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Preventing pelvic organ prolapse

There are a number of things you can do to reduce your risk of prolapse or help prevent a mild prolapse form getting worse:

• One of the most effective things you can do to reduce your risk of prolapse is to exercise your pelvic floor muscles. Doing regular pelvic floor exercises (also called Kegel exercises) throughout your adult life helps keep the muscles toned and strong. Most women do Kegel exercises when they are pregnant and for a few months after birth, but by making pelvic exercises part of your daily routine you can further reduce your risk of both prolapse and incontinence in later life.
• If you are significantly overweight, try to lose weight. This will remove some of the pressure from your pelvic area.
• If you smoke, try to cut down or stop, as this will help reduce strain from coughing.
• Don't lift heavy objects. This can damage your pelvic muscles.
• Eat a high fibre diet (fresh fruits, vegetables, bran) to help prevent constipation and reduce straining.
• If you are menopausal or post-menopausal, some doctors may suggest you use hormone replacement therapy to protect against prolapse or prevent an existing prolapse from getting worse, but there is little scientific evidence to support the claim that HRT prevents prolapse. Before you make a decision about whether or not to use HRT, discuss the risks and benefits with your doctor.

Pelvic Floor Exercises (Kegel Exercises)

Pelvic floor exercises help prevent prolapse by strengthening the muscles that support the pelvic organs. The exercises are easy and quick to do, but it's important to do them correctly, and many women benefit from guidance from a physiotherapist.

Start by locating the muscles you need to exercise. There are a few different ways to do this:

1. Place one or two fingers in your vagina and squeeze your muscles until you can feel your vagina tighten around your fingers. These are your pelvic muscles. Imagine you're trying to stop the flow of urine mid-stream. The muscles you tighten (contract) are your pelvic floor muscles.
   
   
2. The other way to identify the correct muscles is to imagine you are trying to stop yourself from passing gas. The muscles you squeeze to do this are your pelvic muscles.
   
   
3. Once you've identified the correct muscles you're ready to begin. The exercises can be done while lying down, sitting or standing, with your knees together or slightly apart.

Set 1 —lowly tighten your pelvic floor muscles and count to four, then let the muscles relax for a count of four. As your muscles get stronger gradually increase the count to 10. Try to repeat this 10 to 15 times.

Check that you're not tightening the muscles in your legs, abdomen or buttocks, as it's important to use only your pelvic muscles. Remember to keep breathing.

Set 2 — Now tighten and relax your pelvic muscles as quickly as you can, again 10 to 15 times.

As a preventive measure, try to do the exercises two or three times a day. If you have a prolapse, you may be advised to increase the number of times you do the exercises, but don't overdo it. Excessive exercising of the pelvic muscles can cause muscle fatigue and make the exercises less effective.

You can do the exercises anywhere, anytime, but studies show that when women do them at home, they are more likely to do them correctly. Some women find it helps to set aside specific times to do the exercises, such as before getting out of bed in the morning and before going to sleep at night.

If you think you're doing the exercises incorrectly or need help locating your pelvic floor muscles, a physiotherapist will be able to help you. Ask your doctor for a referral.

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Written by Tamara Beus and published in printed format (2003) by Women's Health

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