Prolapse is present in 50% of women and 1 in 10 women will need at least 1 surgical procedure (NICE, 2019).
I know, these figures are big and concerning. So before we go any further, I'm excited to bring this article to you in order to upgrade the terminology associated with prolapse and talk about very new and upcoming research into the area of treating prolapse and symptom's of heaviness/dragging in the pelvis with restorative massage therapy and releasing movement.
What is Prolapse?
Prolapse is graded from Grade 1 to Grade 4 and as you can see from this image, can involve the bladder, uterus/cervix, or bowel. It is a condition that some women are not even aware they have (Grade 1), where some experience the condition up to a life-changing Grade 4.
Typical symptoms of prolapse include:
A feeling of heaviness or dragging in the pelvis,
A feeling that something is going to fall out,
Difficulty with bowel movements or emptying the bladder,
Difficulty keeping a tampon in,
Discomfort during sex.
Traditionally, it is thought that the organs in the pelvis are supported from below by the pelvic floor muscles and that prolapse is a condition described as a "fall" in the pelvic organs due to pelvic floor "weakness". Your conscious, maybe subconscious response to this would be to grip and clench your pelvic floor in an attempt to hold these organs up. Traditional treatment has also therefore included kegals (pelvic floor squeezes) to build muscle bulk and tightness. Unfortunately the terminology used to describe this condition, the actions women take caused by this terminology as well as the traditional treatments methods are doing women a HUGE disservice.
The pelvic floor is closely associated with the hips, abdomen, glutes and adductors (inner thighs), so a dysfunction in the pelvic floor and a hip dysfunction will play into each other. The pelvic floor is also related to our breathing system and works in synergy with our diaphragm.
When you inhale the pelvic floor expands and lengthens.
When you exhale the pelvic floor contracts.
The main area of your pelvic floor capable of most expansion is the area between your sitting bones. This area is able to expand the most during childbirth due to the capability of the folds of muscle tissue to uncurl and stretch.
It is also very important for this area to be flexible in order for us to move through a variety of ways - for example, to squat or sit down, or to raise one knee up, to walk or run.
The pelvic floor affects and is affected by our whole body mobility. For example, if there is restriction in the spine or shoulders, this will restrict ribcage and diaphragm movement and this will mirror into the pelvic floor. A foot, knee, hip restriction will also feed into a pelvic floor problem and vice versa.
How does this happen?
The body is structured via a complex system of tensional webbing called fascia. We are not just a stack of bones with everything draped over the top as originally thought. If an area of fascia is tight it will cause a tensional pull on surrounding fascia and the tissues which are embedded within it - bones, nerves, muscles and organs! So bringing this concept back to the pelvis, tension in the pelvis can tug on surrounding tissues and organs as the body moves.
Just like if you pinched part of your top in your fist, then this would cause a pulling in of the surrounding material towards that pinch.
Fascial tissue can be stiffened via static postures, repeated movements, tissue trauma/injury, or scarring and it can be released and softened via manual therapy (massage techniques) and diverse well-considered movement.
Based on this modern thought on body structure, the idea that the pelvic floor is holding everything up doesn't support how we're actually built!
Tension creates a pulling, rather than weakness causing a fall!
Tension can be treated by finding or releasing it to restore correct arrangement of tissues. This really does explain the importance of posture correction and fascial release.
What does the research say?
The PDFI-20 questionnaire is a tool used to measure pelvic floor dysfunction and a 15% reduction in a PFDI-20 score shows a treatment was "clinically meaningful".
Weigersma et al. 2014 found that women performing pelvic floor muscle training - traditional kegels - led to a 9% PFDI-20 score reduction.
Due et al. 2016 found that pelvic floor muscles training led to a 3% score drop.
However, based on recent (2020) and ongoing research by Anna Crowle researcher and women's health physiotherapist and Clare Harley PhD, pelvic floor tension release leads to a 50% score drop!
Vaginal birth related lacerations to the pelvic floor occur in 90% of women causing scar tissue which is the major contributor to tension, disrupting the fascial web causing a pull on surrounding tissues. Women who had a c-section obviously have the tension pulling coming from their c-section scar.
The degree of scarring can be increased if an infection was present in or around the wound, if an episiotomy was performed too early, if there was inadequate postnatal healing and also via movement dysfunction or injury which can also increase tension in the pelvic floor. Excessive impact exercise or excessive heavy lifting as well as chronic constipation can also lead to a build up in tension. Interestingly, the pelvic floor muscles are also linked in it behaviour to our emotions. Susan Coel Clinton states that;
"A woman in fear over-recruits her pelvic floor".
In a study from 2001 it was found that there was a correlation between subconscious over-recruiting of the pelvic floor when women are in fear or stressed. This fear can be driven by previous trauma or birth trauma, pain or fear of pain, or fear of being weak or broken.
Tension can present as pain (including in surrounding areas), restricted movement and tissue stiffness.
Treatment for Pelvic Tension
Treatment for, and prevention of prolapse, leaking/incontinence or pelvic pain should include movement and therapy techniques to release pelvic tissues, not tighten them! And we can influence this by not only working directly on the problem area, but also by mobilising and freeing up tightness around the whole body, improving posture and treating tissues feeding into the pelvis with flexibility, mobility, mindful breathing and movement!
Anything that acts to release and open through the pelvis and hips is essential. Manual therapy on structures that feed into the pelvis is all very valuable. Self-techniques on perineal and massage on c-section scars can also be incredibly helpful.
Functional exercises with integrated pelvic floor focus is better for building a dynamic and resilient pelvic floor rather than isolated contractions including a rich diversity of movements.
If you are keen to resolve symptoms of prolapse or to move through Motherhood and Peri- to Post-Menopause in a way to prevent prolapse, please get in touch to discuss your specific situation and I'll be more than happy to advise.
Extra Resources and Services
You may like to initially take a look at my free 20 minute Move & More session themed "For Prolapse" I delivered live in the Willow Women's Wellness Facebook Group.
My two regular timetabled classes you may like to take a look at initially include Core & Floor and also Stretch & Rest. This doesn't mean other classes are off limits, so please get in touch if you'd like to discuss your specific goals.
Please also take a look at my Myofascial Release for Pelvic Health treatment.
Myofascial Release for Pelvic Health
This 121 session is for any woman looking to improve core and pelvic floor function including reducing pelvic pain, treating symptoms associated with incontinence, and prolapse/heavy feeling in the pelvis.
This session will involve an advanced soft tissue massage therapy technique called myofascial release as well as appropriate movement/exercises. It's more hands on than a group exercise class in that I can manually correct technique and positioning to support restoring optimal function of the body. As a Sports Therapist and specialist in Women's Wellness, together we can work to treat injuries, dysfunctions and improve issues like pain and tightness that may currently be limiting your current exercise regime and/or daily life. Please note, I do not cover any internal work for the pelvic floor, but I'm happy to refer to a local Women's Health Physiotherapist if I feel you would benefit from this.
I can also advise on a supplementary Willow group class to join weekly.