What Is A Pessary And Do I Need One?

What Is A Pessary And Do I Need One?

If you have incontinence, or a pelvic organ prolapse, you’ve likely heard the term “pessary” tossed around at some point.  Pelvic organ prolapse is a condition in which your pelvic floor becomes weak or compromised – sometimes due to age, sometimes due to trauma (like childbirth), causing one or more of your pelvic organs to collapse into the vagina. Pelvic organ prolapse can be mild, or severe, and symptoms can vary greatly depending on the severity. Some women may not even realize they have a prolapse until later in life.  Symptoms can include pressure or a feeling of heaviness in the vagina, incontinence, or even pain.

While some women can see big improvements in their condition with physical therapy, the condition cannot truly be “fixed” without surgery.  But, it is possible to manage pelvic organ prolapse by using a pessary. 

A pessary is a medical device, typically made out of silicone that is placed in the vagina and is used to support the pelvic floor, and the bladder, uterus and rectum.  Pessaries are not a one-size-fits all type of device. Everyone is different so your doctor will usually fit you for one that works for you. This may take a few tries, so don’t get discouraged if the first one you try doesn’t feel quite right.  Just be open with your doctor and work with them until you get the right fit.

Once you’ve found the right fit, your doctor will train you on how to insert and remove the device.  You’ll also learn how to care for your pessary, which will require weekly or biweekly cleansing.   

Pessaries can be a great solution for women with pelvic organ prolapse, or bladder incontinence, who don’t want to consider surgery (or are not quite ready for surgery yet).  It works by “holding up” the organs that may have collapsed into the vagina, relieving many of the side effects of a prolapse, such as the feeling of pressure or heaviness in the vagina, or incontinence.   

If you think you may be a good candidate for a pessary, talk to your doctor. They can review the pros and cons and help get you fitted for one.  It’s a great option for those experiencing symptoms of pelvic organ prolapse, and can provide great relief without undergoing surgery.

 

The Best Sex Positions If You Have Incontinence Or Pelvic Organ Prolapse

The Best Sex Positions For Incontinence Or Pelvic Organ Prolapse

The Best Sex Positions For Incontinence Or Pelvic Organ Prolapse

We all want a satisfying sex life.  But sometimes, medical conditions can get in the way of that. If you struggle with incontinence or pelvic organ prolapse, sex can often be a source of great anxiety. Fear of leakage, odors, or even pain can sabotage intimacy and leave you feeling undesirable or anxious when it comes to intercourse. There are many things you can do to prevent incontinence and pelvic organ prolapse from interfering with your sex life. However one of the simplest things you might try changing is your sexual position.

Your sexual position can make big difference when it comes to easing anxiety about leakage or pain and enjoying sex. Certain positions can put lots of pressure on the bladder, making it more likely that you may have an episode of stress incontinence. And if you have pelvic organ prolapse, some positions may feel more uncomfortable than others.  Here are a few sexual positions you may want to try, depending on your condition.

Sex Positions If You Suffer From Bladder Leakage: 

Just as you may experience bladder leakage when you sneeze, laugh, or workout, putting extra pressure on your bladder or urethra during sex can also cause incontinent episodes. This shouldn’t hinder your sex life. While it may make you feel anxious, there are ways to avoid bladder leaks during intercourse. Women who are concerned about leakage during sex should avoid positions that put extra pressure on these areas.

 Avoid:  The missionary position, or all fours.

Try:  Lying on your back with some pillows underneath your lower back. This position raises your pelvis and helps to reposition your bladder, reducing the extra pressure.

Sex Positions If You Suffer From Pelvic Organ Prolapse:

Pelvic Organ Prolapse (POP) is a condition in which your pelvic floor is weakened to the point that one of your pelvic organs (bladder, uterus, or rectum) “falls” into your vagina. Many women with POPs report feeling a heaviness or bulging feeling in their vagina, or a feeling that they are sitting on top of a ball. In severe cases, the pelvic organ may protrude past the vaginal opening. 

While this condition may leave you feeling uncomfortable and anxious about sex, rest assured that sex is still completely possible and will not affect the POP at all. Many women report having great sex even with a POP and, since it is extremely difficult for non-medical professionals to detect a prolapse, your partner probably doesn’t even know it’s there.

However, certain sexual positions can create discomfort in women with POP. Here are some positions to avoid, and some to try:

Avoid: Standing, “Cowgirl” or “Reverse Cowgirl” (where the woman is sitting on top). Gravity is not on your side here, and sitting or standing upright will only create more pressure on your pelvic floor during sex.

Try:  Modified Missionary Position: Woman is lying on her back with a pillow under her pelvis and her partner is on top.

 From behind: Woman is lying flat on her stomach or in supported kneeling position with her partner entering the vagina from behind.  (Note: Avoid this position if you have a rectal POP.)

Above all, be sure to communicate with your partner about what feels good and what doesn’t. Sex should be enjoyable for both of you so if something feels uncomfortable or doesn’t make you feel good, speak up.  And, if you’re still having difficulty finding a position that works for you, talk with a pelvic floor physical therapist. They’ll help create a custom treatment plan to strengthen up your pelvic floor muscles, and can suggest other tips that may make sex more enjoyable to you.


If you are worried about leaking during sex, you may also want to practice kegels. Kegels can help strengthen your pelvic floor so that you have more control over bladder leakage. Want to learn how to perfect your kegel? Read our how-to guide!

What Is The Pelvic Floor? (And Why Should I Care?)

What Is The Pelvic Floor and Why Should I Care?

If you’ve never thought much about your pelvic floor, you’re not alone. Most people don’t give this section of the body much consideration until it’s too late – they become incontinent, or worse, suffer a pelvic organ prolapse as a result of pregnancy, obesity or chronic constipation. But the pelvic floor is one of the most important muscles in the body, and ignoring it can have potentially great consequences later in life.

Anatomy

Let’s begin with a little bit of anatomy. The pelvic floor is a basket of muscles that supports some pretty major organs – your bladder, rectum and uterus in women, and your bladder, rectum and prostate in men, to be exact.  The muscles stretch across the pubic area from front to back and from side to side. They are typically very firm and thick, but are also flexible and are able to move up and down (kind of like a trampoline).

These muscles are very important in supporting the organs listed above, and are essential in maintaining control over our bladder and bowel. The pelvic floor muscles also play a large role in sexual function for men and women, and provide support for the baby during pregnancy. 

Over the course of our life, many things can compromise the stability of the pelvic floor, leading to things like incontinence, or pelvic organ prolapse. Obesity, childbirth, chronic coughing, chronic constipation, or other things that put strain on the pelvic floor can cause it to weaken. And with age there is often a weakening of the connective tissues of the pelvic floor.

What You Can Do To Protect The Pelvic Floor

The good news is that much like the other muscles in the body, the pelvic floor can be trained and strengthened over time.  By learning to strengthen the pelvic floor, you may be able to prevent or even eliminate symptoms of incontinence or prolapse.

Read: 4 Moves to Help You Strengthen Your Pelvic Floor Before You Get Pregnant

There are many exercises you can do to strengthen the pelvic floor. Kegels are great at isolating the pelvic floor muscles, but because the pelvic floor connects to many of the muscles that create your “core” (your diaphragm, transversus abdonminis, and multifidus), you also need to incorporate workouts that build strength in those areas as well. And remember – it’s not just about tightening. We need to ensure that our muscles are neither too tight, nor too loose. Learning how to relax the pelvic floor is just as important as learning how to strengthen it, since a pelvic floor that is too tight can create weakness and cause problems too. Like any other muscle in the body, we are looking for our muscles to be strong and flexible. 

Symptoms Of Pelvic Floor Tension

  • Constipation

  • Painful intercourse

  • Pelvic Pain

  • Inability to empty your bladder completely

  • Painful urination

If you experience these symptoms, we recommend that you see a pelvic floor physical therapist prior to starting any strengthening program. Performing strengthening exercises on a pelvic floor that is already too tight can create additional problems, or make any existing issues worse.

Symptoms Of Pelvic Floor Weakness

Learning how to strengthen, and relax the pelvic muscles can help with pelvic floor weakness.

Want tips on how to improve your pelvic floor strength? Check out these great resources:

Incorporating Pelvic Floor Exercises Into Your General Workout Routine – 3 Best Moves To Add Now.

It’s All About The Base

Ask The Expert: Can Pelvic Floor Exercises Really Help My OAB Symptoms?

Men And Kegels – The Ultimate Guide

Note: If you are experiencing symptoms of either pelvic floor weakness or tension, we strongly advise you to see a physical therapist specialized in pelvic floor therapy. A physical therapist can help provide you with a diagnosis and put you on a custom treatment program specific to your needs.

Your Guide To Personal Lubricants

Your Guide To Personal Lubricants

Sex is a great way to connect with your partner. But as our bodies change, certain conditions can make sex more challenging than it used to be.  For those with pelvic floor issues, it’s common to also see a reduction in natural lubrication. And as women enter menopause, the decrease in estrogen levels can reduce the amount of moisture available, and can make the vaginal wall thinner and less elastic. And even if you aren’t yet experiencing menopause, common occurrences such as stress, lack of sleep, or other medical conditions can often lead to vaginal dryness.

Vaginal dryness can cause discomfort on it’s own, but it can wreak havoc on your sex life, making it painful and uncomfortable. Lucky for us there are a plethora of choices for personal lubrication that will have you back on track in no time. If you experience any dryness during sex, try using lubrication to help remove the unwanted friction and make sex more enjoyable for both you and your partner. 

Popular Types Of Personal Lubricants

Water-based lubricants  

This is the most natural feeling lubricant and one of the most poplar. Note that a water-based lubricant will dry out faster than other forms and you may need to reapply it during sex.

Silicone-based lubricants 

Silicone lubricants are a bit slicker than water-based ones, and they may be used in water. They also last a bit longer than water-based lubricants so you won’t need to apply them as often. Avoid using silicone-based lubricants with silicone sex toys though, as it can deteriorate softer silicone sex toys due to how the molecules interact with other silicone products.

Hybrid lubricants  

Hybrids are a blend of water-based and silicone-based lubricants. They provide the feeling usually associated with a water-based product, but they won’t dry out quite as quickly. Note: because these are typically 90% water-based, they won’t work well in water.

Oil-based lubricants 

Oil-based lubricants – including petroleum jelly – are the least commonly used. Coconut or VitE oil are good daily options to use for general vaginal dryness. However, oil-based lubricants should never be used with condoms, latex, diaphragms, or rubber, since the oil will weaken these materials and may cause them to be ineffective.

Everyone’s preference is different and what may work great for one person may not be the best choice for you. Don’t be afraid to try out different types of lube to find one that you like best. 

Life After Leaving The Closet

Six months ago I announced that I was ‘coming out of the closet’ regarding my health issue with Pelvic Organ Prolapse. Today I’m back to share how that decision has improved my life.

After dealing with POP symptoms for what seemed like an eternity, I finally decided to seek answers to my questions concerning this health condition. It took a fair amount of courage to face the fact that I needed help. It wasn’t an easy decision by any means because I tried to tell myself it was just part of the aging process and I would just have to ‘deal with it’ the best I could.

I’m here to tell you, that isn’t the case. No woman needs to suffer in silence or hide their health issues in a closet. I totally understand how reluctant some women are to talk about or be treated for this health issue. I grew up in the era when women’s health issues weren’t openly discussed among peers, but were generally relegated to a dark closet. However, times have changed and although some may not know it, there is hope and help for those who suffer with this malady. New treatment options occur on a daily basis that allows women to control, improve and repair this cryptic health condition. It’s time to openly discuss women’s health issues.

Although I tried to keep up with a daily exercise program prior to surgery, it became difficult because of the pressure and pain I was experiencing. Because of this I gained an extra 15 pounds in a very short period of time. It was a very depressing time for me. But, after the brief recovery from surgery in January I was once again able to exercise and follow a simple diet that resulted in my losing 22 pounds by mid-March.

My life today is one-hundred percent better than it was prior to my surgery. I can go for walks, out to dinner, and shopping without having to worry about what might happen.  If you suffer from Pelvic Organ Prolapse I encourage you to not hide in a closet or allow it define how you live your life. Take charge of your health. After all, there is a better life after leaving the closet!

Betty Heath

Did you miss Betty's original article about her surgery? Read it here!


betty+heath.jpg

About The Author:  Betty Heath lives in Colorado with her husband. She is “retired from work, but not from living”, and has a weekly column called “As I See It”, which appears each Sunday in the Longmont Times-Call, owned by the Denver Post. She enjoys writing, cooking, gardening, and quilting. Betty also volunteers in the St. Vrain Valley School District, helping students learn how to write from their heart. For the past six years, she and her husband have volunteered as Santa and Mrs. Claus for the Holiday Festival in the Carbon Valley. You can read more from Betty at her blog, The Rejoicing Soul.

Coming Out Of The Closet About Pelvic Organ Prolapse

This is a guest post from Betty Heath, of The Rejoicing Soul.

During the past twelve years I have shared much of my life’s journey with you. Well, today I am coming out of the closet.  Stunning isn’t it? I was recently diagnosed with Pelvic Organ Prolapse. How many of you can identify with me? The current estimate of the number of women in the U.S. with this condition is approximately 4.3 million. According to a recent study by the World Health Organization guestimates indicate that there are 36 million women world-wide with this condition. The reality is that it is difficult to know what the real numbers are because women are reluctant to be talk about it or be treated for it.

Pelvic Organ Prolapse (POP) is quite common among today’s female population. Many women have the symptoms but because they are embarrassed to discuss them with anyone they suffer in silence.  POP can occur when the pelvic floor muscles weaken and one or more organs shift out into the vaginal canal and even bulge outside of the body.

My journey with POP began sometime in the spring of 2016. I began having symptoms of POP which include pressure, pain and/or fullness in vagina or rectum or both; sensation of ‘your insides falling out’; bulging in the vagina; severe back pain and incontinence. Every time I went for a walk or even sneezed I thought my insides were going to fall right out onto the ground. I began staying home more often and said little about it to my friends. At first I attributed these symptoms to old age and laughed them off. After all, I am approaching the ripe old age of 80. We hear and see so many TV ads regarding incontinence and because the causes are never addressed we become oblivious to what they might be.

This past fall I finally decided I didn’t want to spend the rest of my life worrying about my insides falling out and was tired of dealing with this issue so I made an appointment with a gynecologist. After the initial exam I was referred to Dr. Alexander Shapiro who is a specialist gyn/urologist in Denver. That exam took place in early December and was one hour and thirty minutes.

After the exam I told him I never dreamed I would be sitting in a gyn/urologist office at the age of 79. He smiled and replied, “We do have ways to keep popping up in your lives, don’t we.”  I then told him this was the most disgusting, gross thing that has ever happened to me. He said, “Right now your insides are a total mess. This is a very intimate surgery and is a major surgery. This is who you are right now and you can’t allow this to define your life. I promise you I can repair the damage and relieve the pain and discomfort”.

The four-hour surgery took place on Monday, January 30. I told my physician that most women my age are having face lifts and here I was having a butt-lift. I went home Tuesday and Wednesday as I was having breakfast I suddenly realized that the fullness/pressure feeling and the back pain I had prior to surgery were totally gone. Oh, what a relief it is. I cried tears of joy. I’ve experienced minimal pain with this surgery.

Today, if you are a woman reading this (or a man who has a woman in your life with this condition) I urge you to make an appointment to at least talk with your physician about your problem. There is help and hope for women with POP. New treatment options evolve daily to control, improve and repair this cryptic health condition.

Join with me in taking Pelvic Organ Prolapse out of the closet and make it common knowledge for women of all ages. Don’t allow this condition to define who you are or how you live your life.  Don’t wait! Call for your appointment today.

Betty Heath
Betty Heath

About The Author:  Betty Heath lives in Colorado with her husband. She is “retired from work, but not from living”, and has a weekly column called “As I See It”, which appears each Sunday in the Longmont Times-Call, owned by the Denver Post. She enjoys writing, cooking, gardening, and quilting. Betty also volunteers in the St. Vrain Valley School District, helping students learn how to write from their heart. For the past six years, she and her husband have volunteered as Santa and Mrs. Claus for the Holiday Festival in the Carbon Valley. You can read more from Betty at her blog, The Rejoicing Soul.

Prolapse After Pregnancy – It’s Not Your Fault.

Prolapse After Pregnancy - It's Not Your Fault.

Around 6 weeks postpartum, I had expected to feel a bit more like myself.  I had avoided exploring anything in the vaginal area for fear of what I would find, but had felt a general heaviness since I had given birth.  Not knowing for sure if this was normal, I made an appointment with my doctor to get checked out. 

Upon examination, my doctor confirmed that I had a prolapsed bladder.  His tone was nonchalant, as if it was totally normal and something that just happened sometimes. 

I was completely shocked. What had gone wrong?  And why did I never hear that this was a possibility?  I immediately started blaming myself.  Why had I not done more kegels during my pregnancy?  Why didn’t I do more research to know that something like this could happen?  Did the decision to use a vacuum during the last bit of pushing influence this?  What could I have done to prevent this?

But the truth is, some women really are just more susceptible to prolapse.  While a prolapse can occur for many reasons, some women have more of a genetic risk for the condition due to the strength of the connective tissues.  It’s not your fault. 

That being said, there are some things that may help you either avoid a prolapse, or at least improve your symptoms if you have one.

How to improve symptoms of pelvic organ prolapse

  • Maintain a normal weight.  If you are overweight, you are more susceptible to a prolapse due to increased pressure inside the abdomen. 
  • Avoid constipation.  Becoming constipated can cause you to strain during bowel movements, increasing the chance of a prolapse.  Ensure you are eating a high fiber diet and drink plenty of water every day.
  • Keep active.  A regular exercise plan keeps your weight in check, and also helps promote healthy bowels.  Be sure to include your pelvic muscles in your daily workout routine too.
  • Avoid extra pressure inside the abdomen.  Things like lifting heavy objects, and chronic coughing, create persistent pressure, which can increase the likelihood of developing a prolapse, or making your symptoms worse if you have one.  Stay healthy and avoid strenuous lifting. 

Whatever you do though, don’t blame yourself for developing a prolapse.  Instead, use that energy to find out what you can do to improve your symptoms and treat the condition.  Talk to your doctor about your options, and find a qualified physical therapist to help you learn how to strengthen your muscles to improve symptoms.

What To Expect After Pelvic Floor Reconstruction

What to expect after pelvic floor reconstruction surgery for pelvic organ prolapse

The decision to undergo pelvic reconstructive surgery to correct pelvic organ prolapse (POP) can be difficult. Women often wait years dealing with symptoms of POP before they commit to surgery. Aside from decreasing symptoms of prolapse, a desired outcome of pelvic floor reconstruction is for the woman to be able to return to her active life. Likely, the surgeon has provided some information about do’s and don’ts, but this is usually related to immediately post-surgery.  Most pelvic floor surgeries require an initial 6 to 8 week rest period —keeping activity very light—no sexual intercourse, no heavy lifting, no running etc.

But after the initial rest period, then what? Are there activities to avoid or limit? How much is “too much” to lift?  Should anything be avoided altogether? Medical literature tells us that 30% of women may require a second surgery at some point in the future due to failure of the first or because of another pelvic problem.1 Yet, there is little information on improving outcomes in order to prevent another surgery. Most surgeons use a common-sense approach in advising their patients, and if a woman has specific questions or concerns, she is always advised to ask her surgeon. The surgeon has the best understanding of how the procedure went and in what shape the woman’s pelvic tissues are.

The primary cause of POP is trauma to the pelvic floor muscles (PFM,) connective tissue or “fascia” and ligaments. These structures become unable to support the pelvic organs. The majority of women undergoing surgery sustain tissue injury from childbirth trauma.  More rarely, women may develop severe prolapse due to extreme increases in intra-abdominal pressure (IAP) for other reasons.  Examples include illnesses that cause chronic coughing or performing frequent Valsalva maneuvers (straining) such as with chronic constipation.

In attempting to identify risk factors and make post-surgical recommendations, research has determined that indeed, the two things that increase IAP and vaginal pressure (VP) the most are coughing and Valsalva maneuvers. Most of these studies compared pressure measurements during everyday activities like supine lying, standing, lifting, running, coughing and straining. According to the research, many things increase IAP; just getting out of bed will mildly increase IAP, as will lifting moderate weight and running. One study went so far as to say that many post-surgical guidelines are “needlessly restrictive.”5 The researchers found that in subjects without pelvic floor problems tasks such as lifting eight to 20 pounds off a counter, lifting 13 pounds from the floor, walking briskly, performing crunches all produced no more increase in IAP than getting out of a chair. They summarized that “how lifting is done impacts intra-abdominal pressure.” The good news is, that the research, found that unless a woman has a chronic cough condition or habitually performs Valsalva maneuvers, everyday stressors like standing, walking, lifting normal weight, sexual intercourse and running should be okay post pelvic surgery.

Women seen by a specially trained pelvic physical therapist (PT) after surgery are taught strengthening exercises and postural strategies, as well as how to lift correctly. If risk factors are present the woman may need extra help to learn how to care for her pelvic floor during stressful activities, this may include diet counseling and information on sexual positions to limit stress to the PFM.

Here is a list of some things PT’s might teach their patients post surgery:

Posture

PFM works best when the spine, pelvis and hips are in good alignment. If a woman’s back is too rounded, the normal bony structure of the pelvis can’t act to support the pelvic organs as intended. If the back is too arched, the pelvic muscles can become overstretched and strained. Normal spinal posture is a simple and effective way to support the pelvic organs. Learn how to maintain good posture with your normal daily activities, such as sitting at a computer, lifting, squatting etc.

Diet

To avoid constipation and straining (Valsalva) with bowel movements, drink plenty of water, eat a balanced, healthy diet with whole grains and fresh vegetables and learn about soluble and insoluble fiber. If constipation exists, it needs to be assessed to determine the type of constipation, and then be properly treated.Toilet Posture: We know that the vast majority of people evacuate their bowels best when in a squatting position. Most modern toilets don’t accommodate for this. Try placing a phone book or two under the feet to elevate the legs. Or try this device, which allows for a nice squatting position when on the toilet:  spine in neutral, but hips flexed and knees above the hips.

Restful Rescue Poses

There are excellent resting positions that utilize gravity to encourage organs to “reposition” back into the pelvic cavity. Here’s one: lie on your back and place a pillow or small wedge under the pelvis to invert your pelvic region. Place pillows under your knees as well and one pillow (or none) under the head. It’s a lovely position to rest in, and for those doing a strengthening program, it’s a great position for that too. If you want to go all out, place a heating pad over your tummy, turn the lights low, play soothing music and rest for a blissful 20 minutes or so. 

Biomechanical Considerations for Sexual Intercourse

Let’s face it, the majority of women going through POP surgery are sexually active. Sex must be addressed and often it’s the PT who spends the time with the patient and can make the best recommendations. For example, if a woman has pain with vaginal penetration, she may need to perform special stretching exercises to open the vaginal introitus and the PT can advise on intercourse positions that will least stress the PFM. Menopausal women may also need to discuss additional local estrogen and lubricant with your surgeon or physical therapist.

Pelvic Bracing

This is a technique of co-contracting one’s lower abdominal muscles, deep back stabilizing muscles, with the PFM. When done correctly it can limit the stress on the pelvic organs during activities of increased IAP, like lifting or squatting. It sounds complicated but it’s really not. Women should learn to do this in any position. First, attend to your PFM by giving them a gentle squeeze (feel the perineum lift) followed immediately by a relaxation (feel the perineum release down.) Starting from a relaxed place, gently draw the PFM upward as you gently draw the navel inward. Imagine you are trying to lift your vagina like an elevator as you feel your lower tummy gently flatten. Do this gently, not full force. You should be able to breathe normally as you do this. You’ll feel the two muscle groups acting together to tighten the lower belly and “brace” the pelvic floor. The deep back muscles should activate when you do this providing posterior support simultaneously. Hold this co-contraction for a few seconds then release. If you have trouble with this, seek out a pelvic floor PT in your area to help you learn. Learning how to brace during functional activities sometimes requires a bit of training, so again, seeking a specialist may be indicated if you are someone who has risk factors.

Pelvic Floor Muscle (PFM) Strengthening.

Often called “Kegels,” PFM strengthening involves exercising the PFM by contracting them for short or long periods of time—usually from two to four seconds to train the “fast twitch” muscle fibers, and five to 30 seconds to train the “slow twitch” muscle fibers.  Sometimes these exercises are done in conjunction with other muscle groups. The muscle fibers of the pelvic floor are 70% slow twitch and only 30% fast twitch. This means that the PFM are much better at endurance events than brute strength activities. They act more as supportive postural muscles; however we occasionally need a quick strong contraction to avoid leaking with a sneeze. Correct PFM strengthening incorporates exercises for both types of muscle.

Some women actually do too much exercise and develop tight, painful muscles. Sometimes, after a pelvic surgery, a woman might actually feel “tight” or “tense” inside. This is from the surgery, not because the muscles magically strengthened from the procedure. If after surgery you have symptoms of pain (either at rest or with an activity like sex), urinary urgency or frequency, then tell your doctor. Kegels would not be appropriate for you. If this is the case be sure to talk to your doctor for other options, such as biofeedback.

Other women need to exercise to develop more muscle tone and strength. The trick is to ensure there is balance between strength and flexibility. If you are still leaking or feel weak, then strengthening may be helpful.

Physical therapists with a pelvic floor specialization are trained to assess the whole person to determine an appropriate exercise routine, and women are advised to be evaluated before undertaking a rigorous strength program.

ASK THE EXPERT: Is It Safe To Have Sex With A Vaginal Prolapse?

Is it Safe To Have Sex With A Vaginal Prolapse?

Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.

Question: Is it safe to have sex if you have a vaginal prolapse?

Answer: Yes! A prolapse occurs when a woman’s vaginal wall weakens and collapses, causing the uterus, rectum or bladder to fall into the vagina. However, in most cases, it is completely fine to have sex as long as the woman feels comfortable.  And, having sex when you have a prolapse will not cause any harm to the bladder, rectum or uterus, nor will it make the prolapse worse.

Some women with a prolapsed organ may feel some slight discomfort during sex. Using lubricant can help, as well as ensuring your pelvic floor is completely relaxed before you begin. Trying other positions may also alleviate any pain you are experiencing too. Talk with your partner about what feels best for you.

Are you an expert in incontinence care? Would you like to join the NAFC expert panel? Contact us!

Why Didn't Anyone Tell Me About Pelvic Organ Prolapse?

A Guest Blog By Sally Connor

I am a 38-year old woman, and I am angry. Angry that my body has changed so much since I’ve had children, angry that I developed a prolapsed bladder after the birth of my first son, angry that I can no longer run the way I used to without making several trips to the bathroom, or worse, wetting myself. I am angry with my doctors for not telling me that this may be a side effect of pregnancy and that there were steps I could have taken to prevent it. I’m angry with other women for not telling me that it has happened to them. I am angry for my sheer ignorance of the situation until it happened to me. But more than anything, I am angry that no one knows any of this because in our society, it feels too embarrassing to really talk about.

When we are young, we don’t think about these things. Before I had children, I don’t think that I ever even gave the pelvic floor much thought. Quite frankly, I didn’t even know what it was.  Here is what I didn’t know:  That the pelvic floor muscles act as a basket, supporting your bladder, uterus, and rectum. It is also connected to and supported by your deepest core muscles – your transverse abdominus (below the ‘six pack’ abs) and your multifidus (the tiny muscles that support the spine), and is affected by almost every movement you make.  The pelvic floor, what I now refer to as the epicenter of my body, is called upon every time you sit, stand, squat, walk, and even breathe. 

So I ask, why is it that we don’t hear more about this vital web of muscles? Why are we kept in the dark until it is too late? Because, really, much of this can usually be prevented. The pelvic floor, just like any other muscle in the body, can be strengthened and trained. With regular exercise, the pelvic floor and the supporting muscles around it can provide a strong foundation for continence for your entire life. But, like any other muscle, if it is already in a weakened state, and then becomes traumatized by something like childbirth, well, the damage is done. 

That is the case with prolapse. You can try to repair it, and may see marked improvement through physical therapy, or even surgery, but once the damage is done, it is done. 

It doesn’t mean that there is no hope though. I know this. I have seen great improvement in my symptoms and am grateful to have had access to a very skilled physical therapist who was able to show me how to strengthen things up ‘down there’. But, I still do experience some symptoms and I can’t help wonder if things would be the same had I been more aware of this muscle and what I should have been doing to keep it strong prior to and during pregnancy. 

With over 25 million Americans experiencing incontinence, I am baffled that the issue is not publically talked about more often. It is estimated that about 40% of women will experience prolapse at some point in their life. When will we decide that these conditions deserve attention? Talking about them would encourage more people to get help, and, maybe even more importantly, take steps to prevent it. 

Instead, the silence only encourages the shame, embarrassment, and isolation that many people with incontinence experience.  It does nothing to help those who are experiencing the issue to know there are ways to treat it.  Nor does it educate those who have not experienced it to know that this is something that should be considered. Until we can all be more open and recognize that this is a problem worth talking about (shouting about!), we will be a society that continues to allow it’s people to ‘quietly manage their symptoms’ instead of really preventing or treating them. 

So please, speak up about your incontinence, your prolapse, or any other pelvic floor issue you may have. While it may be common, it’s not normal, and is nothing that anyone should have to suffer with in silence.

About the author:  Sally Connor is a mother, wife, entrepreneur, and homemaker who suffered a prolapse after giving birth to her son. She has refused to let this symptom rule her life and strives to increase awareness of pelvic floor issues and what women can do about them by simply talking more about the issue.  She hopes that one day pelvic floor issues and incontinence will be a less taboo subject.

Why You Should Not Be Afraid To See A Physical Therapist For Your Incontinence

Don't Be Afraid To See A Physical Therapist For Incontinence

I’m 38 years old, and I have a prolapsed bladder.  I discovered it after the birth of my first son, and needless to say, it was alarming.  I hadn’t even realized something like this could happen, yet there I was, 6 weeks post-partum at my doctor’s office, with him confirming that, yep, I had a stage 2 cystocele.  I was devastated.  What did this mean?  How would I be able to keep up with my son?  Would it affect me having another child?  Would I experience incontinence because of this?

Determined not to let this problem control my life, I sought out the help of a physical therapist specialized in women’s health.  (Yes, these people exist!)  I’m sure that I was nervous before my appointment, but I shouldn’t have been.  Looking back, all I remember is the understanding, help and wonderful instruction my therapist provided me during this time.  She walked me through my own anatomy, showed me how my muscles all work together to support the pelvic floor, and taught me moves that I could do on my own to help “strengthen things up down there”.  She was my teacher and my cheerleader, who gave me encouragement when I needed it most and helped push me to work hard to see improvements.

And I did improve.  Partly from just the natural recovery process after giving birth, but also due to the help from my weekly sessions with my PT.  Through her I have a much greater understanding of how my pelvic floor and supporting muscles work together and how to keep them strong.  Although I still do have a prolapse (it will never really go away), due to regular exercise that I learned from my PT, it rarely bothers me and I do not experience any incontinence.  I’ve even started running again! 

What I’d like you to take away from my story is this:  If you are experiencing some type of incontinence – no matter what the cause – a trained Physical Therapist can help you.  The exercises and moves that they will teach you may help you alleviate many of the symptoms you experience, and, regardless of treatment, truly should be a part of any plan – whether you are managing with medication, absorbent pads, or even thinking about surgery in the future. 

BE STRONG!  Take control of your life!  Don’t let a prolapse or your incontinence dictate how you live. 

Ready to take the plunge but need help finding a Physical Therapist?  Check out the NAFC Specialist Locator and make your appointment today! 

What Is Bladder Prolapse And Why Does It Happen?

What Is Bladder Prolapse?

Bladder prolapse is when your bladder is no longer being held up in its appropriate location in your body by the muscles around it. For some women, bladder prolapse can feel like a heaviness above their vagina, and for others, the bladder is actually resting or ‘leaning’ on the vagina. The condition can be very mild (some women may not even realize they have it), or they can be very severe. If left untreated, many women may see an increase in symptoms such as incontinence or pain as they get older.

Prolapse can occur for many different reasons. The most prevalent is in direct result of pregnancy and childbirth. During pregnancy and childbirth, the women’s organs are shifted around in their abdomen and are often pushed to make room for the baby.  The pelvic floor, which typically holds up those organs, is now helping keep a growing baby hoisted healthfully above the pelvic bones and the reproductive organs. Childbirth exacerbates the pressure and trauma those organs and the pelvic floor withstand because of the sheer force needed to birth a child. This all results in the pelvic floor being very weak and overworked.

When the floor can’t withstand any more weight and pressure, the organs it supports begin to prolapse.

There are many options for treating a prolapse. Physical Therapy can do wonders for women with this condition. In addition, management tools, such as pessaries, can help ease many of the physical symptoms of pelvic organ prolapse. And, if none of these options do the trick for you, there are surgical procedures that can help correct the issue (read about this woman's journey to healing her pelvic organ prolapse.)

If you think you may be experiencing this and want to learn more, go here for more detailed explanation and suggested treatment options

It's All About The Base: Learning How To Work Out Your Pelvic Floor

It's All About The Base

We all have health goals. They are often about being more health conscious and physically active.  I’ve heard varying goals from “I want to lose 15 pounds” to “I want to be able to run my first marathon,” but rarely do I hear “I want a stronger pelvic floor” or “I want to be able to jump or exercise without leaking urine every time.” In fact, most people don’t even know about these muscles and how essential a strong pelvic floor is for everyday function.  

The pelvic floor is an amazing set of muscles that span inside your pelvis, from your pubic bones to your tailbone, that act as the base of your core.  They work to control your bladder and bowel and maintain continence, allow for pain-free and enjoyable intercourse, hold up the pelvic organs and help stabilize the pelvic girdle and spine…that’s a lot of responsibility for muscles that are often neglected in the daily workout plan.

As a pelvic floor specialist, I am often asked “How do I work out my pelvic floor?”  The fact is, most people don’t know how to turn on their muscles the RIGHT way.  They are often trying so hard to squeeze as tight as possible that they are engaging everything but their pelvic floor! They will hold their breath, clench their butt, squeeze their inner thighs, tighten up their abdominals and totally miss the boat. 

A pelvic floor contraction, or Kegel, is a very subtle feeling.  It includes a compression and lifting of the muscles deep inside the pelvis, like you are trying to suck a marble up with your vagina or lift your testicles in fear of walking into ice cold water!  Too frank? Well then imagine that you are stopping the flow of urine, which is actually a good test to see if you are engaging the RIGHT muscles.  You can always tighten your pelvic floor mid-stream and see if you can stop, or at least slow down the flow, but this should just be a test, and never a means to actually exercise these muscles.

Although the pelvic floor is the star of this article, you have to also understand that these muscles don’t work in isolation.  Remember that the pelvic floor is the BASE of the core, but also works with other muscles as an integrated system.  The major supporter of the pelvic floor is the diaphragm, which is the dome-shaped muscle at the bottom of the rib cage that is essential for breathing. 

When you take a deep breath in through your nose, your rib cage expands and the diaphragm moves downwards, changing the pressure system in your abdomen so your pelvic floor muscles RELAX.  As you exhale through your mouth, the diaphragm moves upwards, and again, the intra-abdominal pressure is changed, and the pelvic floor returns to its resting position.  Wow! Who knew that just practicing breathing could also be working the pelvic floor!

If you want to get fancy, you can coordinate the two muscle groups together:  

Start lying on your back with your knees bent.  Place each hand on the side of your rib cage. Inhale deeply through your nose, imagining your rib cage is expanding in all directions into your hands, and keep your pelvic floor relaxed.  As you exhale through your mouth, let your rib cage return to resting position and gently tighten your pelvic floor muscles and hold for up to five seconds, then release.  Repeat this sequence for a good 5-10 minutes each day…it’s more about the quality of the breathing and pelvic floor contractions, not just the quantity.  (If you are a numbers kind of person, then try to shoot for 30-50 contractions a day.)

It is essential that you allow for the relaxing aspect of this exercise.  Like any other muscle in the body, we need to make sure the pelvic floor is able to go through its entire range of motion, which means it should be able to tighten, and then release or relax, so it can be able to contract again.  Remember that these muscles are working 100% of the time, and in order to maintain a strong pelvic floor, you need to let these muscles RELAX in between each contraction

 As you feel more comfortable with this exercise, try it sitting or standing, so you can start working out your pelvic floor throughout the day. The beauty of exercising your base is that no one even knows you are doing it!  You can be standing in line at the grocery store or sitting in your car, waiting for the light to turn green, and BAM!  You are working your base out!  Even better, think about integrating your pelvic floor and diaphragm into your gym routine, especially lifting weights or doing other core work.

I dare you to start thinking about exercising all aspects of your core, especially your pelvic floor.  Remember, it’s all about the base!

Victoria Yeisley, DPT, has been specializing in pelvic floor physical therapy since 2008.  She completed her Doctor of Physical Therapy at Boston University and currently works with Northwestern Medical Group in Chicago, IL, where she is integrated as a part of the OB-GYN team.  Victoria’s passion lies in empowering her patients to not only be educated about their pelvic floor, but to gain control over their symptoms.  She feels extremely lucky to be able to practice her passion every day and hopes to be able to continue to promote pelvic floor muscle awareness for all!