Finding a prolapse during menopause may be one of the changes many women experience. There are many different symptoms we may experience like hot flashes, night sweats, mood changes, weight gain…the list is unfortunately endless! This post is going to focus on a pelvic organ prolapse!
What is Menopause?
Menopause occurs when a woman has not had her period for more than 12 months
Peri-menopause is the 2-10 year period before menopause when levels of progesterone, estrogen and testosterone change
What happens to these hormones?
Progesterone levels typically lower. Progesterone is the hormone that contributes to calmness, allows you to have a good sleep, and helps you handle your pain.
When progesterone levels decline, there may be a relative increase in estrogen. Further through peri menopause, estrogen levels also decrease. Estrogen helps with vulvar lubrication and tissue elasticity, heart health, bone density, sleep quality and mood.
Testosterone levels often also decrease. Testosterone affects the ability to build muscle, sexual desire, bone density and mood.
Menopause symptoms and pelvic health
So why did I want to write about this particular topic? Being a pelvic health physiotherapist, my clients come to see me feeling concerned about whether or not they might have a prolapse. They often share how active they are, how healthy they are eating and how completely gobsmacked they are at finding a prolapse! Oftentimes, these same women are venturing through menopause and so this topic must be talked about.
What is a pelvic organ prolapse?
Pelvic organ prolapse (POP): this is when the bladder, the uterus and/or the rectum sit lower within the pelvic cavity than they once did
Why might a prolapse happen during menopause?
There you are, venturing into midlife happy and carefree, doing all the things you love to do, and wham… you feel something different! There is a heaviness in your pelvis you hadn’t felt before. It feels like a tampon is coming out yet you know there isn’t a need for one to be there in the first place. You may notice a bulge when you are washing in the shower or perhaps you are brave enough to take a mirror, have a look and you actually see something that wasn’t there before. What the heck has happened? You haven’t been doing anything differently lately so why is your body betraying you?
Besides giving birth to a baby, menopause is the next challenging time in a woman’s life. The changes in hormones cause the pelvic floor muscles to have less muscle bulk. Less muscle bulk may equal less muscle strength. If you add in the fact that the majority of women are not actively using their pelvic floor muscles, (through no fault of their own as this information just isn’t widely known) these muscles are destined for weakness. There is also the loss of passive support we get from the fascia and connective tissues. This we have far less control over. So why not address the active support system which we have much more control over…our pelvic floor muscles?
How do we help our prolapse during menopause?
There are 3 main strategies…
- strengthen our pelvic floor muscles
- use some prolapse relief positions
- manage our intra abdominal pressure
How do we strengthen our pelvic floor muscles?
Our pelvic floor muscles are part of our deep abdominal core that help support us so we can get our daily activities done without pain. Are we supposed to be using these muscles? Absolutely! But let’s face it…we just aren’t taught this.
Actively engaging our pelvic floor muscles needs to happen every time we exercise!
How do we do this? I want you to start blending a few things together and keep practicing until it becomes automatic.
- Exhale on the harder part of a movement
- Exhale = engage your core muscles
- Engage = lower belly draws in during your exhale and you lift up with your pelvic floor
If you need more help with how to find your pelvic floor, check it out here:
What are prolapse relief positions?
These are positions we can place our bodies in where there is less pressure right over our pelvic organs. Many women use these positions at the end of the day or simply whenever they feel pelvic heaviness. Positions such as:
- legs up the wall
- knees over a bolster or chair
- happy baby
How do we manage the intra abdominal pressure?
Prolapses are a ‘pressure’ problem. There may not be enough pressure/tension that the pelvic floor muscles can generate in order to support our pelvic organs. Or, we may be generating too much pressure from our bellies. This happens when we laugh or cough or sneeze and instead of our bellies moving inwards, they pooch outwards. There are 2 easy things we can do right away to help with this:
- Cough Test
- No abdominal pooching with exercise or lifting things
What is the cough test?
I want you to place your hand over your lower belly. Do a little cough and notice:
Is your belly moving into your hand or is it coming away from your hand when you cough?
You want your belly to come away from your hand. A cough is just like an exhale. With proper breathing, we want our ribs to expand and our bellies to get a little bigger when we inhale. When we exhale, everything should get smaller and our lower belly should move inwards. This lessens the amount of pressure our pelvic floors experience. If we notice a prolapse during menopause, we definitely want to reduce the pressure on top of our pelvic floor muscles.
What’s with the no pooching?
If we push our bellies out, this causes too much pressure right on top of our pelvic organs. We want everything pulled up and in, not moving down towards our feet. Before you lift something or someone, engage your core:
- lower belly draws in
- pelvic floor lifts up
And then lift…….
if you want to see how to activate your transverse abs in action, check it out here:
Will my prolapse go away?
When you experience a prolapse during menopause, both the passive (the fascia) and the active (the muscles) have weakened. The component we can have an impact on is the active component; the muscles. When women begin to strengthen their pelvic floor muscles, ensure they are not constipated (pushing and straining when having a bowel movement will further push our organs down), and use good techniques (belly drawing in) when coughing and sneezing, they find they are able to ‘manage’ their prolapse symptoms. The prolapse does not necessarily go away, but the severity of the symptoms may lessen or disappear.
Remember that strengthening muscles takes time and consistency. Commit to a 8-12 week strengthening regime so you can see how much progress you can make. But don’t panic! These exercises only ask about 10 minutes of your time per day!
I know for myself, that I need to think a day ahead about when I will be doing my workout for the following day. If I don’t have that plan made, it likely will not get done. And boy, do I ever feel better when I get my exercise done! So, plan a day ahead so you know when exactly you will do your exercises each and every day.
Most people do Kegels to help strengthen their pelvic floor muscles and this is a great start. But remember what you have now read; there are other muscles that help manage the pressure and including these muscles is super helpful! At the very least, get started on doing some Kegels (pelvic floor contractions) and if you want more help with how to strengthen your pelvic floor and core, click the button below:
Check out my next blog on an alternate option to strengthening your pelvic floor that is great for everyone but will definitely help if you have a prolapse.