Jess Kostos

Prolapse seems to be this scary ominous thing that most consider happens to some women after they have a baby. It’s hardly spoken about and is almost taboo.

I mean, it’s not exactly a topic you bring up at lunch and check in to see how well everyone’s organs are sitting, am I right?

Let’s bust some myths today with the help of Jess Kostos, a pelvic health physio based in Melbourne, Australia.

What is a Prolapse?

Jess explains that a pelvic organ prolapse is when one of our pelvic organs falls into or down into the pelvis.

“Generally it’s when it falls into the vagina. The symptoms you might be feeling include heaviness, dragging or a bulging sensation. Sometimes it might almost also be getting difficult emptying your bladder or you might also have leakage or pain with sex”.

What Causes a Prolapse?

Prolapses are quite common because they’re a part of the process of ageing.

“With time, all the structural supports that hold up the organs. So these organs [are] your uterus, bladder and rectum. They can stretch with time”.

Another cause of pelvic organ prolapse is from childbirth. “So sometimes as the baby comes through, there can be damage to the structures that kind of support everything as well”.

You can also get a prolapse without going through childbirth.

Jess explains “I know some athletes may even have this issue because of all that pressure that can come down”.

Jess says she sees this in her practice and that “’s actually quite common to have one in gymnasts or ballet dancers- people who tend to do higher intensity exercise that involves quite a lot of ballistic jumping movements”.

Common vs Normal

What is ‘normal’ can be difficult to define which is why it can come down to the symptoms vs the diagnosis.

It’s important that “ always comes back to patient orientated goals. What do they want and what are the symptoms for them. And you know, what one symptom might affect one person might not affect them quite as much as the other. So someone who is leaking might not care as much as someone who is only leaking a small amount or someone who wants to go for a run might have different goals to someone who just prefers a walk”.

Managing a Prolapse

With patient-orientated goals being the focus this means that the approach to treatment does follow a guideline but the plan for each woman may be different and individualised.

Why is it That Not All Symptoms Are the Same?

“I suppose, just because everyone’s body is different and everyone’s body awareness is different as well”.

Jess explains that “…some people tend to have really good awareness and sensitivity around the vulva and the vagina area. The tiniest of something in the area or a bulge or a heaviness will really irritate them. Whereas some people, they come in, they probably have quite a moderate to larger prolapse and they don’t feel anything at all.

Can We Prevent a Prolapse?

There are definitely ways we can help prevent a prolapse. 

One of the most common ways is to have a strong and functional pelvic floor.

Jess uses an analogy to help people visualise how it works. Imagine a boat on a dock, sitting on water and it has ropes on the sides. In this scenario the boat is your organ (bladder, uterus or rectum) and underneath the boat is your pelvic floor- the higher the water, the stronger your pelvic floor is. So to keep the boat sitting where it needs to be, having a high water level (strong pelvic floor) will help.

Alternatively if your pelvic floor is weak or the water level is low, the boat has to hang off of the ropes, which in this analogy is your connective tissue that helps hold up your organs. So with time the ropes (connective tissue) can stretch.

However the pelvic floor isn’t the only way to prevent or manage a prolapse. We also need to make sure that we’re managing the pressure from above. These pressures can come from things like coughing, high impact exercise, sneezing, and so on.

It becomes an equation that the strength from below needs to match the pressure from above to avoid stretching the connective tissue.

Jess says that “…a lot of people do get confused and relate pelvic floor as being the same as prolapse. Or think that if you have a strong pelvic floor, you don’t have a prolapse, or if you have a weak pelvic floor, that means you’ll have a prolapse and they’re not directly correlated that way”.

Aids to Manage a Prolapse

A pessary can be a great aid to help manage a prolapse. Jess explains it as “…the sports bra of your vagina and holds everything up so that you can squat and you can weight lift and everything, and you don’t really have to worry about what’s going on with your prolapse”

Is it Possible to Reverse a Prolapse?

Jess explains that physios have to be careful how to answer this question because it is improving the symptoms that we are focused on and improving the symptoms doesn’t necessarily change the grade of the prolapse.

However, it can depend on the situation. You’re more likely to reverse a prolapse in someone that is early in their postpartum recovery because they’re in the healing time frame.

“Generally it might be the first, like three to six months whilst they’re still healing. But if you get on top of everything, it probably might have already gone back on its own, but you’ve helped it go back a bit faster”.

Why Do Symptoms Feel Worse During a Period? Is it Common?

“Yeah, it’s actually quite common to get a prolapse feeling worse just before and around the period. It’s generally hormonal related”.

“If you think about the changes during your period, your estrogen tends to drop just before your period, signal to release the blood through [and] as that happens, things start to lower. The walls of the vagina change and they can just become more sensitive and actually a little bit thinner as well. So it is a bit more common to feel the heaviness and you’ve also got the bleeding, so that can feel quite heavy as well”.

Thanks, Jess!

This is one of the top listened to episodes on the pod and with the wealth of knowledge Jess brings and explanation of prolapse in a clear and easy way, it’s no surprise!

To learn more from Jess about pelvic health make sure to check out her Instagram page

Jess also has a physio-led online pilates program called ‘The Pilates Lifestyle’. It’s designed especially for pre and postnatal fitness and pelvic floor. If you’re pregnant, or just had a baby, you should check it out! You can find it on Instagram @thepilateslifestyle_

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