A Brief Overview of Pelvic Organ Prolapse

(POP) Diagnosis & Integrative Treatment Strategies

by Laura Farnsworth

How is a prolapse diagnosed?A pelvic organ prolapse (POP), a type of pelvic floor disorder (PFD), is typically diagnosed through: o a pelvic exam performed while the woman is

lying down or standing and “bearing down” o a diagnostic test such as an ultrasound or MRIo the POP-Q classification guide, which is a tool

used by practitioners to help determine the severity (stage and location) of the prolapse

Who is qualified to diagnose a POP?o A practitioner qualified to assess a POP is generally an

individual with training in pelvic floor disorders (PFD) and female anatomy. Typically, family physicians refer patients to specialists trained to identify a POP.

o Qualified practitioners may include: • a urogynecologist (a specialist in pelvic floor

disorders)• a gynecologist • a midwife (a practitioner who assists with birth and

women’s health) • a physical therapist familiar with pelvic floor disorderso Each practitioner will assess the symptoms uniquely

and recommend different testing strategies.

Non-Surgical Approacheso Treatment strategies vary depending on the

type and severity of the prolapse. Integrative and holistic approaches for clients with POP may involve one or more of the following:o Physical therapy (PT) o Nutrition counselingo Fitness coaching, when trained in PFDo Yoga and mindfulness trainingo Massage therapy, such as a Mayan

abdominal massageo Colon hydrotherapy

Physical Therapyo Physical therapy (PT) is recommended for

non-invasive treatment to address underlying causes of POP.

o If pelvic floor muscles are weak, a PT may recommend Kegel exercises to strengthen the pelvic floor muscles (i.e., levator ani muscles).

o Additional exercises may be provided to help strengthen the core and pelvic muscles and to modify habits that exacerbate the condition.

Nutrition Guidanceo In addition to PT, a nutrition professional will

likely offer beneficial support to clients with a POP.

o If a client with a POP is overweight, effective nutrition and exercise strategies should be provided. Even minimal weight loss may result in reduced symptoms and better quality of life.

o Whole foods nutrition inclusive of high-fiber and nutrient-dense foods, including collagen-supportive nutrients such as vitamin C and adequate protein should be encouraged.

Fitness TipsThe following is a general guideline for fitness with a POP:o High-intensity weight lifting (i.e., Cross Fit) is typically

not recommended. High-weight, low-repetition training may cause substantial strain to the pelvic floor muscles.

o Low-intensity weight training is advised when done with proper form and completed without strain.

o High-impact cardiovascular exercise (running, etc.) is often not recommended, particularly if the woman is new to running or is overweight. However, an avid runner may continue running when approved by the PFD practitioner.

o Low-impact exercise is generally safe and recommended.o Core strengthening exercise that does not cause a “push

downward” motion is beneficial when done correctly. (See the Optional Extras section in the Wikipage for more information.)

o Yoga (and mindfulness) exercise that does not create stress to the pelvic floor is highly recommended.

References• American Urogynecologic Society (AUGS). (n.d.). POP diagnosis. Retrieved from

http://www.voicesforpfd.org/p/cm/ld/fid=183• American Urogynecologic Society (AUGS). (n.d.). Can I prevent POP? Retrieved from

http://www.voicesforpfd.org/p/cm/ld/fid=25• Hagen, S., Stark, D., Glazener, C., Dickson, S., Barry, S., Elders, A., ... Wilson, D. (2014).

Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): A multicentre randomised controlled trial. Lancet, 383(9919), 796-806. doi: 10.1016/S0140-6736(13)61977-7. Retrieved from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961977-7/fulltext

• Lee, S. J., Karter, A. J., Thai, J. N., Van Den Eeden, S. K., & Huang, E. S. (2013). Glycemic control and urinary incontinence in women with diabetes mellitus. Journal of Women’s Health, 22(12), 1049–1055. http://doi.org/10.1089/jwh.2012.4093

• Lodish, H., Berk, A., Zipursky, S. L., Matsudaira, P., Baltimore, D., & Darnell, J. (2000). Molecular cell biology (4th ed.). Section 22.3, Collagen: The Fibrous Proteins of the Matrix. New York: W. H. Freeman. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK21582/

• Maserejian, N. N., Giovannucci, E. L., McVary, K. T., & McKinlay, J. B. (2011). Intakes of vitamins and minerals in relation to urinary incontinence, voiding, and storage symptoms in women: A cross-sectional analysis from the Boston Area Community Health Survey. European Urology, 59(6), 1039–1047. http://doi.org/10.1016/j.eururo.2011.03.008

• Maserejian, N. N., Giovannucci, E. L., McVary, K. T., McGrother, C., & McKinlay, J. B. (2010). Dietary macronutrient and energy intake and urinary incontinence in women. American Journal of Epidemiology, 171(10), 1116–1125. http://doi.org/10.1093/aje/kwq065

• Persu, C., Chapple, C., Cauni, V., Gutue, S., & Geavlete, P. (2011). Pelvic organ Prolapse Quantification System (POP–Q) – a new era in pelvic prolapse staging . Journal of Medicine and Life, 4(1), 75–81. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056425/

• Podzemny, V., Pescatori, L. C., & Pescatori, M. (2015). Management of obstructed defecation. World Journal of Gastroenterology : WJG, 21(4), 1053–1060. http://doi.org/10.3748/wjg.v21.i4.1053