Living Life with Pelvic Organ Prolapse
By Lara Desrosiers, MSc. OT Reg. (Ont.)
A diagnosis of Pelvic Organ Prolapse (POP), the departure of normal sensation related to the position or felt position of any/all of the pelvic organs (bladder, uterus, and rectum) often leaves womxn feeling blindsided, helpless, broken or scared. If a POP diagnosis has rocked you to your core, you are definitely not alone!
My name is Lara and I am a womxn with POP in the process of learning to live my best life with it. I am also an Occupational Therapist and in my practice, I support womxn with rehabilitation, navigating this diagnosis and the emotions that can come with it. Together we look at the relationships we have with our bodies and the different ways this can be impacted by POP. We minimize fear and optimize engagement in the things that are important.
Important healing beyond what’s happening in the pelvis happens within these conversations and my goal is to have more of them with more womxn like you.
It’s a process that often starts with seeds of hope and so I’d like to share the 4 messages that have been amongst the most helpful for both my clients and I.
Message #1: Choice
There is no perfect one size fits all approach to POP. There are many strategies that work effectively for some, but not so well for others.
- Behaviour shifts
- Varied movement
- Pelvic floor muscle training
- Toileting habits
- Day to day movement adaptation
- Strength training
- Breath work
- Pressure management
- Cognitive Behavioural Therapy
- Acceptance and Commitment Therapy
- Myan Abdominal Massage
- Visceral mobilization
What is universally NOT effective for addressing POP are blanket recommendations and messages of restriction and movement avoidance. Expectation for danger can create a hypervigilant POP alarm. Fear and avoidance also end up fueling disability and negatively impacting quality of life alongside those physical sensations.
A strong way forward…Find a therapist who is willing to walk WITH you, equip you with information, guide you through experimenting with the tools in their toolbox (and yours), help you get curious about how these strategies feel in your body, refer you on if you want to try something they are less familiar with AND acknowledge the choices about how you inhabit your body and move forward with POP as YOUR choices!
Message #2: Grappling with Grade
What’s in a number?⠀
POP is assessed using a grading system from 0-4.
0: Organ has not descended at all
4: Organ has descended the maximum amount (Vaginal wall/uterus is protruding outside the introitus (vaginal opening)
A couple of key considerations:
#1. Our organs are not stationary structures and are designed to slide, shift and move. This helps them to move as we move and do what we need them to do.
This means that these measurements may differ depending on time of month/day, the position we are being assessed in, recent activity, whether bladder/bowels are full, etc.
#2. The experience of POP symptoms (pressure, heaviness, discomfort) is not dependent on grade. The experience of POP symptoms (much like pain) is an alarm produced when our brain takes in and interprets the information that we get from our body and environment.
This means that past experiences, stress, beliefs and context will certainly influence our experience of symptoms in any given moment. This also means that someone who has a Grade 1 prolapse may experience more symptoms or be more bothered by symptoms than someone with a Grade 3 prolapse.
Can we reduce the grade of prolapse?
This is a goal commonly cited by womxn when first presented with their diagnosis and grade.
The reality…some womxn do find that with individualized pelvic floor rehabilitation, their POP grade does reduce. Many more, however, find that while there may not be a significant reduction in the grade, they do experience a reduction in symptoms and improvement in quality of life with therapy that focuses on symptom management and function.
Message #3: Getting back to living life!
Life is dynamic and while we are busy grading, progressing and controlling exercise regimens to help us work towards fitness goals, life carries on and we still have to live it!
A function first approach to prolapse involves:
- Getting to know how symptoms AND how we feel about our symptoms are showing up in our lives and interfering with meaningful activities, life roles and relationships
- Building dynamic home exercise programs filled with variation and relevant to the demands of life
- Finding creative strategies to integrate into the components of life that are important and have been impacted by prolapse so that you can carry on living and build capacity and self efficacy in the contexts that matter
- Building awareness of habits, routines and CYCLES and noticing opportunities to do something different that might have an impact on the experience of symptoms by the end of the day (or whenever they are at their worst)
- Building a toolbox of symptom management strategies so that flare-ups are less riddled with fear and conditioned avoidance
Message #4: Rebuilding trust in your body
- Let Down
Many womxn with POP also struggle with body image.
The relationship we have with our bodies can be a lot like the relationships we have with other humans. It comes with a history, requires nurturance and compromise, patience and the ability to listen.
When we feel let down, betrayed or disconnected in that relationship, trust (in both directions) can be shaken to its core. This is a common experience for individuals with core or pelvic floor dysfunction.
Sometimes physically rehabilitating that core is enough for that trust to be restored.
Sometimes, even after function is regained, the distrust can linger. This can look like lingering fear, anxiety or anger, hesitancy in our movement, restriction in our exercise/sport, preoccupation with our bodily sensations OR complete disconnection from our bodily sensations
Rebuilding communication and trust in your relationship with your body is an important component of POP recovery that requires practice with taking a step back and looking at the experience with some new perspectives.
Let me help you to get started with my FREE 5 day series to help you navigate some of the biggest mindset hurdles that often come along with a POP Diagnosis.
A broader awareness of the factors that might be aggravating your POP symptoms
An understanding of the connections between stress, the pelvic floor and POP symptoms
My top 3 stretches for managing pelvic floor tension
My favourite strategy for putting the brakes on hypervigilance to stop POP for robbing you of the present moment
Clarity about what it is you’re wanting to move towards in your recovery
“She began to inhabit her body, instead of fighting it, and to embrace the idea of her own presence.” Caroline Knapp, Appetites