can be very annoying, uncomfortable and painful.

Yes. Many women are ashamed of their complaints and do not take them to the doctor. But the longer you wait, the harder it is usually to do something about it.
Yes. Many women are ashamed of their complaints and do not take them to the doctor. But the longer you wait, the harder it usually is to do something about it.

As soon as you experience complaints. The doctor can treat some forms of incontinence with medication. In case of other complaints, he will usually refer you to a pelvic physiotherapist or a gynecologist. You can also go directly to a pelvic physiotherapist; no referral letter is needed.

There you learn to feel where your pelvic floor muscles are and to train them, so that you can tighten and relax them at the right time. On average, this involves six to nine sessions, spread over six months.

There are then two options: a diaphragm or surgery. A diaphragm is a ring that is placed in the vagina and provides extra support there, so that the organs do not prolapse (further). This is not very drastic but must be changed two to four times a year. Another option is an operation in which a gynecologist puts the prolapsed organs back in the right place via the vagina. This is done either by strengthening the walls of the vagina or by restoring the 'suspension system' of a prolapsed vagina. Nowadays it is almost always possible to keep the uterus, even if it has prolapsed.
There are then two options: a diaphragm or surgery. A diaphragm is a ring that is placed in the vagina and provides extra support there, so that the organs do not prolapse (further). This is not very drastic but must be changed two to four times a year. Another option is an operation in which a gynecologist puts the prolapsed organs back in the right place via the vagina. This is done either by strengthening the walls of the vagina or by restoring the 'suspension system' of a prolapsed vagina. Nowadays it is almost always possible to preserve the uterus, even if it has prolapsed.

The most important thing is that you learn to work your pelvic floor muscles correctly. Without being aware of it, this often goes wrong. Lifting a heavy box or stack of books, unscrewing a stuck lid, squeezing during a difficult bowel movement: to apply force, you naturally hold your breath. The pressure that this creates on the abdomen and pelvic floor stretches the ligaments and muscles further and pushes the organs downwards. By properly absorbing that increased abdominal pressure, you can be ahead of many problems. You do this by contracting the pelvic floor and abdominal muscles during heavy exertion and breathing through them at the same time. In this way, the pressure is, as it were, off the boiler.

No, because stretched or damaged tissues and muscles cannot be repaired with exercises. But you can (considerably) slow down the process of sagging and prolapse. That is why it is useful to do the exercises if you still have no complaints. Pelvic floor physiotherapy may also prevent the complaints from recurring after a treatment.