Pelvic organ prolapse (POP) is a condition that occurs when the connective tissues and muscles that support the pelvic organs weaken and stretch, causing the organs to drop down into the vaginal canal. This is a common condition that affects many women, particularly those who have had multiple vaginal births or who have experienced menopause.

The pelvic floor is a complex system of muscles, ligaments, and connective tissue that provides support for the bladder, uterus, rectum, and other pelvic organs. When the connective tissue weakens or stretches, it can cause the pelvic organs to shift out of place, leading to the symptoms of POP.

There are several different types of POP, including:

1. Uterine prolapse: This occurs when the uterus drops down into the vaginal canal. This type of prolapse is most common in women who have had multiple vaginal births.

2. Cystocele: This occurs when the bladder drops down into the vaginal canal. This can cause a feeling of pressure or fullness in the vagina, as well as difficulty urinating.

3. Rectocele: This occurs when the rectum protrudes into the vaginal wall. Symptoms of rectocele can include difficulty having a bowel movement and a feeling of pressure or discomfort in the rectal area.

4. Enterocele: This occurs when the small intestine drops into the vaginal canal. Symptoms of enterocele can include a feeling of pressure or fullness in the vagina, as well as discomfort during sexual intercourse.

5. Vaginal vault prolapse: This occurs when the top of the vagina drops down into the vaginal canal. This type of prolapse can cause discomfort or pain during sexual intercourse.

Symptoms of POP can vary depending on the type and severity of the prolapse. Common symptoms include:

• A feeling of pressure or heaviness in the pelvis

• Back pain

• Difficulty urinating or having a bowel movement

• Pain or discomfort during sexual intercourse

• A feeling of a bulge or lump in the vagina

• Incontinence or leakage of urine or feces

Treatment options for POP often focus on strengthening the pelvic floor muscles and improving the health and integrity of the connective tissue. Pelvic floor exercises, also known as Kegels, can help strengthen the muscles that support the pelvic organs. Other treatments may include lifestyle changes, such as losing weight or quitting smoking, or the use of a vaginal pessary, which is a device that helps support the pelvic organs.

In more severe cases, surgery may be necessary to repair the weakened connective tissue and support the pelvic organs. Surgery can involve repairing or removing damaged tissue, or using a mesh to support the organs and provide additional strength to the connective tissue.

Sex references are in the mainstream culture on a daily basis and this can be hard for those experiencing pain with intercourse (i.e. sex). For some, sex has never been pleasurable, or has been the cause of physical, mental, and emotional pain. Articles in magazines talk about how to orgasm better and different ways of pleasuring oneself or partners but rarely focus on the experience of many others out there.

If you have always experienced pain with sex or it has come about later in life, please read on.

Sexual function is supported by the pelvic floor muscles which run from the pubic bone to the tailbone and are involved in bladder and bowel control along with the ability to orgasm.

In our patients, the main causes of painful sex we see are the following:

a) “Tight” pelvic floor muscles

Tight, overactive, or hypertonic pelvic floor muscles may be the cause of discomfort or pain with intercourse. Sometimes the vaginal entrance alone can be tight or it can also be tighter deeper in. Although it may be difficult to determine the direct cause of tight muscles, (especially if someone has had this since the first time they were sexually active), we have had clients mention sexual trauma, pelvic floor trauma from birth, and stress as contributing factors.

b) Pelvic organ prolapse

With organs shifting and putting pressure on the vaginal walls, penetration deeper inside can be painful and often patients will describe this as a block or that during sex it is “hitting something” and can be dependent on the position as well. This can be due to pelvic organ prolapse, descending of the vaginal walls + organs.

c) Vaginal dryness

This can be related to hormonal issues, outside of pregnancy, postpartum or around menopause. Use of lubrication, topical estrogen prescribed by your physician, other non-estrogen creams or hormonal treatment can be beneficial in this case.

d) Scar tissue

For vaginal deliveries, if an episiotomy was performed or there was tearing, depending on how the region healed, there may be scar tissue that can lead to sensitivity in the vaginal region or tightness.

The above causes of painful sex can occur in isolation or there may be multiple reasons at once. Pelvic Floor Physiotherapy can help reduce and eliminate pain with intercourse and move towards pleasure. Find more by reading this article - Treatment for “tight” pelvic floor muscles. Know that even though you might be experiencing these symptoms right now, there is help out there from professionals who care and will take the time to listen to your concerns.

Questions? Comment below, e-mail us at hello@kaaiaa.co, or book a free phone consult.

This is one of the big questions we get as pelvic floor physiotherapists. When is the best time to go and does it matter if it’s during pregnancy or postpartum? If you don’t have any issues during pregnancy is it worth going or is it better to use your physiotherapy insurance afterwards in case you have issues? 

First, a bit on the pelvic floor. 

The pelvic floor is a group of muscles that support the bladder, uterus, bowel, hips and back (read more here). Common signs and symptoms of pelvic floor issues can include bladder leakage, urinary urgency, frequency, heaviness, pressure, prolapse, bowel issues and pain. Research indicates that 30-50% of women may develop pelvic issues during pregnancy and these issues can linger into postpartum OR develop postpartum.

Now, there is evidence to suggest that doing pelvic floor strengthening can help prevent issues during pregnancy. Prevention is one of the big tools that we should be harnessing because it can not only help prevent discomfort and pain, but you can continue doing all the activities you love during pregnancy. Furthermore, you may require less appointments postpartum, return to fitness sooner and feel better overall. Less appointments is less money spent and it is difficult for mothers to come in postpartum because they are so busy with taking care of themselves, baby and their families, or returning to work and juggling everything at once.

However, there is the old adage: better late than never. Even if you do not feel there are issues postpartum, it is good to learn the appropriate exercises to prevent issues down the line. Research indicates that urinary leakage and prolapse can occur months to years down the line after child birth.

So, when should you start physiotherapy during pregnancy and postpartum?  Appointments can begin at any time and it can be as soon as you know you are pregnant. I have had clients book in pre-conception as well, to learn the appropriate exercises because there is more pressure on the pelvic floor and abdominal muscles during pregnancy. However, an internal examination will not be performed for those who are pregnant until after the first trimester.

Usually we can see clients late into pregnancy as long as they feel comfortable with the appointment. Postpartum we can start as soon as you would like but again, no internal examination until 6 weeks postpartum. Having said this, depending on the client and their wishes, the birthing experience and any pelvic trauma, internal examinations have been performed earlier than 6 weeks postpartum. 

Questions? Comment below, e-mail us or book a free phone consult.