Prolapse Management: Reduce Your Symptoms with Healthy Bowel Habits

June is Prolapse Awareness Month. 

Prolapse is incredibly common - according to some research up to 50% of women will get one but prolapse is incredibly varied - no two women experience it in exactly the same way.

Many women discover they have a prolapse after giving birth or going through menopause although some women will experience prolapse for seemingly no reason at all. 

It's possible to have a prolapse with no symptoms or a prolapse with a lot of symptoms which can fluctuate according to activity levels and time of the month. It can be a debilitating and psychologically troubling condition but thankfully there are lots of different treatments which can all have a big impact. 

There are 4 types of prolapse - vaginal, uterine, bladder, and rectal - and all involve one or more pelvic organs descending into the vagina. This can create an internal bulge but if it is more progressed, this bulge can be externally visible too.

Prolapse can feel like heaviness or pressure in your vagina, and there can also be urinary or faecal incontinence, painful sex, increased UTIs, and incomplete emptying. 

Owing to a historical lack of research and funding in this area, women with prolapse haven't been particularly well served by the medical establishment even though women have been treating prolapse for centuries by using everything from a pomegranate to a potato to try and support their pelvic organs (do not try this).

But the good news is that prolapse can be very treatable. Many women experience great results with lifestyle changes, pelvic floor exercise, pessary use, and even surgery. 

The important thing is to be seen by an experienced professional such as a women's health or pelvic floor physiotherapist who can assess your individual circumstances and design a personalised care plan.

To find someone local to you, ask for a GP referral (be specific about what you need and ask for a specialist physiotherapist as a first port of call) or if you are able to go privately, you can search here for chartered physiotherapists in Ireland (search 'women's health' under 'common conditions'). 

In practical terms, many women with prolapse live fully active lives by engaging with their medical professionals, building up their core and pelvic floor strength, and managing their intra-abdominal pressure.

There are loads of ways to do this but I want to talk about today is how managing your bowels can really reduce the pressure on your pelvic floor muscles and your prolapse symptoms. 

Your pelvic floor muscles support three major structures in your pelvis: the bladder at the front, the vagina (leading to the uterus) in the middle, and the bowel at the back. Your pelvic floor muscles support the weight of these organs - holding them in place with a combination of connective tissue (fascia) and muscle.

When you have a prolapse, some of this connective tissue or muscle may have become over stretched or weakened causing your pelvic organs to bulge into the walls of the vagina. 

If your bowel is full of poo this can put further pressure on the vaginal walls and pelvic floor muscles, especially if you are constipated regularly. 

There are two main strategies for keeping your bowel healthy and taking pressure off your pelvic floor:

The first is to make sure your body is producing poos that are easy to pass, and the second is to make sure you're pooing in a way that takes the pressure off your pelvic floor. 

Making poos that are easy to pass is a matter of making sure you're drinking enough water and eating enough fibre.

Drinking lots of water can feel counterintuitive when you're managing leaks but water is essential for good muscle function as well as regular bowels so it's a non-negotiable for anyone with prolapse.

Keep this really simple by making sure you get at least 2 litres of water every day. Little and often throughout the day is better than all at once. 

Fibre is essential for a healthy gut, for maintaining a healthy microbiome, and for keeping your digestive system moving. Luckily, eating enough fibre is straight forward too.

The best sources of fibre are whole fruits and vegetables.

You need aim for 30g of fibre each day. You can easily achieve this by including two portions of veg/fruit and one portion of seeds/nuts/pulses at each meal.

Switching from white to brown carbohydrates will also boost your fibre intake (brown rice/pasta/bread).

Fibre is not actually digested by your body but feeds the good bacteria in your gut and provides the bulk of your poo which gives your body a way to excrete the things it doesn't need. It also helps you feel fuller for longer and lowers blood pressure and total cholesterol.

Bonus points if your fibre sources contain soluable fibre. This kind of fibre draws more water into your poos making them slippy. You'll know a food is high in soluable fibre if it's a little slimy - fruits like kiwi, berries, or pears, seeds like chia and flax, and even wholegrains like oats are all great sources.

So that's your poos sorted. Now you just have to get them out safely and that means no more pushing and straining. 

When I tell people that's the rule, they always look at me like I'm crazy. Sometimes you have to push right? Well..... only half right. 

The first thing you need to do is use a step for your feet when you do a poo. This raises your knees slightly higher than your hips which helps your colon to straighten meaning you won't have to push as much. 

Next you need to lean in to how your muscles actually work.

Your poo comes out with the help of gravity and a gentle squeeze and release motion that actually happens all by itself when you breathe deeply in a relaxed way. 

When you take a relaxed breath in with your belly soft, your pelvic floor muscles will relax which allows the poo to move down in your colon.

When you breathe out, your pelvic floor and deep abdominal muscles will contract a little, which puts a bit of a squeeze on the poo and helps it move down even further.

Breathe in again, the muscles release, and the poo moves down a little more.

A couple of rounds of gentle breathing and the poo should be out easily.

You can purse your lips as you blow your breath out (like blowing out the candles on your birthday cake) to increase the breath pressure if you need a little more squeeze. 

This way, there's no holding your breath and pushing - which increases the pressure in your abdomen, can cause prolapse symptoms to worsen, and give you haemorrhoids. Not something any of us want. 

Keeping your bowels regular with diet and great toilet technique are two daily habits that can make a massive difference to your experience of prolapse.

Knowing that you're not going to be constipated can help build your confidence and improve urinary incontinence symptoms too. 

If you are affected by prolapse, know that improving your quality of life is always possible, no matter how severe your symptoms or how long you have been suffering. Work with your GP or Women's Health Physiotherapist to get the support you need.

If you'd like to know more about keeping your bowels healthy download our FREE GUIDE - Tip Top Toilet Technique. 

At Sheela, we're committed to making free, research based, original content every week to help you connect to your body.

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