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03 443 7271 | 21J Gordon Road, Wanaka | 15/5 Hawthorne Drive, Frankton Queenstown

Prolapse management

A prolapse diagnosis can be a hugely emotional moment for women. A prolapse is when the bladder, uterus or bowel drops down and sometimes outside of the vagina.  This is an area that still carries a lot of stigma and shame, and we’re so passionate about breaking down the walls around this topic and empowering women to make choices that give them their lives back.

Prolapse is surprisingly common.  Researchers believe that even as high as 50% of women have some degree of prolapse after childbirth, be it prolapse of the bladder, bowel or uterus. Prolapse symptoms include urinary or bowel incontinence, difficulty emptying the bladder or bowel, the feeling of not emptying completely the bladder or bowel, a vaginal heaviness or dragging sensation, aching in the lower back or vaginal or rectal bulge.

There are loads of measures we give on how to help with your symptoms and we urge you to know that surgery is not always the first port of call.

If you do end up having surgery down the track, there are plenty of things we can do first to help you prepare and set up for success.

Basically, we need to increase support from below the pelvic organs and reduce downward pressure from above the pelvic organs.  We have to make sure the bowels are working well and the bladder is emptying properly.

We can also provide support devices such as pessaries, which can help support the bladder, uterus and bowel if they’ve dropped a bit. We can give you advice on appropriate exercise, when to rest with feet elevated, management of constipation and respiratory conditions, weight loss and advice on avoiding / safe lifting.

Conditions we treat

A cystocele is when the bladder drops down into and sometimes outside of the vagina.  It can cause the feeling of  vaginal heaviness or a bulge into the vagina, problems emptying the bladder, incontinence, and feeling like your insides are falling out through the vagina.

A rectocele or posterior wall prolapse is when the bowel drops down into and sometimes outside of the vagina.  It can give the sensation that you have not fully emptied the bowels and sometimes you might need to push with the hand / finger in a certain place to empty fully.  The consistency of the stools matter here, and how you empty is important.  It can be a cause of many bowel issues like constipation, and bowel leakage. 

A uterine or apical prolapse is when the uterus drops down into and sometimes outside of the vagina.  It can feel like a lump or bulge into the vagina, a heaviness or dragging feeling into the vagina, or a back ache.

This is when prolapse can happen after a specific event such as lifting, running, straining on the toilet, after a coughing or vomiting sickness for example.  Rather than a gradual worsening of symptoms over time, this is a sudden onset of vaginal heaviness, bulge, or problems emptying the bladder or bowel.  Like any acute injury, the faster we can get onto it and give you the right information and support like a pessary, the better chance of healing.

Our services related to pelvic organ prolapse

Lifestyle advice

Reducing the downward pressure onto the pelvic organs and the pelvic floor can help improve prolapse symptoms. Common strategies that we see are ladies who are very grippy with their abs, creating pressure from above which can worsen prolapse symptoms. The way you breath also has a big impact on the ability of the pelvic floor to be able to support you. Improving things like chronic constipation and chronic coughing can help take the load off too. Posture matters. Subtle postural changes can make the world of difference to prolapse symptoms.

Being a healthy weight matters when it comes to prolapse. We can help you with this and also work closely with other member of our trusted team to give you the best advice on how to become a healthy weight.

Pessary fitting

A pessary is a flexible silicone device that goes inside the vagina and can help improve the anatomical position of the pelvic organs, and relieve prolapse symptoms such as vaginal bulge, heaviness or difficulty emptying the bladder or bowel. They can be worn all the time, or you can choose to wear them just when you need them, like in impact sport. Pessaries can also be used to improve urinary incontinence, as a rehabilitation tool for feedback of downward pressure into the pelvis during exercise and to facilitate pelvic floor strengthening.

No two vaginas are shaped the same, so there are a number of different pessary design options that may be of benefit, depending on your anatomy and type of prolapse.

All of our clients are taught how to insert, remove and self manage their pessary during a fitting. We work in collaboration with doctors to make sure that a pessary is safe and able to be used for each client.

Appropriate Exercise assessment and advice

Impact sport can cause downward pressure to the pelvic organs and the wrong kind of exercise, or exercise performed with poor strategies has the potential to make prolapse worse. We will assess to make sure your strategies and system is functioning well, and advise you on the most appropriate form of exercise after a full functional assessment. We want you to be able to do the exercise you choose, but in the right way, with the right strategies and support.

Running assessments can be completed to make sure you are using your dynamic stability system correctly, and minimal pressure is put on the pelvic organs.

Pelvic floor muscles Strengthening

Getting these muscles optimised to their full potential is what we are best at! This is our jam! No flimpsy pamphlet and generic instruction given… we assess you fully, and get your started on how to get these wonderful muscles, power house strong, and able to respond to what you will throw at it. Your program will be individualised to EXACTLY what you need. We don’t want your pelvic floor muscles to be your weakest link! Sometimes that might involve pelvic floor muscles relaxation (link through to this service from the pain section) first, before we can work on the strength, power, co-ordination and endurance of these muscles. They have to be fast enough to catch those coughs and sneezes, and have enough endurance to last a full day on your feet! They have to have enough tone to support your pelvic organs, and be able to fully relax to wee, poo and have sex! They need to be able to respond to impact during a lift or a jump…. And if you follow our recommendations… who knows…. Maybe you just might be able to shoot that ping pong ball across the room!

We will even help you with tips and trick on how to fit these exercises into your day, so that you can keep up the great work life long.

Safe exercise with prolapse assessment

We will help you determine the best type of exercise for you, so you can stay fit and healthy despite having a prolapse.

Frequently asked questions

No.  You can make your appointment without a referral.  ACC and private appointments are available. If you do have a referral from your doctor or health care provider, then they will send it to Pelvic Solutions directly. To book now click here.

Physiotherapists are experts at working with the musculoskeletal and neuromuscular systems of the body. With their additional specific training, Pelvic Floor Physiotherapists are well-placed to assess and treat muscle groups, including the pelvic floor. The muscles of the pelvic floor are found at the opening of the vagina (in women), urethra, and rectum. Thoroughly assessing the function of the pelvic floor is possible with an examination performed with one finger (gloved) inserted into the vaginal or rectal canal. There is a strong anatomical basis for this seemingly unconventional exam. Pelvic Floor Physiotherapists train in both internal and external evaluation and treatment techniques and current medical research backs this approach.

An internal assessment is the “gold standard” for a comprehensive assessment of the pelvic floor. Some patients may be hesitant at first but then choose to go ahead with internal assessment. However, for patients who are not comfortable with internal examinations, there is no obligation to have one. Pelvic Floor Physiotherapists can assess the function of the pelvic floor by using external observation and cueing. A surface EMG (electromyography) biofeedback test can be used to assist this examination.

No. To be able to practice in this highly-regulated profession, our therapists have completed extensive post-graduate training in this field to gain the knowledge and clinical skills necessary to treat this complex clinical area. Our therapists study through The Women’s Health Training Associates and Melbourne University, as they offer a comprehensive training for Physiotherapists in this field. To be competent to work in this area, our therapist’s professional development has included hundreds of hours of theory and practical study, and multiple workshops, courses and monthly peer review meetings with other trusted colleagues in this field. Although our therapists can treat musculoskeletal injuries like ankle or shoulder sprains, they focuses on treating those with pelvic floor dysfunction, rather than standard injuries, but take a whole body and mind approach to treatment.

To help patients achieve optimal health, Physiotherapists usually work very closely with surgeons. Surgery can repair a structural problem, but it is equally vital to restore muscular control and function to accomplish the best results after surgery. Research has shown that physiotherapy prior to and after surgery improves patient outcomes, as well as reducing the need for future surgery. Pelvic Floor Physiotherapy can also help after procedures such as vaginal botox, to help with restoring muscle function, retraining of the complex core system including the breath, and optimising sexual functions.

While we strive to be family-friendly it can be beneficial for Mums if children are not present, so they can focus completely on the treatment. There is often a lot of new information to absorb and if internal treatment is required we want you to be as relaxed as possible. However, we will do our best to accommodate the needs of your family.

During your initial appointment extra time is allocated to gather detailed information about your presenting complaint, bladder and bowel function, medical, gynaecological and surgical history, birthing history, sexual function, dietary habits, toileting behaviours, and lifestyle.

A thorough physical examination is then performed which includes assessment of posture, breathing mechanics, musculoskeletal testing, and if appropriate may include an internal vaginal or rectal examination. This examination is performed by observing and/or palpating the perineal region including the vagina and/or rectum. This evaluation will assess skin condition, reflexes, muscle tone, length, strength and endurance, scar mobility and function of the pelvic floor region (note: your therapist will explain the procedure completely and only proceed with your consent).

This allows us to form a working diagnosis. Your Pelvic Floor Physiotherapist will explain the diagnosis to you and discuss the different treatment approaches which may be appropriate. In some cases, referral back to your GP or another practitioner may be required.

Up to 60 minutes is allowed for the initial consultation. This allows for a thorough understanding of your condition and for initial treatment to take place.

Follow-up appointments will likely be required to achieve best results. Return appointments are up to 30 minutes. Extended 45 and 60-minute appointments are available for more complex and chronic problems. Your progress is reviewed at every appointment and the treatment adjusted accordingly. Some conditions may improve quicker with a prescription of specific exercises: your Physiotherapist will advise you.

Most people feel fine after an internal vaginal examination, no different than after a pap smear test usually. If treatment involves extended internal body work, releasing the pelvic floor muscles and trigger points, then some people can experience some aching after treatment (like after a massage!), but this generally resolves within a few hours. Some people can feel thirsty, have headaches, and feel tired after internal body work, especially if the muscles are chronically tight. Listen to your body and rest as you need to. It is important to hydrate with plenty of water. It is recommended that after an internal examination you drink a large glass of water, and empty your bladder as standard care. You will be provided with detailed aftercare instructions after your treatment.

If you have any concerns about how you are feeling after internal body work then please get in touch with us by email here.

Some results can be felt immediately after the first session, however for permanent changes to be made it usually takes longer. Usually 3 treatments are indicated initially one week apart, then usually a follow-up anywhere between 2-4 weeks later, and then further treatments less often as required. This is due to the complex nature of most cases our therapist treats, and usually the problems are chronic, meaning it takes time to change behaviour, and strengthen muscles and co-ordinate body systems to improve function. We will strive to resolve your problem in the minimum number of treatments; the greatest success occurs when you are an active participant in your treatment program, and follow the advice given. Our therapists communicate directly with patients outside of appointments and are always available by email or phone to discuss any problems or concerns you may have with your program.

 

For our out of town clients, it may be difficult to get to the follow up appointments.  We will discuss with you the suitability or an online follow up, if you are unable to make it in person.

**Due to high demand we encourage all new patients to book their initial and two follow up appointments two weeks apart to ensure you get the most out of your treatment.

There is strong evidence that treating prolapse (Grade 3 or less) conservatively with Pelvic Floor Physiotherapy (for up to 6 months) can significantly improve or even reverse prolapse and symptoms. Grade 4 prolapse (outside of the vagina completely) usually needs surgical intervention to resolve.

Book an appointment

Take the first step and book your appointment 60 minute appointment, which is always 1:1, and involves a treatment tailored to you exact needs.

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Wondering if we can help? Give our trained staff a call!
We can answer your detailed questions, and if we're not a great fit for you, we can provide resources and recommendations for treatment options.

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