Menopause prolapse – the lowdown!
So, urinary leaking is something that most women become aware of over time, even if they haven't made the link with menopause, but what about prolapse? What is it, why does it happen, what can you do and why do you need to know?
Women’s Health Physiotherapists Christien Bird and Sophie Vohralik work with women at different stages in their lives, treating pelvic floor problems and prolapse. We met with them to find out just how depleted oestrogen levels and a weakened pelvic floor can cause prolapse in menopause. We were gobsmacked to hear that an unbelievable 50% of women in menopause will have a mild to moderate prolapse!
Read on for information and advice from prolapse experts, Sophie and Christien.
What is a prolapse?
The bladder, uterus, vagina, small bowel and rectum sit above, and rest on top of, the pelvic floor. This is a group of muscles and connective tissues that form a ‘hammock’ across your pelvic opening which normally holds everything, organs and all, inside the pelvis.
Where the pelvic floor is weak, or ligaments are damaged, it won’t support the organs as needed. The ‘hammock’ comes away and the organs start to descend downwards or come fully out of the vagina. This is a prolapse.
What causes the pelvic floor to weaken?
The main risk factors include:
- Pregnancy & childbirth - not just restricted to vaginal delivery.
- Constipation - a menopause side-effect. Straining and pushing puts pressure on internal organs. A full rectum sitting on the pelvic floor contributes to pelvic floor weakness.
- Exercise - inappropriate exercise puts a strain on the pelvic floor or when exercise causes pressure to come down from your abdominals.
- Perimenopause & Menopause – oestrogen is no longer around to keep the all-important pelvic floor in tip top condition, weakness strikes, organs are no longer supported.
What are the symptoms of prolapse?
- A bulge in the vagina
- Feeling something hard around your rectum when you wipe yourself after going to the toilet
- Lower back pain
- A chafing/rubbing sensation
- A feeling that something’s fallen internally, especially in women who are standing on their feet for long periods of time
Sometimes, woman can’t see or feel if they’ve had a prolapse. Check out our vlog, ‘Hot Flush talking pelvic floors, incontinence, prolapse and prevention’, where Sophie suggests taking a look inside your vagina. Using a rubber chicken to demonstrate what to look for, she explains it so much better than we can!
How to deal with prolapse?
Christien and Sophie both agree that if you manage prolapse appropriately and stay on top of it, it’s manageable for the rest of your life. Prevention being better than cure, start by exercising your pelvic floor:
- If exercises are done correctly and regularly, pelvic floors can be built up and strengthened, helping to keep organs in place as well as stopping urine leaks. See our vlog, ‘Hot Flush talking pelvic floors, incontinence, prolapse and prevention’, for simple, expert advice as Christien talks us through how to exercise correctly. (At around 9 minutes 50 seconds, you’ll find her step by step guidance, it's worth checking out!).
For a correct diagnosis, you’ll need a thorough assessment from a specialist doctor or Women’s Health Physiotherapist. A physical check alongside your lifestyle, bladder and bowel movements and any pregnancy and delivery histories will determine the the best support for you, including:
- Internal supports or pessaries – space occupying shapes inserted in the vagina to keep everything in place. Ring or cube-shaped, or natural sponges, these supports must be fitted by an expert.
- Modifying or introducing exercise regimes
- Using a pelvic floor toning device such as a Kegel8.
Reassuringly, Christien and Sophie say that 85% of women do well with a personalised pelvic floor programme which help with bladder and pelvic floor retraining and managing constipation to prevent prolapse. Talk to your GP if this resonates with you. The sooner, the better!
(If you experience urine leaks when you laugh or cough, see our blog ‘how to strengthen your pelvic floor to stop menopause incontinence’.)