Pelvic Floor Physiotherapy: 5 Helpful Tips for Bladder Prolapse Management

5 Helpful Tips for Bladder Prolapse Management

The bladder is an organ that is supported by ligaments, muscles, fascia, and soft connective tissue.  These structures enable the bladder to maintain its position within the pelvic cavity.  Bladder prolapse may occur when any part of the pelvic organ support system is compromised.   As a result, the bladder may sit low and shift downward within the pelvic cavity out of its normal position.  The development of pelvic organ prolapse is often multifactorial and this non exhaustive list includes the following:  childbirth, menopause and other causes of estrogen loss, genetics, chronic constipation, chronic coughing, heavy and repetitive lifting, and post hysterectomy.  Some people have no symptoms at all whereas others may experience sensations and varying intensities of pelvic heaviness, pressure, a dragging sensation, or even notice a bulge at the opening of their vagina.
For some of my clients, they experience a lot of fear that this condition is “a lost cause” and there is nothing that can be done to change the damage that has been done.  However, a 2010 study completed by Kari Bo et al. assessed symptomatic changes in a group of women with mild to moderate degrees of prolapse who received lifestyle advice and functional pelvic floor exercise education.  As a result, the study group showed a significant reduction in prolapse symptoms.  The take home message here is prolapse is not a sentence and there is so much that you can do to help resolve, if not significantly minimize, the symptoms of prolapse.
Lesson Number One:  Learn to empty your bowels properly!  Many people develop poor bowel emptying strategies over time and this may cause unnecessary and potentially harmful pressure on the pelvic organs and supportive structures in the pelvic cavity.  The number one goal during pelvic physiotherapy and prolapse management is to identify and address any issues contributing to constipation.  It is important to position your body when toileting to ensure that you feel properly supported so that the pelvic muscles can fully relax as they are meant to do for emptying.  This includes never hovering over a toilet (even public toilets!!), legs set comfortably wide, positioning your body in a semi-squat position and focusing on relaxing your abdominal muscles and breathing slow and deeply.
Lesson Number Two:  Don’t power push your pee!  Many people have such a busy and fast lifestyle that taking time to properly empty the bladder can feel like a waste of precious time.  If you find that you are halfway out the door before you have even finished your stream and you push and bear down to hurry up the process or even at the end of the stream to get the last few dribbles out, this may aggravate a prolapse condition.  Use the advice in lesson one for positioning and most importantly, give your body permission and the time needed to slow down, take a break from life and be present in the moment as your bladder contracts and your pelvic muscles relax to void fully safely.
Lesson Number Three:  Don’t hold your breath when you pick up, push, or pull objects that require a little extra effort.  Do you notice you grunt when you pick up that laundry basket or pick up your little toddler?  This is a sign that you may be placing excessive downward pressure toward your pelvic floor organs and muscles.  It is important to, along with awareness of proper body mechanics, take a moment to try and coordinate an exhale or blow out gently through pursed lips as you prepare to lift and throughout the lift.  This strategy helps to gently engage your inner core muscles thereby supporting your spine and pelvis through movement.
Lesson number Four:  Consider helpful lifestyle changes like exercise and diet modifications to promote weight loss.  If there is excessive weight on the pelvic cavity, this constant pressure may contribute to pelvic floor and structural fatigue over time.  A pelvic floor physiotherapist will be able to guide you on the correct exercise program that is right for you.  Consider smoking cessation as well as a way to reduce persistent coughing and to promote overall physical health of your body’s organs and muscles.
Lesson number Five:  Last but definitely not least, strengthen your pelvic floor muscles.  Book an appointment with a pelvic health physiotherapist who will be able to identify and train you on the correct pelvic floor exercises that you should be doing.  The pelvic floor muscles play a supportive role in that they act like a sling of support from below in order to keep the pelvic organs in their position within the abdominal cavity.  The stronger these muscles are, the more support there is for the bladder and the rest of the pelvic organs.  We are able to identify what aspects or behaviours in your life may be contributing to your pelvic organ prolapse symptoms and guide you on the correct strategies and behaviours in your day to day life to find optimal bladder and pelvic health again.
By Leeanna Maher, Registered Physiotherapist
Physiotherapist Leeanna Maher
PALM, S.  Pelvic Organ Prolapse The Silent Epidemic 3rd edition. DE, USA: POP Publishing and Distribution, 2017.
The Bladder Book.  Digital Version (purchased 2018).  Your Core PT.  NC, USA.
DRAKE, G., ed. Springer handbook of atomic, molecular and optical physics. 2nd ed. New York: Springer, 2006..  Sherrie Palm

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