Bodies change over time. It’s a fact of life that we just have to accept if we’re going to have any hope of loving ourselves. Men and women lose hair to different degrees, our skin gets thinner, and our knuckles become prominent. Pregnancy and childbirth affect the body in unique ways and certainly don’t help with anything that needs to fight gravity!
Breasts sag, bellies hang, and we develop an underarm flap. Isn’t motherhood lovely? At least our kids make us feel young.
One thing that can descend is the pelvic organs. This typically happens after childbirth but it can also happen to women who have never been pregnant. A pelvic organ prolapse is when the bladder, uterus, or rectum encroaches into the vaginal canal and takes up space there. Remember that the vagina is a tunnel and it can’t do anything if a neighbour wants to spread out.
Have you ever sat on an airplane with an empty middle seat and a very tall and large person in the window seat? You will have noticed that there’s less available space in the middle seat. The same thing happens down below: that poor vagina is your middle seat.
Let’s continue the analogy to understand how a prolapse happens in the first place. In an airplane, if the armrests are down, there’s a physical resistance to the window and aisle passengers spreading out. They’re held in place and there’s a normal amount of space in the middle seat. Now imagine if the armrests were made of a flexible material. (Stay with me here. It will make sense in a bit.) The stiffer the material, the more resistance it provides and the more room there is in the middle seat. A stretchy material won’t provide much resistance and will bulge under pressure.
What can cause the vaginal walls to lose their stiffness? Pregnancy, vaginal childbirth, weightlifting, constipation, and hormones.
Luckily, women have options for lifting things up and relieving the discomfort of being weighed down. The pelvic muscles can support the uterus, bladder, and rectum and decrease the symptoms of pelvic organ prolapse:
The first step in assessing and managing a pelvic organ prolapse is to see a pelvic health physiotherapist. S/he will be able to determine the degree of the prolapse and the develop a treatment plan with you.
Sometimes pelvic muscle strengthening isn’t enough to resolve the symptoms of a prolapse, so what are some other options? Let’s return to our airplane analogy for a minute. If we could brace the armrests, the window and aisle passengers could be propped up and stay in their places. This is what a pessary does.
A pessary is a silicone device that’s inserted into the vaginal canal to prop up the pelvic organs. It can come in different shapes and sizes that accommodate the many varieties in female anatomy. Depending on the type of pessary, it may stay inside for a day or up to a couple of months. Then it’s cleaned and re-inserted. Many can be kept in during intercourse but not menstruation.
Some women have small prolapses that don’t resolve with pelvic strengthening. They may only need a pessary for certain tasks like running, yard work, or their occupation. Women who spend a lot of time on their feet such as nurses, teachers, and actors can use a pessary to support their pelvic organs on long shifts when the muscles fatigue.
Because each woman needs a shape and size of pessary that’s specific to her anatomy and lifestyle, the device is custom fitted. A physiotherapist, physician, or nurse practitioner does a pelvic exam and determines the best device for each individual. This is a great non-surgical option that gives women independence and control.
If you’re unsure if you have a pelvic organ prolapse, start by getting assessed by a pelvic health physiotherapist.
If you’ve been diagnosed with a pelvic organ prolapse and your symptoms persist after physiotherapy, you can be fitted with a pessary.
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