You did it. You birthed a bouncing baby and your body is in recovery from enduring the sheer awesomeness that is childbirth. As the months that follow unfold and that baby starts to grow, you can’t help but shake the feeling that something is not quite right down there. Why is peeing so weird now? When did my body decide it was okay to just leak out said pee every time I cough? Am I supposed to just wear panty liners all day every day just in case someone makes me laugh? Why does it feel like there is a bulge in my vagina? Though it is a common post-birth issue, the first time you hear that you have pelvic organ prolapse may be frustrating and quite upsetting. I mean, your body was made to have babies. Why would something so natural cause such an issue? Avoiding the S WordYour doctor may suggest many treatment options to help prevent your prolapse from advancing to the point where they begin to start talking about surgery. Surgery is a SCARY word that we would like to help you avoid. Prolapse reconstruction surgery, or Vaginoplasty, may be recommended in advanced cases. However, if you aren’t severely prolapsed, there are steps you can take that may help you avoid surgery all together. Yes, early prolapse can be corrected without ever ending up under the knife. Even a grade 3. Popular less invasive treatment offered can include vaginal pessaries and Kegels as the only form of pelvic floor treatment. Don’t hear me wrong, these can be very helpful, but I am more a fan of using a functional, whole body exercise approach to healing core and pelvic floor issues. Here at Restore your Core®, we are fellow partners of your health-focused team and are seriously invested in empowering you to make every movement throughout your everyday life healing. We believe and have seen first hand with many clients, that our 12-week program can train you to bring symptom relief and avoid the discussion of surgery altogether. No matter when you discover a prolapse, we always recommend 1 year of pelvic floor rehab before deciding on more drastic routes. Pelvic Organ Prolapse: What is it?First things first, let’s make sure we are all speaking the same language here: pelvic organ prolapse is the injury in which one or more of your pelvic organs “drop” from their normal position. Though bladder prolapse is the most common, any pelvic organ (bladder, uterus, rectum) can make the descent. This injury happens for a variety of reasons and sometimes, it is really not known why. Birth injury, core and pelvic floor muscle imbalances, postural misalignments, and excess intra ab pressure are all reasons one might sustain a prolapse. If pelvic organ prolapse is allowed to advance to its fullest potential, the prolapsed organ will make its way down the path of least resistance into the vaginal canal. Eventually, the organ may exit the vaginal opening. Different types of Pelvic Organ Prolapse include:
Though pelvic organ prolapse can be caused by obesity, aging, and other stressors on the floor muscles, vaginal birth is the leading cause of prolapse. As you can imagine, vaginal birth does a number on those pelvic floor muscles because of the amount of stretch the pelvic floor muscle must undergo to make way for the baby’s grand entrance into the world. This is why it is pretty common to pelvic floor prolapse after childbirth. How Do I Know if My Prolapse is Severe?The severity of Pelvic Organ Prolapse has to be diagnosed by your healthcare provider, but the general rule of thumb for staging is:
Stage 3 and 4 are when you may be experiencing the more severe effects of prolapse. If your prolapse is severe, you may experience a wide range of symptoms. Check out our other articles that break down the specifics for different types of pelvic organ prolapse. Some of the most common symptoms for severe prolapse can include but are not limited to :
If you experience any of these, contact your doctor. We recommend seeing a Urogyn to get tested, and ideal is to be tested standing up, not lying down. Can Prolapse Correct Itself?We have many clients who are not symptom free! Unfortunately, if left to its own devices, organ prolapse may continue getting worse if no intervention or treatment measures are taken. Our muscles and skeletal systems are the protectors and stabilizers of our organs. When our pelvic floor is just as strong as the rest of our core, straining and bearing down is countered within the core to keep all the organs in their assigned spots. Once the pelvic floor muscles have been compromised / weakened, they are no longer able to counter the force of your rest of your core. If your prolapse is the result of a vaginal birth you had, you are likely to be doing some heavy lifting in the day to day life just to take care of your newest addition to your family. Every time you do heavy lifting, the force that is placed on your already prolapsed organ may push it further down the path of least resistance and right into your vaginal tissues. Because of this it is important to begin building a strong organ support system to help prevent pelvic organ prolapse from becoming worse. Can I push a Prolapse back up?When our insides decide to try to escape to the outside, it is time to get a professional involved. Though it may actually be possible to temporarily push fully prolapsed pelvic organs back into the vaginal opening, this is not a long term solution or an actual treatment. It is important to seek medical advice and see a pelvic floor therapist if severe symptomatic stage 3 or stage 4 prolapse occurs. Why is My Prolapse Worse Some Days?There are times during your cycle where you might feel worse. Hormonal changes can affect how your prolapse feels. This is common and even if you are doing great in your rehab process and this happens, do not panic! Many women feel it worse during ovulation. If you have just finished moving furniture around the house or gotten home from an intense workout just to be greeted with worse prolapse symptoms for the rest of the day, this is actually very normal for many women who suffer with pelvic organ prolapse. Straining on the toilet while trying to work through some constipation can also worsen your symptoms. When doing strenuous activities, we bear down and increase the pressure within ourselves and this can place even more pressure and force on the organs. What should you not do with a prolapse?You may have noticed a bulge in your vaginal wall, a lower hanging uterus or experienced a change in your urine, stool, or discharge pattern that makes you suspect a pelvic organ prolapse. As you seek medical advice, it is important to begin to treat your conditions by cutting back on strenuous exercise until you can build up your pelvic floor muscles through direct treatment. Prolapse can be frustrating to deal with to say the very least, but if there must be a silver lining, it is that the doctor has ordered you to get another family member to move that couch. Here are the things to avoid when you have pelvic organ prolapse:
Here are the things TO DO when you have pelvic organ prolapse:
How Can I Reverse Prolapse Without Surgery?Pelvic organ prolapse may be reversed without invasive procedures like surgery. Working on your pelvic floor system in a functional way can begin to reverse the prolapse descent. If I have not said it enough, I will say it again: always talk to your provider if you are experiencing symptoms that interfere with your daily routine and you are worried about. Your doctor may recommend Kegel exercises as the only form of pelvic floor muscle treatment. Kegel exercises are the favorite prescription within the medical field for weakness in pelvic floor muscles but it is essentially an old school approach that fails to work for many and makes things worse for many others. We strongly believe in a more functional approach to the pelvic floor – one that incorporates the whole body for healing and works on integrating your pelvic floor into the whole system of pressure, load and movement. Restore Your Core program was created to offer ways of treatment for women that does not involve just sitting and clenching your pelvic muscles a thousand times over, but rather teaches you patterns of movements that build a functional, responsive core and pelvic floor. RYC® is a whole body approach that takes your daily movements and patterns into account so that you can retrain your body all day long and not just when you are sprawled out on the floor doing your next set of Kegels. To our excitement, our hypothesis was confirmed when we began to hear feedback from women who had restored their core and minimized or eliminated prolapse symptoms. Give us 12 weeks, and we will show you how to champion your own core. from https://restoreyourcore.com/learn/prolapse/how-to-stop-a-prolapse-from-getting-worse
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Surgery for pelvic organ prolapse is a big deal. It is a big deal because you live in an age where you have many pathways to health, and don’t have to live with pelvic organ prolapse.Although surgery can be a viable, medically recommended option for many people, it is very invasive without a guaranteed outcome. Some people may find relief from their painful symptoms, yet, like many procedures, it can often require more intensive medical treatmenteven after the first surgery was performed. Surgery should be considered a last option when dealing with core, pelvic floor, or other related issues. To be clear, our goal here at Restore Your Core is to strengthen your core and pelvic floor so you can live without surgery being a part of your story. Thousands of women use our program with amazing success as an alternative route to surgery because we work to restore function and integrity to the pelvic floor. However, we do not judge anyone’s choice to have surgery and we understand that sometimes it is the only choice! We support all choices so we would like to use this article to educate you on those choices. Please note, even if you decide on surgery, one year of pelvic floor rehab is very much recommended to prepare the body as it is a major surgery. How Do I Know if My prolapse is Severe?Surgery is for severe cases. So when are you considered severe? We strongly urge you to discuss it with your provider and get multiple opinions from doctors and therapists regarding your case. It is important to recognize that pelvic organ prolapse can involve one or more of your pelvic organs, including your uterus, bladder, and rectum. After injury to or the weakening of your pelvic floor muscles, your organs can drop into the wall of your vagina. We break down the different types of pelvic organ prolapse in other articles, but for your knowledge, we will include a list here:
How Do I Know What Stage My Pelvic Organ Prolapse Is?Severity of Pelvic Organ Prolapse has to be diagnosed by your healthcare provider, but the general rule of thumb for staging is:
What Happens if Prolapse is Left Untreated?That is hard to know because some women have it for years and it can stay the same! However, for others, it can actually get worse. It can depend on a variety of factors, many might be out of your control: like tissue integrity and genes. Other elements, like movement and exercise choices are more in your control. Strengthening your pelvic floor can keep your organs from bulging further into the wall of the vagina without surgery. What are the Symptoms of Severe Pelvic Organ Prolapse?A range of symptoms can be present in any stage of your journey with prolapsed pelvic organs. It is when your symptoms are interfering with your everyday routine or when interfering with other bodily functions that your doctor may talk seriously about surgery for your pelvic organs. Surgery is especially needed when we have organs exiting the body, a vaginal vault starts folding in on itself or your body becomes unable to rid itself of waste. Other symptoms can include:
People can often experience a prolapse post birth. Other common causes can be obesity, aging, or other surgery in the pelvic area. It can also be genetic and related to tissue integrity. Why is My Prolapse Worse Some Days?There are times during your cycle where you might feel worse. Hormonal changes can affect how your prolapse feels. This is common and even if you are doing great in your rehab process and this happens, do not panic! Many women feel it worse during ovulation. If you have just finished moving furniture around the house or gotten home from an intense workout just to be greeted with worse prolapse symptoms for the rest of the day, this is actually very normal for many women who suffer with pelvic organ prolapse. Straining on the toilet while trying to work through some constipation can also worsen your symptoms. When doing strenuous activities, we bear down and increase the pressure within ourselves and this can place even more pressure and force on the organs. How Do You Fix a Prolapse?Many forms and stages of prolapse, or pelvic organ prolapse can be treated by exercises that strengthen the pelvic floor. However some women need a little extra help getting their pelvic organs to stay where they are supposed to be. In these cases, surgery may become a necessary part of the journey. When it comes to surgical prolapse repair, there is no one size fits all reconstructive surgical option. Since we are not doctors, we do not give medical advice. The following is simply educational material and not intended as a form of medical advice. The type of surgery for your prolapse depends on your type of prolapse. We set out to tackle some of the most common questions regarding this. What Types of Surgery are There?Reconstructive surgery returns organs to their original position while repairing the pelvic floor. This can be done through an incision either in the abdomen or the wall of the vagina. Laparoscopic surgery is also an option here, which just means the surgeon makes smaller cuts in the abdomen while using instruments specialized for the surgery. Obliterative surgery is the last effort to prevent vault prolapse. This type of surgery is used if other invasive surgeries haven’t worked or can not be tolerated due to other health conditions. During this procedure, the vagina is narrowed or all together closed up. The goal is to provide more support to the organs that have dropped out of their normal positions and are pressing against the walls of the vagina. This isn’t the first choice because after the surgery, intercourse would no longer be an option. Sacrospinous ligament fixation and uterosacral ligament suspension surgery. A vaginal mesh of your own tissue is made to improve the support of the uterus. Mesh is placed under the vaginal skin to support the organs that are attempting to sag. Stitches are used to attach the vaginal vault to a ligament on your pelvis. Anterior and posterior colporrhaphy surgery. The anterior surgery is used for cystocele that bulges through the vagina with urinary incontinence. Surgery is used to make tissue stronger and tighter. Posterior repair is used when in rectocele that has dropped prominently into the vagina. This procedure often uses mesh as well as existing tissue to repair the sagging organs done through the vagina by using your own tissues or vaginal mesh to repair the prolapse. Sacrocolpopexy and sacrohysteropexy surgery. Both of these procedures focus on anchoring organs with mesh. Sacrocolpopexy is used to repair vaginal vault prolapse. Sacrohysteropexy is used to fix prolapse uterine. These can be done laparoscopically or through incisions on the abdomen. Can Your Organs Descend After a Hysterectomy?A prolapse of the uterus is unique because it is the only pelvic organ prolapse in which one of the surgical options is to just remove the problem organ if it will not stay in place. It is said that the traditional approach to uterine prolapse is to remove the uterus through the vagina, otherwise known as a vaginal hysterectomy Other treatment options are vaginal reconstruction, the placement of a pessary. (Of course, there are many other reasons why one would have a hysterectomy.) The issue with a hysterectomy is it could cause further prolapse of other organs because that sizable uterus isn’t there to claim its space anymore. Also, in doing the hysterectomy the underlying issue that is the weak, stretched out pelvic floor muscles were not dealt with. Information regarding the rate of post-hysterectomy prolapse varies. Currently, cumulative data shows the risk that your pelvic floor does not keep your organs in place is 1% three years after hysterectomy and up to 15% fifteen years later. This is why it is so important to strengthen your pelvic floor after you have healed from your hysterectomy. Many women who have a prolapsed uterus and want the surgical option will opt for the less invasive laparoscopic surgery or vaginal reconstruction surgery with a vaginal mesh rather than a hysterectomy. What Type of Surgery is Required for a Prolapsed Bladder?Cystocele, also known as a bladder prolapse, is one of the most common types of pelvic organ prolapse. The common surgical procedure to attempt to fix this condition is mid-urethral sling surgery. This surgery implants a mesh sling around the urethra, connected to the pubic bone, to help properly re-align the urethra to resolve urinary incontinence (leak pee). However, there are known complications with this surgery. If the mesh sling does not resolve your symptoms, often the surgeon will recommend anterior repair surgery. Surgery is not something we encourage or discourage our clients to consider. However, if your doctor has recommended surgery as being your best option, it is better to discuss this solution with a medical professional Is Prolapse Surgery Painful?As with many surgical procedures, there is a time for recovery that may be painful for some. With pelvic prolapse surgery, your body has undergone a pretty dramatic transition. Post-op, you will most likely be given medication to help reduce pain. Take it as directed by your doctor. It is important that if you are considering, or have received surgery to repair pelvic floor dysfunction that you address any concerns you may have with your healthcare provider. How Long Does it Take to Recover from Prolapse Surgery?Your recovery time will be dependent upon the length, type, and invasiveness of your procedure. In some cases, recovery times may only take up to a week or two and in others it may be over a month. When talking with your doctor, be sure to discuss recovery time and what is expected during your recovery. What Should I Expect After Surgery for Pelvic Organ Prolapse?We hope that your recovery will be a quick transition back into your daily activities. It is common for many women to experience fatigue, slight bleeding at the surgery site, and to be prescribed pain medication post-op. If you have any concerns or questions regarding the requirements after surgery, it is best to discuss this with your doctor. As soon as your doctor has confirmed that you have recovered from surgery, we hope that you join us in our 12 week program and learn how to Restore Your Core beyond surgery! from https://restoreyourcore.com/learn/prolapse/prolapse-surgery/ Cystocele is the most common type of pelvic organ prolapse that occurs after vaginal childbirth. During a vaginal delivery, the pelvic floor muscles can be compromised as they stretch to make room for the baby to make its grand entrance into the world. The pelvic floor muscles are designed to hold up the organs of the pelvis. A severe enough breach in the system can cause a prolapse. When these muscles are compromised, the organs are able to drift or “sag” down the path of least resistance until they bulge into the vaginal canal. It is important to know that there are many types of pelvic organ prolapse besides cystocele that will not be discussed in this article, but are listed below for educational purposes:
What causes a Cystocele?Cystocele (cysto- meaning bladder, -cele meaning pouching or herniating) is the downward displacement of the bladder that descends until the bladder bulges into the vaginal wall. This is sometimes referred to as “fallen bladder” or “prolapse of the bladder.” Though it is possible that cystocele occurs because of reasons outside of childbirth, such as genetic disposition, increased age or obesity, it is most commonly seen in women who have experienced a vaginal delivery. How is a cystocele diagnosed?Methods of diagnosis depend on how much the prolapsed bladder has advanced from its usual position. The pelvic exam is used for the obvious prolapsed bladder. The provider may only need to do a visual exam of both the vaginal opening and the pelvis to spot the bladder in late staged prolapse (I’ll break down the stages for you momentarily). Typically this presents as a pronounced bulge in the vaginal canal or through the opening of the vagina. I strongly recommend doing this exam from a standing position. A voiding cystourethrogram may be used in less obvious cystoceles since the prolapsed bladder is not always visible In the vaginal opening in earlier stages of descent. Essentially, an X-ray is taken of the bladder while you urinate to capture the shape and placement of the bladder and vagina during the effort. Your provider will guide you through the preparation for this procedure, but there are typically no special precautions needed. What are the symptoms of Cystocele?Symptoms of a cystocele vary from mild, moderate or severe depending on just how far that bladder has sagged from its usual position. The Grading System
How Can You Tell if you have a Bladder Prolapse?Typically the first tell tale sign is a feeling of bulging in your vagina, heaviness, fullness, feeling of bubbles in your vagina and a change in your urine frequency/incontinence after a vaginal delivery that doesn’t improve over time. If it is more advanced you may be able to see the bulge formed by the bladder prolapse in the canal or vaginal opening. Heavy lifting, bearing down or straining during bowel movements may increase the feeling of pressure in the pelvic floor. Some women report feeling as if they are sitting on a ball. What do I do if I Suspect Cystocele?If you experience any of these, contact your health care provider for further investigation to get you on the best track to getting back a healthy pelvic floor. Restore Your Core® has a Cystocele-specific workout program that we recommend to our community of ladies (if you’d like to join the community, you can find our group of 20K+ women here). It is important to note that we always recommend talking with a doctor to get an official diagnosis. How do you treat Cystocele?We always recommend conservative treatment as a first step. The typical goal of conservative treatment is to improve symptoms, reduce progression, and all together avoid or delay surgical treatment. Providers may talk to you about hormone therapy and other cystocele treatments that fit your unique medical picture. Please note: Typically at the beginning of treatment, heavy lifting or straining during bowel movements should be avoided. How can we help you along your cystocele journey?I have spent 20 years developing a method that addresses core and pelvic floor dysfunction from a functional perspective. What that means is that we address the compromise, the injury from a very “whole body” perspective. We see the pelvic floor as a system that is connected, dependant upon other systems. Pelvic positioning, posture, breathing, spine mechanics, all affect the pelvic floor. Our approach is not a spot treatment one. We do not simply say “do your kegels.” That is a pretty old school method that often does not work and can make things worse. Rather, we look at the whole of you and help you determine what your movement compensations are so you can help your pelvic floor become reflexive, responsive and supportive to your organs and body once again. Cystocele Recovery with Restore Your CoreIt is important to understand that our overall health can be significantly impacted by the way in which we move. My 12 Week Program: Restore Your Core offers a step by step approach to developing a strong, healthy, responsive core & pelvic floor system, for the health of your whole body. Restore Your Core® seeks to train women to intelligently and holistically heal from core and pelvic floor disorders while educating them on how their body’s function and how to properly engage their bodies during their daily activities. To learn more about the various exercises that assist in core strength and resolving core and pelvic floor pain, check out one of my previous blog posts. from https://restoreyourcore.com/learn/prolapse/what-is-cystocele/ Repair for a vaginal rectocele is pursued in order to correct the herniation or bulging of the bottom wall of the vagina. Symptoms of rectocele can become quite uncomfortable and painful over time. If left untreated, rectocele can lead to symptoms such as: the feeling of increased pressure or protrusion in the vagina or rectum, inability to defecate or feeling of incomplete emptying of the bowels, pelvic pain, and/or painful sex. Both non-surgical and surgical procedures for rectocele repair are only considered if symptoms become severe and inhibit daily life. Surgery for rectocele is typically performed transvagianally, yet, in some severe cases, may be completed both vaginally and abdominally. Why Do I Need Treatment for Rectocele?Treatment for rectocele can greatly aid in managing and reducing symptoms of rectocele or other forms of pelvic organ prolapse. In some cases, rectocele and POP may be undetectable until the condition has progressed in severity. A small rectocele is often unrecognized until a doctor notices it during a physical examination. In many cases, rectocele occurs alongside other pelvic organ related conditions. Treatment is designed to help reduce symptoms and heal any herniations, tears, or prolapses. Treatments include both surgical and non-surgical options. Although surgery for rectocele is often rare, in severe cases surgery may be your best option. Severe rectocele symptoms include:
Is Rectocele Repair Major Surgery?Rectocele repair surgery is a major, out-patient surgery. A doctor will typically only recommend surgery for rectocele if at home exercise programs and / or physical therapy has not resolved the problem. The surgical procedure for rectocele removal is called posterior colporrhaphy which removes the herniated bowel from the wall of the vagina. Rectocele surgery is designed to:
What is a Rectocele Repair Procedure?The procedure for rectocele repair surgery is typically a straightforward process. The surgery is often performed through the vagina (transvagianlly.. The procedure is typically performed by a surgeon making a small incision along the posterior vaginal wall. Excess tissue along the herniation is removed and stitches are sewn around the tear sight. If the doctor notices any other forms of pelvic organ prolapse, he may resolve those issues as well during the procedure. Once complete, the vaginal incisions are stitched up and packed with gauze. Please speak with your doctor for more information on this process. Post-Op Rectocele RepairPost operation there are a few things that may occur. The most common symptoms post rectocele surgery is slight pelvic and rectal discomfort and pressure, as well as slight vaginal bleeding, and minimal pain during bowel movements. These symptoms typically resolve in a couple weeks once the tissues have healed. Please speak with your doctor for more information on post-op expectations. Rectocele surgery is usually successful and helps resolve the symptoms in nearly all patients. Rectocele Surgery Recovery TimeRecovery for rectocele is usually quick and has minimal risks during recovery. The incisions made at the repair sight will typically heal in approximately 2 to 3 weeks. Please speak with your doctor for more information on recovery expectations. Post-operation, you should be able to move about, carefully, within a few hours after your surgery. You may be prescribed some pain medication to help relieve any discomfort during your recovery. You should abstain from any physical exercise and sex until after 6 to 8 weeks post-op. Please speak with your doctor for more information on post-op instructions. There will typically be a follow-up appointment required within the final 4 – 6 weeks after your surgery. What are the Risks of Rectocele Surgery?Although uncommon, there are a few risks with rectocele surgery. These can include:
Can you Fix a Rectocele Without Surgery?Often, yes. As with many forms of pelvic floor prolapse, rectocele is treatable without the need of surgery. Various forms of exercise, pelvic floor therapy, dietary restrictions or additions, staying hydrated, and practicing proper core and pelvic floor engagement techniques are highly beneficial for treating rectocele. Surgical procedures should always be a last resort when dealing with core or pelvic floor related issues. Some of the best advice I give to my clients regarding their health includes practicing proper breathing mechanics and good posture as well as learning how to have a reflexive core and pelvic floor to support their daily activities. Good Practices for Pelvic Organ Prolapse (POP)A few of the techniques and practices I cover in my program Restore Your Core include: Proper Breathing Mechanics:I teach my clients in RYC how to breathe 3-dimensionally. This means that as you inhale, you use your ribcage to accommodate air as it enters your body. Think of it like this: breathing in air creates a shape change in your body. You can change shape by pushing your belly out and increasing pressure, or you can change shape by allowing your ribcage to expand to make space for your lungs. Doing the latter allows your body to properly engage and respond to the demands of daily life. Your pelvic floor function is closely related to your core function. So, when I am working with my clients to resolve any pelvic floor issues (i.e. rectocele), I am essentially addressing their core issues as well. Belly breathing does not only affect your pelvic floor, but also significantly impacts core function. Posture: Pelvic Alignment and Reducing Abdominal Pressure:Our posture and how effectively we use our bodies in our daily activities significantly impacts our overall core and pelvic floor health. Not only that, but our posture can also greatly affect our joints, muscles, and bone health. When it comes to working with my clients on their rectocele, I always ensure part of their treatment involves restoring and healing their pelvic floor function. An unintentional mistake many women make when standing upright is shifting their weight forward in their hips. Think of the hips leaning forward. This shift can actually increase tension in the muscles of the pelvic floor leading to varying types of POP. In the process of resolving pelvic alignment, I might work on hamstrings, upper back mobility, glute function, pelvic mobility and more. Resolving pelvic floor issues requires us to view the pelvic floor as a part of an entire system and therefore requires a whole-body approach. The process of learning how to align your body to better support you while you stand takes time, but is well worth the process. And your pelvic floor will thank you for it! Better alignment = less pelvic floor tension and pressure. Now that you know that rectocele can be treated without the need of surgery, it may be time to learn more about how to use exercise to heal your pelvic floor. My 13 Week Program: Restore Your Core offers a step by step approach to developing a strong, healthy, responsive core & pelvic floor system, for the health of your whole body. from https://restoreyourcore.com/learn/prolapse/rectocele-repair/ A woman’s vagina is separated from her rectum by ligaments and tissues known as the rectovaginal septum. The tissues that line this wall are called fascia. At times, due to compromised pelvic health or pelvic injuries, a woman may experience a weakness of the vaginal wall and rectovaginal septum. When this occurs, a part of the rectum can bulge and protrude into the vagina. This is called a rectocele prolapse. What is Rectocele?Rectocele is a condition which causes the supportive tissues between the rectum and the vagina to weaken. This can occur due to excess pressure in the rectum, excess vaginal pressure, or excess intra-abdominal pressure leading to pelvic floor issues such as pelvic organ prolapse (POP). When this occurs, the separating tissues can herniate causing the front wall of the rectum to bulge into the vagina. This issue is also commonly called a posterior vaginal prolapse. Oftentimes, the prolapse is small and does not pose any painful symptoms or difficulties. However, in severe cases, the bulge may manifest outside of the vaginal opening and require surgical repair. Signs and Symptoms of RectoceleIn many cases, someone may have a rectocele for a long period of time without noticing any symptoms. In minor to moderate cases of symptomatic rectocele, someone may experience feelings of mild discomfort, pressure, or minor pain in the vaginal or rectal regions. This may be accompanied by a feeling of incompletion after bowel movements. In moderate to severe cases, women with a rectocele may have an increased sensation of pain and discomfort in their vagina, rectum, or abdomen while pooping. This can be a result of the feces being pushed into the rectocele during a bowel movement. Women with moderate rectocele run a higher risk of constipation, painful intercourse, and lower abdominal and lower back pain. In severe cases, the rectocele can prolapse causing the tissue to protrude out of the vaginal opening. Other symptoms of rectocele may include:
Rectocele is a common condition many women may face without ever knowing it. Most often it is associated with postpartum issues, but it can affect women who have never been pregnant as well. If you are experiencing severe issues such as: tissue bulging through your vaginal opening or constant struggles with constipation, it may be time to consult your doctor for a proper diagnosis. Generally a Urogyn is the best bet for diagnosis. What Causes Rectocele?There are many reasons why someone may have pelvic floor related issues. Most commonly the weakening of the pelvic region, the vaginal and rectal tissues, and core strength relate to pregnancy and difficulties in vaginal childbirth – especially birthing multiple children. Women who required equipment assistance during their delivery (suction, forceps, etc) may run a higher risk of developing a rectocele than women who did not. Large babies and longer labor periods can also contribute to weakened pelvic floor muscles. Some other possible causes for rectocele include:
Women going through menopause go through a host of changes and significant hormonal shifts that can affect the pelvic floor muscles. Aging can also affect durability and strength of muscles over time, especially in the pelvic region. Excess pressure in the abdomen like constant abdominal tension, excess abdominal tone, poor core strategy, poor exercise strategy can also contribute to pelvic floor weakness. What happens if Rectocele Goes Untreated?Rectocele is usually not a very serious condition and may go unnoticed for years. However, if someone is experiencing symptomatic rectocele and leaves it untreated, they might suffer a host of painful symptoms. A few risk factors of untreated, symptomatic rectocele include: chronic constipation, vaginal bleeding unassociated with menstrual cycles, prolapse the rectal wall into the back wall of the vagina, and rectocele repair surgery. It is important to consult your doctor if you are experiencing any of the symptoms listed above. Can a Rectocele Go Away on its Own?Unfortunately, it is ot thought that a rectocele will heal on its own. Although it can go asymptomatic for years, it will still remain there unless treated in some way. If ignored, a rectocele can become larger and present more problems over time. During a regular health exam, your doctor may notice the presence of a rectocele. If so, there are many ways you can pursue treatment without the need of surgery. How do you Fix a Rectocele?Fixing a rectocele can be done in many ways. Diet & ExerciseNon-surgical treatment depends entirely on the severity of your rectocele. In most cases, rectocele can be treated through: Exercise: Your doctor will most likely recommend performing daily exercise routines or pelvic floor therapy in order to strengthen and heal your pelvic floor. Exercises for POP are designed to heal many forms of pelvic organ prolapse and can greatly aid in your rectocele treatment. Dieting: Dieting can also significantly help with any digestive issues that might be contributing to your rectocele. A high fiber diet and ensuring you are consistently well hydrated can help reduce your risk of constipation and straining during bowel movements. Vaginal Pessary: Your doctor may recommend a vaginal pessary to help support the bulging tissues in your vagina. A pessary is a small rubber or plastic ring used for vaginal health. SurgeryAt times, exercise based treatment is not enough to treat rectocele. Surgical repair may be considered if you are experiencing: a prolapse which protrudes outside of your vagina, or additional pelvic floor issues that may be increasing the painful symptoms. In this case, rectocele repair surgery might be advised and any co-occurring issues can be repaired at once. In many cases, it is a minimally invasive surgery that removes any excess tissue along the bulge and stitches the area up for support. from https://restoreyourcore.com/learn/prolapse/rectocele-symptoms/ Persistent pelvic floor pain can be difficult to endure. Pelvic floor dysfunction issues can range between hyperactivity to pelvic organ prolapse. The result of both cases can lead to painful and embarrassing symptoms for both men and women. In this article, I will address helpful exercises and stretches that help free you of painful symptoms and aid in restoring pelvic floor and core function. To be clear, stretching is just one type of input into the pelvic floor system and is not the only thing you should do for a tight / tense pelvic floor. Downtraining your pelvic floor will require a variety of loads and inputs, stretching is one important one. Symptoms of Tight Pelvic Floor MusclesWhen addressing tight pelvic floor muscles or pelvic floor pain, there are a few symptoms that are common between men and women suffering from POP or a weakened pelvic floor. These can include symptoms such as:
Dealing with these symptoms can be embarrassing and prolonged suffering can result in a host of other issues. The goal with movement programs like Restore Your Core, is to help you overcome these painful symptoms while encouraging proper core and pelvic floor engagement on a daily basis. Below are a few of the techniques, exercises, and stretches I teach my clients in my program. How to Stretch Pelvic MusclesThere are several ways you can properly stretch and engage your pelvic floor in order to reduce pelvic floor tension . One of the most beneficial and important techniques that I teach my clients is 3-D breathing – a pattern of breathing that uses the rib cage expansion rather than belly expansion for an effective and efficient strategy. One of the key elements in resolving pelvic floor dysfunction and POP is breathing mechanics. In Restore Your Core, I spend a significant amount of time teaching my clients proper breathing mechanics. Often people don’t realize the way they breathe impacts the integrity of their core and pelvic floor. Yet, most of us do not even realize easily we can fall into improper breathing patterns. Most people are belly breathers. This means that while inhaling, they’re extending their abdomen – focusing the tension in their belly. An Illustration of this would look like filling an oval-shaped balloon with water and squeezing the top creating a bulge. The exact same thing happens when you belly breathe. Bulging your gut strains your core and pelvic floor by increasing intra-abdominal pressure. This tends to cause muscle and organ damage in those regions. Our pelvic floor is not designed to handle a lot of consistent pressure and stress. I spend a lot of my time with clients training them to 3-D breathe. 3-D breathing trains you to engage your diaphragm and rib cage while breathing. This means that instead of your belly extending as you inhale, your rib cage expands. Breathing in this manner reduces pressure in your core and pelvic region. Additionally, this technique encourages proper core response and engagement in your daily activities. Now that you understand proper breathing mechanics, it is time to learn how to properly stretch and exercise your core and pelvic floor. Stretches for the Pelvic FloorSupine Pelvic Floor Stretch:Lying on your back, keep your knees bent and bring them toward your chest. Slowly extend your knees to the side to stretch the inner groin. Relax your pelvic floor and butt. Remain in this position for 5 to 10 breaths and relax. Supported Slight Backbend Pelvic Stretch:This is a fantastic pelvic stretcher. Using a pillow or bolster of some kind, gently lower your back to rest on top of the pillow. Once in position, slowly bring your feet together so the soles of your feet are touching. Keep your knees bent, but gently allow them to open sideways. If you feel any discomfort at all in your back or inner thighs, you can use pillows for further support or get rid of the bolster. Relax after 30 seconds or more (roughly 15 to 20 breaths) Supported Pelvic Squat:This stretch is an incredible hip and pelvis stretch. Grab a low stool or a stack of books and with your feet spread wide and toes pointed out sideways, gradually extend your buttocks and lower yourself to the blocks. If you are struggling to balance yourself, it may be helpful to use a wall for back support. It is important that if you experience any discomfort during these stretches that you reposition yourself until you can firmly plant your feet and bend without pain. Stay in a squatted position for close to 30 seconds (5-10 deep breaths), stand back up, relax, and repeat several times. Please note, that for some people with prolapse – a deep squat can really irritate and aggravate things due to bearing down, so be sure to only do this one if you feel comfortable that you are not bearing down in a low squat. Yoga for Pelvic Floor Muscle RelaxationLegs up the wall:This exercise offers a lot of people relief from their symptoms and it is a great way to downtrain the pelvic floor. I always teach this with a block / pillows / blankets under the hips for elevation. The elevation is pretty key so be sure to get your hips on something. Elevate your hips and simply bring your legs up a wall. Move closer or further away from the wall depending on your body and comfort. Stay for 3-4 relaxing breaths and then you have a few options. One is to bend your knees and have the soles of your feet touching while still leaning legs against the wall. Adjust your body to make this more comfortable. No stress or tension in your hips. The other is to simply bend your knees and place the soles of your feet on the floor and relax your pelvis and pelvic floor and finally, option #3 is to open your legs wide and keep them against the wall while straddled. Find the position that best allows you to relax and release. Hold for 5-8 breaths. Happy Baby Pose:Lie on your back and bend your knees bringing them close to your chest. Grasp the soles of your feet with your arms inside your knees. Open your knees wide carefully, keeping your feet together, and making sure you’re breathing deeply. While in this position, press the soles of your feet into your palms. Relax and repeat 3-4 times. You can also do this with pillows under your hips if you find that you are fighting tight hips here. Child Pose:Begin this pose by resting on your hands and knees. Extend your arms slightly in front of you while relaxing your lower body and butt down toward your heels. Gradually lengthen the distance between your knees, but keep your feet together. Hold this position for 30 seconds and breathe restfully. from https://restoreyourcore.com/learn/pelvic-floor/pelvic-floor-stretches/ Pelvic floor physiotherapists help women rehabilitate their pelvic floor region. The muscle groups within the core and pelvic region can be weakened by childbirth, surgery, genetics, heavy lifting, rapid weight gain, constipation, menopause, improper breathing mechanics, and more. These muscle groups aid in supporting the uterus, bladder, and bowels. They form a slinglike grouping from the pubic bone to the front of the tailbone at the back. Damaged or weakened pelvic floors can affect bladder and bowel control, leading to urinary and rectal incontinence or even pelvic organ prolapse. At times, the pelvic floor can become overactive or hypertonic. This means that their pelvic floor muscles are overly tight and tense all of the time, even when they should be relaxed. Learning to relax and release the pelvic floor muscles (muscles contractions like the short contraction of the bulging of a bicep or long contraction, like the slow, contained stretching out of a bicep) will help ease overactivity. An overactive pelvic floor can cause many symptoms such as: back pain, pain during sex, heaviness or incontinence. What is a pelvic floor specialist?Doctors who specialize in pelvic floor dysfunction issues are called urogynecologists and physiotherapists. A urogynecologist will care for women with pelvic floor disorders by providing services that help evaluate pelvic floor health and provide primarily surgical treatments for pelvic organ prolapse. Their speciality covers the muscles, ligaments, connective tissues, and nerves within the uterus, vagina, bladder, and rectum. A physiotherapist or Occupational therapist who specializes in pelvic floor treatment helps treat pelvic floor issues non-surgically. This is commonly done through exercise and manual therapy as well as extended education and advice on how to properly engage and strengthen your pelvic floor. Other specialists who aid in pelvic floor therapy include movement specialists and occupational therapists. Movement therapy can play a significant part in retraining the body toward correct posture, alignment, deep-tissue manipulation, and provide educational instruction on how the body works and how it heals. What is involved in pelvic floor physical therapy?Pelvic floor therapy most commonly involves exercises and education on how to properly engage and strengthen the pelvic floor. A specialist like a physiotherapist will help instruct their clients with a range of techniques ranging from:
Pelvic floor therapy seeks to instruct women in how their bodies work while also treating any conditions causing pain or embarrassing symptoms – like pelvic organ prolapse. When seeking treatment for pelvic floor dysfunction or POP, there are a few things you should keep in mind. Professional Care When seeking treatment for PFD or POP, make sure that the instructor or doctor is trained and educated in pelvic floor treatment. An initial assessment by a urogynecologist can assist you with a referral to a great physical therapy specialist. Consultation Seeking physical therapy for pelvic floor issues does not require a referral from a medical professional. When you see a physio, they will take a full history of your bladder and bowel function, sexual function and medical and surgical history. A pelvic floor assessment is commonly performed through what is called a manual palpation. This is an internal assessment to determine pelvic floor muscle function, strength, and overall health. They will also be interested in your fitness activities. Treatment Treatment for PFD could include exercises, biofeedback (electronic monitoring), and manual treatment of the muscles. In my programs I give extensive advice and education regarding daily activities and fitness, as well as good bladder and bowel habits, and proper posture and breathing mechanics. Function based training of the pelvic floor helps get your muscles back to working effectively when you need them. RYC & Movement Therapy for PFD In your search for pelvic floor therapy, you should consider a therapist trained in treating those with PFD – someone who is knowledgeable in their field and has experience in treating symptoms of PFD or POP. As an internationally recognized Yoga + Pilates teacher specializing in core and PF issues, I have been working with people for years with various core related issues. I am a longtime movement teacher with 20 years of experience guiding people through injury rehab. With my years of experience I have created online exercise programs that are challenging, unique, safe, sustainable, and life-changing for clients who may be facing difficult symptoms for PFD or diastasis recti such as prolapse, incontinence, chronic pain, and weakened rectus abdominis muscles. When should you see a pelvic floor therapist?Symptoms vary and differ from person to person. Whether your pelvic floor dysfunction is caused by an underlying illness or disease or caused by incorrect breathing mechanics or a result of an abdominal injury may also increase pain or play a part in the dysfunction of the pelvic region. Some of the most common symptoms associated with pelvic floor dysfunction may include:
Tight and overused pelvic floor muscles can result in painful and embarrassing symptoms. Pelvic pain and loss of control with bowel movements can be an embarrassing result of pelvic floor dysfunction. If you are experiencing any of the symptoms above or any other discomfort or pain, you should consider contacting a medical professional to be assessed. However, if these symptoms are present, there are ways to begin healing and loosen your pelvic floor muscles in order to gain back control over your body. PF therapy can helpA physiotherapist will help increase muscular mobility and strength while helping reduce pain by teaching gentle stretches and exercises. They are specially trained to help strengthen or rehabilitate the pelvic floor. As you know by now, therapy goes way beyond kegels. My 13 Week Program: Restore Your Core offers a step by step approach to strengthening your whole body. If you feel a bit unprepared to tackle a long program, here is a video of 5 exercises that are wonderful to get you started. Regardless of who you see and whether or not a medical professional is needed, PFD physical therapy can assist in treating painful symptoms such as:
from https://restoreyourcore.com/pelvic-floor/pelvic-floor-specialist/ Pelvic floor repair surgery is the most common surgery for pelvic organ prolapse. Pelvic floor repair is a broad term used to classify a variety of simple, surgical procedures for repairing the pelvic floor. The three surgeries for pelvic floor prolapse include anterior repair, posterior repair, and a hysterectomy. Although Restore Your Core does not provide any surgical treatment for pelvic floor issues, my hope is that this article may answer any questions you may have regarding pelvic floor repair and the various procedures and treatments involved in getting you back to a healthy, active lifestyle. What are the Symptoms of Pelvic Organ Prolapse?Prolapse can affect several abdominal organs. These organs are said to prolapse if they descend into or out of the vaginal canal or anus. The medical terminology for these occurrences include:
What Causes Pelvic Organ Prolapse?There are many factors that are thought to cause a prolapse. In most cases, anything that may apply or put increased pressure in the abdomen can lead to a pelvic organ prolapse. Some of the common causes may include:
SymptomsThe symptoms of a prolapse somewhat depend on which organ has descended. If you are suffering from a bladder prolapse, urinary incontinence may occur. If it is a rectal prolapse, constipation, painful bowel movements, and painful sex often occur. Lower back pain, painful sex, and bowel obstruction or incontinence tend to accompany a small intestine prolapse as well. If you are suffering from a prolapse of the uterus, you may also suffer from uncomfortable intercourse, incontinence, and lower back pain. In some cases, there may never be signs of a prolapse or the presence of any painful symptoms. However, in others some women report symptoms ranging from:
In cases where there may be a severe prolapse, POP symptoms may worsen. One may notice:
How long does a pelvic floor repair operation take?The length of the surgical procedure can vary greatly from patient to patient. The general estimate for the surgery ranges from around 3-5 hours, but may have a shorter or longer duration depending on various factors. Some of the elements that may determine the length of the operation can include:
Does Surgery Really Work?Surgery to fix a uterine prolapse are usually successful. In most patients the surgeries for POP have been reported to have an 80% – 95% success rate. The success rate for sacrospinous ligament fixation (surgery to correct the bulging of the vagina) ranges between 80% – 90%, for uterosacral ligament suspension (surgery restoring support to the top of the vagina) is also 80%-90% successful, and sacrocolpopexy (surgery fixing the vaginal vault and the cervix) and sacrohysteropexy (fixing the prolapse of the uterus) have also shown the same success rate. However, even after prolapse surgery, there is still a chance that another part of the vagina or uterus may prolapse. What Can I Expect After POP Surgery?These are the general guidelines that doctors will usually give post POP OP (this is not medical advice): Each day in recovery you can expect to begin to feel stronger. During your recovery, you may need to remain on pain medication for about a week or two and may experience fatigue and weakness. A typical recovery time line varies from 4 to 6 weeks until you recover from an open surgery and anywhere from 1 to 2 weeks to recover from vaginal surgery. Your doctor should give you more specific guidelines. During your recovery period, you should avoid any sexual activity, vigorous exercise, heavy lifting, or any activities that may put pressure or strain your operation area. Your doctor should give you more specific guidelines. The most important aspect to your quick recovery is rest – getting enough sleep will help you recover. During your recovery, you might experience vaginal discharge or light bleeding. If so, avoid using tampons or douche. Use a sanitary pad if necessary. Your doctor should give you more specific guidelines. How long do you stay in the hospital after prolapse surgery?After your prolapse surgery, it is likely that you will need to remain hospitalized for 2 – 3 days depending on the operation and any underlying medical conditions you have. During this time your medical care takers will help ensure your recovery by monitoring for any potential complications and providing clean, sanitized treatment of the operation site. Are There Complications with Prolapse Surgery?Although pelvic surgery has proven to be a very safe procedure, as with any surgery, there are a few risks and potential complications that can arise. Please discuss this with your doctor but the common ones include:
If you are experiencing any of these symptoms of complications, it is important that you seek medical assistance. In some cases these symptoms can be common and unserious, but it is always best to consult your doctor if you have any concerns. Can pelvic floor muscles be repaired?If you have experienced a prolapse, uterine or otherwise, it can be a shocking and painful experience. However, there are ways to decrease symptoms without surgery. Nonsurgical TreatmentsThere are several ways in which to treat a uterine or vaginal prolapse. The three most common approaches are pessary, restorative exercises, and biofeedback therapy. Pessary A pessary is probably one of the first treatments your doctor will recommend if you have symptoms of POP. A pessary is a ring shaped device that is inserted into your vagina. This will help support your pelvic organs. Being fitted for a pessary is a lot like being fitted for a diaphragm. Many of my clients with severe POP find that a pessary is useful for allowing them to live fuller lives while they slowly use PT and exercise to help resolve the prolapse. Restorative Exercises & Physical Therapy Pelvic floor exercises help strengthen your pelvic muscles. Although the most common exercise recommended by health professionals today is the kegel exercise, there are many more exercises that you can do that are helpful for restoring PF function and giving support for your pelvic organs. Kegels are a pretty outdated model of care when used alone, without a more whole body approach to healing. What is involved in pelvic floor reconstruction?Pelvic floor reconstruction surgery is a group of procedures that are performed to treat prolapse of uterus, rectum, small intestines, or other pelvic organs. Anterior Vaginal Repair Anterior repair is a surgical procedure that seeks to reinforce weakened layers between the bladder and the vagina. This surgery helps relieve symptoms such as vaginal bulging and to improve bladder function. The surgery can be performed under general anaesthetic. The most common method of anterior repair is by an incision made along the centre of the front wall of the vagina – starting at the entrance and ending at the top of the vagina. The weakened layers are then repaired and anu superfluous tissue is removed. This is typically done with absorbable stitches. Posterior Vaginal Repair A back wall (posterior) vaginal prolapse is usually caused by weakness in the tissues and muscles that divide the vagina from the lower part of the bowel. This surgical procedure is performed to order to repair or restore the weakened layers between the rectum and the vagina. As with an anterior vaginal repair surgery, posterior repair surgery is usually performed under general anesthetic. The procedure involves a minor incision being made along the back wall of the vagina starting at the entrance and finishing near the top. The weakened layers are then repaired using absorbable stitches. Vaginal Hysterectomy A vaginal hysterectomy is typically performed with a prolapsed uterus. This is when the uterus (womb) descends into the vagina and in some severe cases, protrudes or extends outside of the vaginal canal. The surgery is performed by removing the uterus through the vagina. A vaginal hysterectomy is performed under general or spinal anaesthetic. In order to remove the uterus, the surgeon will make an incision at the top of the vagina around the cervix, clears the bowel and bladder from the uterus, and cuts through the connecting tissues to remove the uterus. The surgeon will then close the vaginal vault and commonly adds additional supporting stitches as the surgery is being performed. Does Physical Therapy Help Post-Surgery?If you are meeting with a physical / occupational therapist or taking part in a rehabilitation program Restore Your Core, post-surgery, some of the common exercises and techniques consist of: Posture Spine, pelvis, and hip alignment is necessary for a sustained recovery. Being mindful of good posture will help relieve any additional strain or pressure you apply to your pelvic region. Restful Poses These poses are positions which utilize gravity to encourage the pelvic organs to be “repositioned” back into the pelvic cavity. Lower abdominal Exercises This involves contracting the lower abdominal muscles while practicing dynamic and static exercises. If done correctly, it can limit the stress placed on the interior organs during activities which increase intra-abdominal pressure (i.e. squats). PFM Strengthening PFM strengthening exercises are a great way to help get your body back to its normal function and to heal from POP surgery. I advise getting instruction from a pelvic floor specialist who is trained in assessing the whole person to determine the appropriate exercise routines for you. In my program, Restore Your Core, I cover many helpful exercises and routines that can help heal POP and any abdominal or core issues. To learn more about restorative exercises for uterine prolapse or other abdominal issues, consider checking out one of my previous blog posts on core workouts and exercises. from https://restoreyourcore.com/pelvic-floor/is-pelvic-floor-repair-major-surgery/ |
About UsRestore Your Core (RYC) is a comprehensive and sustainable fitness program that empowers women who aim to be strong, long, mobile and functional. Lauren Ohayon has taught RYC® throughout North America, Europe and Asia. Restore Your Core also boasts highly trained movement teachers around the world; from India to Alaska and Australia to North America and Europe. Lauren and the Restore Your Core teachers are helping women across the globe to gain core strength, achieve ideal pelvic floor function, and learn to move efficiently and exercise optimally—in a safe and nurturing community-driven environment. ArchivesCategories |