Menopause is a natural episode in a woman’s life end of her reproductive years. Along with hormonal changes, menopause can also bring various health concerns, including pelvic organ prolapse (POP). Pelvic prolapse refers to the descent or displacement of pelvic organs, such as the uterus, bladder, rectum, or vagina, from their normal positions. This article explores pelvic prolapse in menopause, its causes, symptoms, risk factors, and available treatment options.
Understanding Pelvic Prolapse
Pelvic prolapse occurs when the muscles and tissues that keep up the pelvic organs become weakened or damaged. In menopause, the decrease in estrogen levels can contribute to the loss of pelvic muscle tone, making women more susceptible to POP. Factors like childbirth, obesity, chronic coughing, constipation, and heavy lifting can further strain the pelvic floor muscles, increasing the risk of prolapse.
Types of Pelvic Organ Prolapse
a. Uterine Prolapse: Uterine prolapse occurs when the uterus descends from its usual position and bulges into the vaginal canal. This condition can vary in severity, ranging from mild, where the cervix drops slightly into the vagina, to severe, where the uterus protrudes outside the vaginal opening.
b. Cystocele: A cystocele, also known as a prolapsed bladder, occurs when the supportive tissue between the bladder and vaginal wall weakens, causing the bladder to bulge into the vagina. This can lead to symptoms such as urinary incontinence, frequent urinary tract infections, and a sensation of pelvic pressure.
c. Rectocele: A rectocele is characterized by the protrusion of the rectum into the posterior wall of the vagina. Weakening of the pelvic floor muscles and connective tissues can cause the rectum to push against the vaginal wall, resulting in symptoms like difficulty with defecation, a feeling of incomplete evacuation, and rectal discomfort.
d. Enterocele: An enterocele occurs when the small intestine pushes against the vaginal wall. This condition is often associated with previous pelvic surgeries or trauma. It can cause symptoms such as pelvic pain, a sensation of fullness in the pelvis, and discomfort during sexual intercourse.
e. Vaginal Vault Prolapse: Vaginal vault prolapse occurs when the upper portion of the vagina drops down after a hysterectomy. The absence of the uterus weakens the support structures, leading to symptoms like vaginal bulging, pelvic pressure, and difficulty inserting tampons or engaging in sexual intercourse.
Symptoms of Pelvic Organ Prolapse during Menopause
a. Vaginal Discomfort and Pelvic Pressure: Women with pelvic organ prolapse often experience a sensation of heaviness, pressure, or fullness in the pelvic region. This discomfort may be exacerbated by prolonged standing, physical activity, or lifting heavy objects.
b. Urinary Symptoms: Prolapse can affect the proper functioning of the urinary system. Women may experience stress urinary incontinence (leakage of urine during activities that put pressure on the bladder), urgency, frequent urination, or difficulty emptying the bladder.
c. Bowel Symptoms: Prolapse can interfere with normal bowel movements, leading to constipation, difficulty passing stools, incomplete evacuation, and the need for manual assistance to empty the bowels.
d. Sexual Dysfunction: Pelvic organ prolapse can cause discomfort during sexual intercourse, decreasing sexual desire and satisfaction. The physical prolapse-related changes may make intercourse painful or challenging for some women.
e. Visible Bulge: In more severe cases, a bulge or protrusion of the organs may be visible or felt in the vaginal canal. This may occur during activities that increase intra-abdominal pressure, such as coughing, sneezing, or lifting heavy objects.
Prevention of Pelvic Prolapse
- Regular Pelvic Floor Exercises: Strengthening the pelvic floor muscles is crucial in preventing pelvic prolapse. Kegel exercises, which imply contracting and relaxing the muscles that control urine flow, can help improve muscle tone and support the pelvic organs.
- Maintain a Healthy Weight: Obesity and excessive weight can strain the pelvic floor and contribute to its weakening. Keeping a healthy weight through a balanced diet and regular exercise can help reduce the risk of pelvic prolapse.
- Avoid Heavy Lifting: Heavy lifting or straining activities can place undue stress on the pelvic organs and weaken the supporting structures. It is essential to use proper lifting techniques when lifting objects and seek assistance when necessary.
- Quit Smoking: Smoking can impair blood circulation and decrease collagen production, leading to tissue damage and weakness. Quitting smoking can help in overall health and reduce the risk of pelvic prolapse.
- Manage Chronic Constipation: Straining during bowel movements can weaken the pelvic floor. Adequate hydration, a fiber-rich diet, and regular exercise can help prevent chronic constipation, reducing the strain on the pelvic organs.
- Hormone Replacement Therapy (HRT): Hormone replacement therapy, under the guidance of a healthcare professional, may be considered during menopause to help maintain hormonal balance and improve pelvic muscle tone. HRT has been shown to decrease the risk of pelvic organ prolapse.
Lifestyle Modifications For Pelvic Prolapse
- Optimal Fluid Intake: Drinking an adequate amount of water and maintaining proper hydration is essential for overall health and the function of pelvic organs. Optimal fluid intake can prevent urinary tract infections and promote regular bowel movements, reducing the strain on the pelvic floor.
- Balanced Diet: A balanced diet rich in fruits, whole grains, vegetables, and lean proteins provides essential nutrients for overall health. Consuming foods that support collagen production, such as citrus fruits, berries, and leafy greens, can help strengthen pelvic tissues.
- Regular Exercise: Regular physical activity, including aerobic exercises and strength training, can help maintain muscle tone and overall fitness. Specific exercises that target the pelvic floor, such as Pilates and yoga, can provide additional support.
- Adequate Rest and Sleep: Sufficient rest and quality sleep are essential for the body’s healing and rejuvenation processes. Prioritizing rest and ensuring a good night’s sleep can support overall pelvic health.
- Stress Management: Chronic stress can come up with muscle tension and weaken the pelvic floor. Stress-lowering activities such as deep breathing exercises, meditation, and hobbies can help manage stress levels and promote pelvic health.
Emotional Well-being and Support
Dealing with pelvic prolapse can be emotionally challenging for women, impacting their self-esteem, body image, and sexual well-being. It’s important to address the emotional aspects of pelvic prolapse alongside the physical symptoms. Seeking support from healthcare professionals, participating in support groups, and maintaining open communication with loved ones can help women cope with the emotional toll of pelvic prolapse.
Pelvic prolapse is a common condition that affects many women during menopause due to hormonal changes and weakened pelvic floor muscles. While it can significantly impact a woman’s quality of life, effective treatment options are available. Understanding the risk factors, adopting preventive measures, and seeking appropriate medical care can help manage pelvic prolapse and alleviate its associated symptoms. Women can confidently navigate this phase of life by prioritizing physical and emotional well-being.
NourishDoc: Hello, everyone, and happy Friday. Well, all the women out there who are experiencing perimenopause and menopause are probably going through some pelvic pain or incontinence, very sensitive topics. We have never talked about this, and then we want to talk about this with Sarah. Sarah is joining me live from the UK, and she is a Pilates and pelvic floor coach helping women get over all these issues. Thank you so much, Sarah, for joining me.
Pilates Coach Sarah: Thank you. It’s so lovely to be here, Amita. I love that we’re talking about it because I need to find out whether it’s the same in America. However, in the UK, women don’t talk about it, and they put up with these symptoms and feel all alone; they feel it’s just them when so many women suffer from pelvic floor issues. So, it’s great to be here today.
Pelvic Pain & Incontinence Issues in Women
NourishDoc: Yeah, so let’s talk a bit about the different types of issues that women go through. Well, one is you’re talking about pelvic pain, and the other could be incontinence. So talk to us about these two topics. We know other issues like hot flashes, but we want to focus on these two issues for this particular talk today.
Pilates Coach Sarah: Yeah. Well, I’ve got a little sample of a pelvis here to show you. In menopause, when hormones dry our power, estrogen, progesterone, and testosterone, we all know, get all sorts of symptoms. One thing our pelvic floor loves is estrogen. When we don’t have estrogen, things can cause the muscles to get a bit weaker. We also lose collagen as we get older.
Collagen is like, if you think of a trampoline, that’s all nice and bouncy; when it gets a bit old, it gets brittle and doesn’t bounce quite much. So when we lose collagen, we lose that bounce. So, in women, we have this pelvic floor area, which is a band of muscle crisscrosses in the pelvis, and we’ve got a very wide area of bone. In men, they have a narrower area here because they don’t have to push babies out of there.
So, we have this wide area and all this muscle that could be more well supported. So, it’s no wonder that over time, these muscles start to weaken. Within this area, we have our anus, our vagina, and our urethra. So, we have three exits, and the purpose of our pelvic floor is to stop things from coming out when we don’t want them to but to let them out when we do and also to let things in with intercourse, with tampons.
Hence, these muscles need to be nice and strong. However, they must also be nice and flexible and then attach to the pelvic floor; these deep abdominal muscles go out, then attach to our diaphragm. So when we talk about pelvic floors, we talk about more than just this area here. We talk about this whole area that’s connected to our breath, to our deep abdominal muscles, so over time these muscles can get weak and also over time these muscles can sometimes get tight and if you think of a muscle.
So if you’ve got bicep muscles that are nice and strong sorry, I should have a take my jumper off. However, it’s cold in England if your muscles are tight and you walk around with your biceps holding them tightly; they’ll get weak. So to make those biceps strong, you have to exercise and move them, and it’s the same with our pelvic floor area.
So often, in menopause, it causes quite a lot of anxiety. Some of that anxiety comes from not knowing what’s happening, but those hormones can also cause stress and anxiety. So if you’re anxious, you tighten, and actually, you don’t just tighten up here; this pulls everything up, and our pelvic floor area can get tight, and that when these muscles can get weak because they’re tight, they’re overtight, sometimes they get weak because just over time, the muscles have got weak, the collagens reduce, the estrogen’s reduced, and that’s why we can have pelvic floor issues in menopause. However, obviously, throughout our life, women have, can have issues. However, they do often come to a head during menopause. That will make sense so far, Amita.
How Can Women Overcome Pelvic Prolapse?
NourishDoc: Yes, it does make sense. So, I know I have to ask you this question because you are a Pilates instructor, and the next question is, what can women do? What can we do to help ourselves and we are just talking for another few minutes. This is a quick 10-minute session that we do and just a small educational session.
Pilates Coach Sarah: Okay, what can women do? There is so much. This is muscle and muscles; we can train them. So, firstly, we need to learn to relax the muscles. So, what can you do for yourself that helps you relax? Whether it’s meditation, exercise, or getting out into nature, once the muscles are relaxed, we can strengthen them.
So, we can do exercises called Kegels which we draw up inside. It’s like you squeeze up. So, you’re trying to stop yourself from passing the wind, and you squeeze up. You’ll feel those muscles connecting. It would help to breathe while doing it; those exercises can connect with the pelvic floor and strengthen it. But that’s not the only thing.
he main thing is to be able to let go because if you’re squeezing and squeezing and already your muscles are tight, you need to learn to let go. So we can put relaxation into our life; we can do exercises but also movements; we’ve got 46 muscles attached to the pelvis, so by moving, walking, Pilates, and doing yoga, we’re lengthening the muscles. Hence, they need to be strong, they need to be, and they need to be able to relax. So treating them like any other band of muscle.
Daily Routine For Doing Exercises, Yoga, and Pilates
NourishDoc: Okay, and then, is there anything that how often she should do the exercise as you talked about the yoga, the Pilates, and stretching these muscles, right? Do you recommend doing it daily, or should we do it like, and how? What duration of that exercise are you recommending that we do?
Pilates Coach Sarah: Yeah. There’s no real set answer to that, but we do need to, in life, be able to relax just as much as we can; if you can do Pilates two or three times a week, that is brilliant, or yoga so you’ll stretch those muscles. The existing pelvic floor squeezes because it is muscle; muscles do get tired.
So you could do about ten or so at a time, just squeezing up and letting go to ensure you’re breathing while doing it. So if you do that about three times a day but always think more about letting go than squeezing. So you squeeze up; you don’t hold your breath. You don’t hunch your shoulders, let go, and get really good at getting a nice deep contraction through those pelvic floor muscles.
Other Health Problems
NourishDoc: All right, Well, thank you so much. Anything else you’d like to add? This is a quick snapshot of every balance that we bring. Anything else you like to add, Sarah?
Pilates Coach Sarah: Yeah, one more thing. So within this pelvic cavity, you have your bowel, bladder, and uterus. So if you’ve had a hysterectomy, you are more likely to have prolapse or pelvic floor issues because they’re all tightly packed.
So if you’ve had the uterus taken out, they’ve got more room to move around those organs, and prolapse is when the organs drop a little or move around. So, suppose you’ve had a hysterectomy, or you’ve had any pelvic surgery. In that case, it is important, extra important, to do these exercises and to strengthen.
NourishDoc: All right, well, thank you so much for bringing this workshop to everyone within this month of April. So, stay tuned. All these exercises Sarah is talking about will be part of these programs and workshops, which we can do daily as women as we start aging, right? All of us should start early on, not that when we’re hitting the button over there, the emergency button, then we say, oh, let me do this Kegels and all that, right?
Pilates Coach Sarah: Yeah. Okay, absolutely. Always early enough to start.
NourishDoc: Absolutely. Thank you so much, and have a great weekend, everyone, and stay tuned and keep supporting us. Thank you so much, Sarah, for sharing your knowledge here.
Pilates Coach Sarah: Nice to meet you. Lovely to meet you.