Beth Davies Coaching

I’ve done my rehab but still have prolapse symptoms

Still have some annoying prolapse symptoms even though you’ve done your rehab?

On a recent Instagram poll, I asked those who had done their rehab and wanted to progress what was stopping them, a huge 80% said they still had prolapse symptoms. The other 20% weren’t sure how to progress. 

So, what’s the deal? Surely rehab means you’re no longer experiencing prolapse symptoms…? 

Let’s dig a little deeper into this. 

What are the symptoms of pelvic organ prolapse?

There are many symptoms of prolapse. Not everyone will experience them (your symptoms are as unique as you are!). In fact, you can have prolapse and not have any symptoms at all. 

Here are the ones most commonly experienced by those with POP: 

  • A feeling of heaviness or dragging in the vagina/pelvic area 
  • A visible bulge in the vagina 
  • A noticeable change in bowel or bladder habits (e.g. incomplete emptying)
  • A sense of openness or laxity in the vagina 
  • Painful or discomfort during sexual intercourse 
  • Heaviness during exercise 

(if you are reading this and you are experiencing these symptoms but haven’t yet seen a physio, or have never heard of pelvic organ prolapse, I highly recommend it. You’ll find out so much about what’s going on with your pelvic floor muscles!) 

 

What do prolapse symptoms mean?

Weirdly, the severity of symptoms isn’t always an accurate indicator of prolapse severity. In that, you can have a mild prolapse and be highly symptomatic. Equally, those with a more severe grade of prolapse don’t always have lots of symptoms and may come as a surprise when they are diagnosed as part of a routine checkup or smear test. 

That means that symptoms aren’t a reliable way of thinking about prolapse severity. I think (and see this with clients) that symptoms often reflect the sensitivity of someone’s central system and the degree of focus or impact that prolapse is having on someone’s life. 

This study shows that those with pelvic or vaginal pain were found to have higher central sensitized scores, while those with prolapse had scores similar to those with other gynecological conditions. However, a third of those with prolapse had significant central sensitization. 

The proportion of women with central sensitivity syndrome in gynecology outpatient clinics (GOPDs) – PubMed (nih.gov)

In addition, statistics show that a third of those with POP also experience pelvic muscle pain. Those with pain were more bothered by their symptoms, even though their grade of prolapse was lower. 

Symptoms can be influenced by the following: 

  • Hormones (maybe why being newly postnatal or menopausal can make symptoms more noticeable) 
  • Sleep deprivation (because everything feels worse if you’re not sleeping) 
  • Where you are in your cycle (often – but not always – symptoms may increase around ovulation and menstruation – it’s those hormones again) 
  • Healing after birth or surgery 

What is prolapse rehab and how do I know if I've completed it?

The focus of pelvic organ prolapse rehab tends to focus on improving the function of the pelvic floor muscles through a structured pelvic floor muscle training programme. Some of the time, this will also improve prolapse symptoms, but not always! 

Rehab may be different depending on: 

  • Severity of symptoms 
  • Whether your prolapse is driven by weakness or tension 
  • How much time you can dedicate to it 
  • How consistent you can be
  • What you are wanting to get back to
  • Where is your starting point

Many women are signed off (particularly through the NHS system) when they have better muscle function versus the absence of symptoms. This can be confusing, especially where exercise is concerned because, in theory, their body can possibly handle more, but their brain and nervous system don’t always agree. 

It’s not to say push on through your symptoms because all is well with your pelvic floor. However, being able to marry up what you know about your pelvic floor and what you think might be causing your nervous system to feel a little more ramped up than usual is super useful. 

It often starts with kindness and compassion. 

So, the thing about symptoms...

They are not just physical phenomena. In that, they are often a combination of a physical sensation and how that is being interpreted by your brain. Your brain builds a little story around this which combines this info, plus lots of other data. Such as previous experience, beliefs, attitudes and emotions, hormonal and sleep status. Symptoms are like setting off a sensitive smoke alarm. In that sometimes, you’ve just had your toaster setting on too high and there is no danger. And other times, the fire needs to be put out for the system to quieten down again. 

If you’ve done your rehab but are still symptomatic, and you’d like to improve those symptoms and progress your exercise, I can help! You can book a short call here to see if we’re a good fit to work together. Here’s a link to my page so you can check out how I work and get an idea of costs. 

Beth Davies is an experienced personal trainer and coach specialising in female health, pelvic health, pelvic organ prolapse, and exercise. Her programmes educate, empower and support women back to training or their active life, eliminating symptoms and building strength and confidence. She has been featured in publications such as Stylist, Marie Claire UK, Woman & Home, and Metro

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