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The Truth About Pelvic Organ Prolapse (POP)

Who out there has heard, “Your pelvic floor is too weak and loose, so your bladder is falling out.” Who has been told, “Do your Kegels and if that doesn’t work, you need surgery.” If that is you, I hope to enlighten you.

Weak and loose pelvic floor muscles have long been the accepted reason for pelvic organ prolapse (POP). But research on the subject has failed to prove a correlation between pelvic floor weakness/looseness and severity of POP. If a weak and loose pelvic floor is the primary cause of POP, those that are the weakest and loosest should have the most severe POP, but we do not see that. In my practice, I see more often the contrary. Most of my patients have tight, overused pelvic floor muscles, including other muscles within the abdomen and pelvis.

I know, this does not make sense. How does a bladder fall out of a tight pelvic floor, right? What we need to understand is our pelvic organs are not just falling out of our bodies.

The pelvic floor is several layers of muscle that provide support to the pelvis. These muscles assist in supporting the organs of our pelvis, including the bladder, uterus, and rectum. The pelvic floor muscles are not a “hammock” holding the bladder or any other organ into your body. It is far more complicated than that. Like the rest of the body, our organs and joints are held in place by ligaments, tendons, muscle, and other tissue (fascia) that create a perfect balance of pushing and pulling around each joint and organ.

Too much or not enough pushing tension or too much or not enough pulling tension anywhere in the body creates issues, such as back pain, knee pain etc. In the pelvis we see pain, incontinence of urine and/or bowel or POP. POP is more often a symptom of a tension imbalance within the system creating pressure that literally pushes the pelvic organs out vs falling out as so many women have been led to believe.

We also need to understand the pushes and pulls affecting the pelvis are not only occurring in the pelvis. Rather, understand the pelvis and its organs are part of the body as a whole and are affected by pushes and pulls above and below it. So, tightness in your back, weakness in your hip muscles or restrictions in your feet are in part causing POP.

So why have so many women tried Kegels and not improved? Because weakness in the pelvic floor is rarely the cause or the only cause. For most women, Kegels are only addressing a small part of the issue and in others, doing Kegels only makes a tight pelvic floor even tighter, further perpetuating the problem.

And surgery? Failure rates for common POP surgeries are as much as 1 in 3 women. My belief is that these surgeries are only treating symptoms and not the cause of the prolapse. The tension/pressure imbalances in the system are still present after surgery and often magnified by scar tissue from cutting through the muscles and fascia during the surgery. This causes in the “repaired” organ to prolapse again or the prolapse of other organs.

So, what’s a woman to do? Pelvic floor therapy! Isn’t that just Kegels? No!! Pelvic floor therapy should be so much more. Techniques including specific and custom exercises, manual therapies and breathing should all be used to address the body as whole and treat all the tissues not just the pelvic floor muscles that are contributing to POP. When the tension/pressure balance is restored, the pelvic organs can move back into their correct position. Those of you with mild to moderate POP, full resolution of prolapse and symptoms are possible. For those of you that have been told surgery is needed, improvement may still be possible. For those of you with severe POP and when surgery is your best choice, pelvic floor physical therapy is strongly recommended prior to, and following surgery, to promote complete recovery.

In short, if you or someone you know are experiencing POP or any other pelvic floor dysfunction such pelvic pain, pain with intercourse, urinary or fecal incontinence, pelvic floor physical therapy should be your first treatment option. Please seek the expertise of a pelvic floor physical therapist before settling for, “Just do your Kegels” or any surgical intervention.

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