Living Life with Pelvic Organ Prolapse

I am in the process of learning to live my best life with pelvic organ prolapse. What is it? Check out the link below to a fantastic post from @popuplift explaining POP beautifully!⠀

In my Occupational Therapy practice I support women with recovery/rehabilitation AND navigating this diagnosis and the meaning making and emotions that can come with it. We reflect on and work with the relationships we have with our bodies and the different ways that this can be impacted by POP. We minimize fear and optimize engagement in the things that are important.⠀

My wish is to create more awareness of strategies and resources created by myself and other practitioners that approach POP with messages of hope and embodiment! Here are a few…

Choice

FIRST MESSAGE…There is no perfect one size fits all approach to POP! There are a ton of great strategies out there that work well for some and not so well for others.

• Behavior shifts
• Habits
• Routines
• Pleasure snacks
• Varied movement
• Pelvic floor muscle training
• Biofeedback
• Hypopressives
• Pessaries
• Toileting habits
• Diet
• Crossfit
• Yoga
• Sport
• HIIT
• Pilates
• Day to day movement adaptation
• Strength training
• Breath work
• Pressure management
• Cognitive Behavioural Therapy
• Acceptance and Commitment Therapy
• Surgery
• Mindfulness
• Myan Abdominal Massage
• Visceral mobilization ⠀

Just to name a few!

What is universally NOT effective for addressing POP are blanket recommendations and messages of restriction and movement avoidance. Expectation for danger can create a hypervigilant POP alarm. Fear and avoidance also end up fueling disability and negatively impacting quality of life alongside those physical sensations.⠀

A strong way forward…Find a therapist that is willing to walk WITH you, equip you with information, guide you through experimenting with the tools in their toolbox (and yours), help you get curious about how these strategies feel in your body, refer you on if you want to try something different that they are less familiar with, AND acknowledge the choices about how you inhabit your body and move forward with POP as YOUR choices!

Grappling with Grade!

What’s in a number?⠀

POP is assessed using a grading system from 0-4. 0 means that the organ has not descended at all and 4 means that the organ has desceneded the maximum amount. That is, the vaginal wall or uterus is protruding outside the introitus (vaginal opening).⠀

A couple of key considerations…⠀

#1 Our organs are not stationary structures, they are designed to slide, shift and move. This helps them to move as we move and do what we need them to do!⠀

What this means is that these measurements may differ depending on time of month, time of day, the position we are being assessed in, recent activity, whether bladder or bowels are full and tons more factors!⠀

#2 The experience of POP symptoms (pressure, heaviness, discomfort) is not dependent on grade. The experience of POP symptoms (much like pain) is an alarm produced when our brain takes in and interprets the information that we are getting from our body and environment.

What this means is that past experiences, stress, beliefs, and context will certainly influence our experience of symptoms. What this also means is that someone who has a Grade 1 prolapse may experience more symptoms or be more bothered by symptoms than someone with  Grade 3 prolapse.⠀

Can we reduce the grade of prolapse? ⠀

This is the goal commonly cited by women as they are first presented with their diagnosis and grade.⠀

The reality…some women do find that with individualized pelvic floor rehabilitation, their POP grade does reduce. Many more, however, find that while there may not be a significant reduction in the grade, they do experience a reduction in symptoms and improvement in quality of life with therapy that focuses on symptom management and function.⠀

Read more about this topic in the Blog Post Below from POP Up: An Upligting Guide

Intraabdominal Pressure – Friend vs. Foe?

What is intrabdominal pressure (IAP)?⠀

Simply put, IAP is the pressure in the abdominal cavity. This pressure fluctuates as we breathe, move and LIVE! – Bend, squat, lunge, push, pull, lift, lean, carry, sit up, sit down, stand, roll, shift, pivot, twist, rotate, jump, hop, yell, laugh, cough, sneeze!

ALL DAY EVERY DAY!⠀

Women with POP are often told to avoid anything that will increase IAP…JEEBUS that’s A LOT of things! Looking at IAP as a necessary and useful component of our stability, fluidity and dynamic movement can be a very useful way forward with POP! ⠀

We would all be a bunch of pretty limp noodles without IAP.⠀

Moving forward with POP often happens when we can let go of the avoidance narrative. Work with a professional that can help you to learn new and varied strategies for managing intraabdominal pressure effectively with activities or movements that trigger symptoms, fear or frustration.⠀

What strategies help you to feel strong, safe, and supported as you engage in your life?⠀

⠀Be like the Jellyfish!

What do Jelly Fish Have to teach us about living with prolapse?

Something I hear often…”How can I have prolapse? I was told that my pelvic floor muscles are ‘too tight'”

Here’s the thing…tight does not equal strong or perhaps more accurately…tight does not equal functional or responsive.

When fear is a part of the prolapse equation…tension follows and trusting the importance of the “let go” can be tough! Let’s look to the Jellyfish!

Janelle Gullan of The Wild Orange Tree writes about Jellyfish:

“Loved watching these beauties at the aquarium today. The jellyfish is sometimes used as cue for the pelvic floor so I studied their movement in a lot of detail. We live in a ‘squeeze’ centric pelvic floor world. But these jelly fish spend most of their time relaxed. They propel and then let go. Because if they stayed squeezed they wouldn’t actually get anywhere near as fast. The strength is in the release. Be like the jellyfish ??”

⠀Hypo What Now?

Hypopressives™ or Low Pressure Fitness is one approach that some women use to help manage POP.⠀

It is a series of exercises involving specific postures with an added “apnea” breath when appropriate. Some women have described that this approach has helped them to improve their body awareness, proprioception and ability to access those deep core muscles. Some folks have also said that it has helped them to find and release tension around the diaphragm, rib cage, abdomen and/or pelvis. More flexible breathing mechanics can be really helpful when managing POP!⠀

Hypopressives™ it can also be integrated into care for Diastasis Recti, incontinence and postpartum recovery.⠀

Experimenting with strategies such as Hypopressives™ and observing how things shift and change for you when you try them can be fun and empowering. It can also be frustrating and discouraging if an approach that has promised to be THE SOLUTION or the approach that your practitioner may have some bias towards is one that you don’t connect with or doesn’t feel good in your body. Curiosity and flexibility can have such a BIG IMPACT on the process when sorting out the strategies that work for you.⠀

Fostering flexibility and curiosity is a cornerstone at Pelvic Resilience!!!! Get in touch if you are interested in playing with ALL THE THINGS!⠀

⠀Pessa Where?

Meet my pessary! A pessary can be a very helpful tool for women with pelvic organ prolapse. It is inserted into the vagina to help give some support to the pelvic organs. ⠀

Mine is called a ring pessary with support but there are many different sizes and shapes to fit our beautifully diverse bodies. Mine helps to alleviate some of the physical AND psychological symptoms of prolapse and has been an important piece of my recovery. I LOVE it!⠀

Not too long ago I went for a PAP test…fun! ?⠀

The Physician’s Assistance was all set up with the speculum when I remembered…I had forgotten to remove my pessary?‍♀️! Kinda hard to do a PAP with one of these in place!⠀

She asked me…”who fit you for this?” And I told her my fabulous Pelvic Health Physiotherapist. She was floored and unaware that a growing number of Pelvic Health Physiotherapists in ONTARIO have the knowledge and training to do this and do it well! I was thrilled to be able to drop some pelvic health knowledge bombs and add some highly skilled clinicians to their referral network! Thank you my pessary friend!⠀

Clinicians that can fit and prescribe pessaries vary by province, stage, region. Talk to your provider about a referral to the right clinician in your neck of the wood if you are interested in exploring whether a pessary could be a useful tool on your journey!

Function 

There is A LOT of information (albeit conflicting and confusing) out there about pelvic organ prolapse and exercise

I received some fabulous and very individualized support from my Pelvic Health Physiotherapist to get back to the exercise and sports that I love! I am forever grateful because this was SO important to me!

What I noticed on this crazy ride, however, was that when it came to experiencing symptoms of POP, my worst flare ups came…⠀

• after days of solo parenting⠀
• after days of working…sitting and driving for long stretches with few movement breaks⠀
• after being sick with a cough
• when my head was just feeling full, overwhelmed, frustrated or scared.⠀ ⠀

Life is dynamic and while we are busy grading, progressing, and controlling exercise regimens to help us work towards fitness goals, life carries on and we still have to live it!⠀

A function first approach to prolapse involves…⠀

• Getting to know how symptoms AND how we feel about our symptoms are showing up in our lives and interfering with meaningful activities, life roles, relationships⠀
• Building dynamic home exercise programs filled with variation and that are relevant to the demands of life
• Beyond home exercise programs, finding creative strategies to integrate into the components of life that are important and have been impacted by prolapse so that you can carry on living and build capacity and self efficacy in the contexts that matter⠀
• Building awareness of habits and routines AND CYCLES and noticing opportunities to do something different that might have an impact on the experience of symptoms by the end of the day (or whenever they are at their worst!)⠀
• Building a toolbox of symptom management strategies so that flare ups are less riddled with fear and conditioned avoidance.

Values Based Goal Setting

“Surrendering isn’t about what you are doing but about who you are being while you are doing it.” Jen Sincero

Does acceptance or letting go of the struggle to control or ‘heal’ prolapse mean giving up on recovery??? Is it about ignoring the sensations and what is going on in your body??? ⠀

NO!!! NO WAY! NO HOW!⠀ ⠀

I want to acknowledge that the word, Acceptance, can be offputting for folks struggling with pain, chronic illness, prolapse, or other physical symptoms that can create added layers of distress or psychological pain that can be just as uncomfortable to sit with as the physical symptoms.⠀

Acceptance is a shift that often happens for folks in recovery from anything (prolapse included!) AFTER a process of pushing against, fighting, avoiding and grieving over how things used to be. Our brains and bodies are amazingly protective and therefore these processes (in some form or another) are inevitable.⠀

Acceptance is about…⠀

• acknowledging when the “control agenda” is no longer serving you
• learning skills to defuse from the fight to find your way back to how things once were ⠀

One very powerful way to shift from an agenda of control (if you’ve decided it’s no longer serving you) to moving forward is to get in touch with your values…what is truly important to you?

When I begin to speak to my clients about values (usually right away!), I am often presented with a laundry list of activities that they feel they can no longer engage in. That’s great! This is really helpful information to get at your goals.⠀

BUT what I mean by values is…⠀

• The “why’s” behind your goals
• The personal characteristics that are important to you that these activities connect you with
• What do you want to stand for in the face  of this?

This allows us to think flexibly about the possible pathways back to your valued living?⠀

Does it mean we give up on the goals and activities that are important to you? NO!

Connecting to your “why” can help us to find ways to turn towards the discomfort, get curious about it, find out what it might be trying to teach us and use that information to find our way back to the meaningful activities!

Acceptance and Commitment Therapy (ACT) can be an incredibly powerful approach to rehabilitation and adjusting to life with POP!⠀

Relationship Status: It’s Complicated

• Broken
• Betrayed
• Let Down
• Disconnected

Many women with POP also struggle with body image.⠀ ⠀

The relationship that we have with our bodies can be a lot like the relationships we have with other humans. It comes with a history, it requires nurturance and compromise, it requires patience and the ability to listen.⠀⠀

When we feel let down, betrayed or disconnected in that relationship, trust (in both directions) can be shaken to its core. This is a common experience for individuals with core or pelvic floor dysfunction.⠀⠀

Sometimes physically rehabilitating that core is enough for that trust to be restored.⠀⠀

Sometimes, even after function is regained, the distrust can linger. This can look like lingering fear, anxiety or anger. This can look like hesitancy in our movement. This can look like restriction in our exercise/sport. This can look like preoccupation with our bodily sensations OR complete disconnection from our bodily sensations.⠀

Rebuilding communication and trust in your relationship with your body is an important component of pelvic health rehabilitation!

“She began to inhabit her body, instead of fightin it, and to embrace the idea of her own presence.” Caroline Knapp, Appetites

Feel Your Feels

Many women who are diagnosed with POP also struggle with anxiety, depression, body image, anger, kinesiophobia (or fear of movement), frustration, overwhelm, and/or preoccupation with symptoms and checking prolapse. Read more about why you are not alone in this below!

Occupational Therapy is a great fit for addressing symptoms AND support with navigating the impact of prolapse on emotional wellness, function and relationships.⠀There are a gowing number of OTs doing this work. Reach out to get connected!

Lara Desrosiers OT Reg. (Ont.)