Lifestyle Changes to Reduce Your Risk of Prolapse

Pelvic organ prolapse is a very common condition in women. The American College of Obstetricians and Gynecologists says that prolapse affects 1 in 4 women in their 40s; 1 in 3 women in their 60s; and half of women by the time they reach their 80s.

Does that mean it's inevitable? Not necessarily.

Dr. Christine Pan, a urogynecologist with Houston Methodist, is here to provide more information about pelvic organ prolapse and the steps you can take to help prevent the condition.

What is pelvic organ prolapse?

"Prolapse is a common condition in which weaknesses of the pelvic floor muscles and connective tissue results in descent or bulging of pelvic organs into the vaginal canal," Dr. Pan says. "Some conceptually describe it like a hernia of the pelvic organs into the vagina — that's the way I like to describe it to my patients. It is a common enough problem that a separate specialty was developed to address these issues."

Dr. Pan says that it is still hard for women to talk about their pelvic health openly, so it's important to know that prolapse happens to many women and there are good treatment options available.

Types of pelvic organ prolapse

Dr. Pan says that pelvic organ prolapse is ultimately categorized by which vaginal wall has lost its support. Common types of pelvic organ prolapse include:

• Anterior vaginal wall prolapse (often referred to as a cystocele): This type indicates the bladder is protruding into the vaginal canal.
• Apical prolapse: This type refers to the top of the vagina descending below the hymen and can occur before or after removal of the uterus (hysterectomy). It's called uterovaginal prolapse if someone still has their uterus and cervix; vaginal vault prolapse if the person has had a hysterectomy.
• Posterior vaginal wall prolapse (still often referred to as a rectocele): This type refers to the rectum bulging into the vaginal canal.

Dr. Pan says It is important to note that what you visually see is never the bladder or rectum itself, it's the vaginal wall overlying that organ. Most women will have more than one type of prolapse, according to Dr. Pan — the top of the vagina can be falling down along with the other sides of the vaginal walls.

"Anterior vaginal wall prolapse is the most common type of prolapse — sometimes people will use the phrase 'the bladder has dropped' or 'bladder prolapse,'" Dr. Pan says. "But again, it's reassuring to know that what you see is not the actual bladder itself, but the vaginal wall that's next to the bladder.

"Imagine a water balloon resting on a wet paper towel. The wet paper towel is flimsy and has lost its good support structure, and so you can see the outline of the balloon (the bladder) bulging and causing the paper towel (the vagina) to droop down under the weight of the balloon."

Risk factors for pelvic organ prolapse

The main risk factors for pelvic organ prolapse are a previous vaginal delivery, excessive weight and advancing age. Other risk factors can include pregnancy in general (especially with prolonged labor), constipation and occupations that require heavy lifting.

"Though prolapse can appear after childbirth in younger age ranges, most of the time, we start to see more prolapse as we get older," Dr. Pan says. "For example, incidence peaks in women aged 60-69 — though we very commonly see prolapse in higher age ranges as well. In reality, it can manifest over a large age range."

While we can't control our age, we do have some actions that we can take to help prevent pelvic organ prolapse.

"I like to focus on the factors that we can actually control or change," Dr. Pan says.

What you can do to prevent prolapse

Strengthen your pelvic floor muscles

Like any other muscle in your body, your pelvic floor can be toned and strengthened through regular exercise. Kegel exercises, simply known as "Kegels," are the exercises that can help strengthen your pelvic floor. Like any exercise regimen, success comes through commitment. Doing Kegel exercises daily — and correctly — will give you the best chance of preventing prolapse.

"Seeing an actual pelvic floor physical therapist who can make sure we're doing Kegel exercises correctly and can give additional tips and tricks is extremely helpful," Dr. Pan says.

Women can work with their OB-GYN, urogynecologist or primary care doctor to get a referral for a pelvic floor physical therapist.

Manage your weight

Maintaining a healthy weight can have positive effects for almost all facets of our health, and pelvic health is no different. The pelvic floor supports the bladder, bowel and pelvic organs and keeps them inside the body. Carrying excess weight means the pelvic floor has a consistently heavier load to support.

Additionally, the body creates higher intra-abdominal pressure at higher weights (the pressure applied by organs against the abdominal wall), which can cause the ligaments and structure of the pelvic floor to weaken.

Weight loss can be one of the frontline efforts to prevent and address pelvic floor prolapse. Any amount of weight loss can be beneficial to help prevent pelvic floor disorders, including prolapse. Even losing as little as 5% of your body weight can be significant, Dr. Pan says.

Avoid constipation

Straining while going to the bathroom can put a lot of strain on the pelvic floor muscles — that's because our rectal muscles are actually part of the pelvic floor. In some people, rectal prolapse and fecal incontinence can occur in addition to vaginal prolapse after prolonged chronic constipation. So how can we stay regular and make sure our stool is easier to pass? Fiber.

The National Academy of Medicine recommends that women under age 50 should consume 25 grams of fiber a day, and women over 51 should consume 21 grams. Eating a diet that includes a wide variety of fruits, vegetables, nuts, whole grains, beans and lentils is a great way to meet your daily fiber goal. The health benefits of fiber don't stop at promoting regular, healthy stool. Eating enough can also help with managing your blood pressure and cholesterol levels.

Additionally, making sure you're drinking enough fluids per day can help make your stool softer. While several factors can affect how much water you may need, the Institute of Medicine suggests woman get about 2.7 liters of fluid per day. For women who experience overactive bladder or urinary incontinence, they may want to limit their fluid intake to 64 ounces, or just about 2 liters. Avoiding drinks that contain bladder irritants such as caffeine, carbonation or artificial sweeteners may help prevent symptoms of overactive bladder or incontinence.

You could also consider using a toilet footstool to help you go to the bathroom. Sold under various brand names, these stools adjust the body into a "squat" position that straightens the angle of the rectum, making it easier to pass stool. Using one of these devices may help you strain less, cut down your time on the toilet and aid in more complete evacuation.

Be mindful of heavy lifting

A long-term career where you engage in heavy lifting can put women at risk for pelvic prolapse. Heavy lifting can increase intra-abdominal pressure, and repeated lifting can increase your lifetime risk of developing prolapse.

Dr. Pan emphasizes that using correct form when doing any kind of heavy lifting is key to the safety of your pelvic health.

So what can you do to ensure safety when lifting?

• Make sure to "brace" your pelvic floor muscles (perform a Kegel) when lifting, which helps counteract the downward pressure encountered when lifting.
• If you can, make several trips with lighter loads than one trip with a larger load — think carrying your groceries in small trips than white-knuckling it and carrying all your groceries at once.
• Get help from someone else to help lighten the load and carry a large item together.

Weightlifting is more popular than ever as a way to keep fit. If you engage is strength training with hand weights, barbells or machines, do you need to forego this to help prevent prolapse or minimize your symptoms?

"There are some that might advise people to avoid any and all of those activities since it technically may be a contributing risk factor," Dr. Pan says. "But my philosophy is that those particular exercises are so beneficial for general health and fitness that I would not suggest cutting out those exercises. Weight-bearing exercises are good for osteoporosis, for example."

Instead, Dr. Pan suggests focusing on eliminating other risk factors and to be mindful of your form no matter the type of weightlifting.

"Perform a Kegel when you lift, assuming one doesn't have a specific type of pelvic floor dysfunction," Dr. Pan says. "If you already have some type of pelvic floor issue, you'll want to talk with your doctor about beginning or continuing any kind of exercise program."

Pelvic organ prolapse treatments

Despite your best efforts, pelvic organ prolapse may still develop. But Dr. Pan says women can find relief with different treatment options based on symptom severity.

"Generally speaking, the main treatment options are pelvic floor physical therapy, a nonsurgical medical device called a pessary and surgery," Dr. Pan says. "It's possible to find relief with all options, and treatment plans are individualized based on a person's current medical issues and past medical and surgical history."