Why is a Prolapse Worse Some Days?
Do you have a prolapse and wonder why symptoms are better one day and worse the next? You're NOT alone. Many of our patients at Vivid have experienced this as well before starting prolapse treatment.
Let's talk about why this is often the case.
What Is Pelvic Organ Prolapse
First, I want to talk about what pelvic organ prolapse (POP) actually is.
Pelvic organ prolapse occurs when the pelvic organs (the bladder, uterus, rectum) sit lower in the pelvic cavity.
This occurs due to loss of muscle strength and support from the pelvic floor muscles, as well as loss of ligament support to the ligaments and fascia of the pelvis.
Patients will report heaviness, pressure, seeing a bulge in the vaginal opening, as well as generalized weakness, like something is "falling out" of their vagina, or symptoms like urinary leakage and trouble with bowel movements.
The good news: Pelvic floor therapy can help with ALL of these symptoms. But before we dive into that, I'll give you more info on the symptom fluctuation as well as how hormones affect symptoms.
Why Prolapse Symptoms Can Change Day to Day
It's super common for symptoms to change day to day.
Since prolapse is the downward descent of the pelvic organs, an increase in upright activities (standing, walking) will increase the effects of gravity, which leads to an increased downward descent of these organs.
In addition, high pressure activities such as coughing, laughing, sneezing, running, and jumping can also increase the downward descent of these organs
Hormone fluctuations can also play a role in ligament laxity and could be why your symptoms change day to day, or during various points in your cycle.
How Hormones Affect Prolapse Symptoms
The presence of estrogen increases the stretchiness, also known as laxity, in our ligaments. This increased stretchiness results in less ligament support, which allows the organs to sit lower in the pelvis.
The presence of higher estrogen states can thus increase the presence of prolapse symptoms (for some women, this is especially noticeable during ovulation).
An important note, however, is that the lack of estrogen can cause vaginal mucosa dryness and irritation. Sometimes this dryness can mimic the sensation of prolapse, but in actuality, the symptom is actually vaginal mucosa irritation, not an actual prolapse. This can be assessed in an evaluation.
The Role of Activity and Exercise
Due to the effect of gravity, any high impact, upright movements and exercises can challenge the ligaments of the pelvic floor.
During these tasks, the body demands more from the pelvic floor muscles in order to provide support for the pelvic organs.
So while exercise can increase symptoms, it's also important to know that you do not need to avoid exercise forever.
The whole point is to get back to what you are doing with less or zero symptoms. That includes high-impact and upright exercises if that's where you are currently having trouble.
How Constipation and Bowel Habits Play a Role
Constipation poses a challenge to those that have prolapse for 2 reasons.
First, is that stool is heavy. The added weight of a stool filled, constipated rectum increases the stress on the pelvic floor muscles, in addition to increasing the weight and pressure placed on the pelvic ligaments. In those that have chronic or long term constipation, this can result in ligament stretching over time.
Second, when constipation results in stool that is difficult to pass. This results in prolonged sitting, and straining on the toilet, which can stretch the ligaments which thereby decreases the ligament support over time.
Posture, Fatigue, and How You Carry Your Body
Women have a natural gap (called the levator hiatus) in the pelvic floor muscles (which is one of the reasons why prolapse risk is higher in women than men).
Certain movements and postures can affect how the pelvic floor muscles are functioning, and can affect the size of the gap in the muscles.
In addition, fatigue will affect the function of the pelvic floor muscles.
Without well functioning pelvic floor muscles, more stress is placed on the pelvic floor ligaments which can stretch over time.
How Stress and Sleep Impact Symptoms
Stress and sleep affect aerobic capacity of our muscles.
This can therefore affect how well the pelvic floor muscles are functioning, which can thereby increase the risk of prolapse (as well as aggravate an existing prolapse and increase symptoms).
In addition, poor hydration decreases muscle and ligament quality and tensile strength, both of which are necessary for prolapse management.
What to Do on a Bad Prolapse Day
If you are having a bad prolapse day, make sure you take it easy- rest, hydrate, reduce stress.
Laying on your back with your feet elevated can help to offload the pelvic ligaments and pelvic organs which can reduce symptoms. This is a favorite for patients.
If you are struggling with prolapse, it is important that you have a pelvic floor therapist on your team. They can identify movement patterns, and postures, and help to optimize strength and function of the pelvic floor.
Where to Find Prolapse Treatment in Bucks County
At Vivid Women’s Health, we offer a blend of pelvic floor therapy and pilates-based treatment in Doylestown and Newtown and would love to help you address your prolapse symptoms.
We proudly put our patients first by offering one-on-one appointments for a full hour. You will have time to be heard and we will take time to listen to your whole story.
You won’t be passed between different professionals, and we will work to get you a holistic solution to your pelvic health concerns.
We choose to participate in a private pay model so that we can focus on putting patients first.
We’d love to work with you. Feel free to schedule online or reach out to us if you have questions before getting started with prolapse treatment.
