Can I exercise or have sex if I have pelvic organ prolapse?
Pelvic organ prolapse is common, but not commonly discussed. Urogynecologist Xibei Jia, MD, FACOG, is quick to explain to her patients what it is and why most people don’t have to worry about their prolapse.
“This is very prevalent on the Cape, but a lot of my patients come to me worried because they don’t know what pelvic organ prolapse is,” she said. “Often, people feel a bulge, or something protruding through the vagina. A big part of my job is education and reassurance. With vaginal prolapse, if you have no bothersome symptoms, you don’t need intervention. You can continue to enjoy your life.”
Dr. Jia sees patients at Urology Associates of Cape Cod in Hyannis. Urogynecology is a subspecialty that focuses on urinary incontinence, pelvic organ prolapse and other pelvic floor dysfunctions in women.
Although pelvic organ prolapse can occur in younger women, the peak incidence of symptoms is in women aged 70–79 years, according to the American College of Obstetricians and Gynecologists. Based on several sources and studies, the Association for Pelvic Organ Prolapse Support concludes that 50% of women have some form of pelvic organ prolapse.
What is pelvic organ prolapse?
Dr. Jia begins by telling her patients that pelvic organ prolapse is essentially a hernia (or bulge) in the vagina. A lot of people know that a hernia is a bulge in the belly, so that is a good point of reference.
“You’ll hear people say, ‘My bladder has dropped,’ or ‘My bowels have dropped,’ but I always try to stay away from these terms because it frightens people who think, ‘Oh my gosh, my organs are dropping out of my body.’ That is usually not the case. What’s happening is the supportive structure (connective tissue) weakens over the years, so what is prolapsing is just the vagina and sometimes the uterus and cervix.”
“Think of the vaginal tissues like a hammock. Think of the bladder, for instance, sitting on the hammock. The hammock or the vagina is sinking because it’s stretched out or weakened, and now the bladder is sinking with it. The same thing with the rectum and bowels. These organs can drop just because part of the vaginal wall is coming down.” When the uterus and cervix is falling down, it’s usually because of the ligaments supporting these structures are weakened as well.
Dr. Jia reassures patients that pelvic organ prolapse is a quality of life issue; interventions are only necessary if it affects patients’ quality of life or it’s causing other medical problems.
What about patients who feel as though something is falling through the vagina?
“If it really bothers you, you should see a physician for an evaluation. In the meantime, it is safe to gently push the bulge back into the vagina for symptom relief,” she confided.
What about exercise?
Fear and discomfort cause some people with pelvic organ prolapse to stop exercising, and Dr. Jia tells patients they don’t have to stop exercising.
“I tell my patients to live their lives until they experience bothersome symptoms from the prolapse and want to seek treatment. It is hard to predict if the prolapse will get worse in the future and how long it will take for the prolapse to progress ,” she explained.
On the flip side, exercise is critical to maintaining good health and feeling well. Talk with your doctor if anything is sidelining you from living the life you want.
What about sex?
“Pelvic organ prolapse generally does not interfere with sex, although some women may experience discomfort or feel embarrassed because the bulge is there. It usually doesn’t cause pain with sex and it is safe to have sex with prolapse in place,” Dr. Jia said.
Treatment Options
Dr. Jia outlined the four types of treatment for pelvic organ prolapse:
- If symptoms are not bothersome, then you don’t have to do anything about pelvic organ prolapse, she said.
- Pelvic floor exercises (kegel exercises) are a great intervention, and patients find them very effective, Dr. Jia said. “I evaluate pelvic muscle strength to determine if they can do kegels. If I feel they can’t adequately perform kegel exercises, I refer patients to a pelvic floor physical therapist. Shout out to all the pelvic floor physical therapists on the Cape. They are all women, and they are all great. I get great feedback and reviews from my patients.”
- A gynecologist can fit you with a pessary to help manage prolapse. These devices come in different sizes and shapes, are inserted in the vagina and stay for a period of time. A pessary lifts up the vagina, holding up the vaginal tissue. Periodically, it must be removed and cleaned, and the patient is checked to make sure it didn’t cause any bleeding or infection. The pessary is for women who do not want surgery or can’t have surgery, but want to do something about their pelvic organ prolapse.
- Surgery is also a treatment option. Dr. Jia said surgery has a 70-95% success rate. “It can be performed through the vagina or through the abdomen and some procedures are performed using the robots.” Dr. Jia performs both robotic and laparoscopic surgery at Cape Cod Hospital.
