The traditional way that prolapse is described is a ‘falling’ or ‘slipping down’ of the pelvic organs within the vagina. However, this explanation doesn’t fit with what we now know about how the body works.
For hundreds of years, the body was thought to be built like a stack of bricks, with one body part resting on top of the part below. However, back in the 1980s, another explanation was put forward by Dr. Stephen Levin – that all of our bones and organs are suspended within a 3 dimensional, top-to-toe web of connective tissue. This answered many of the huge questions we had about human movement, such as how babies crawl, how we can perform a handstand, and how our movement can be so complex and energy-efficient.
This way of looking at the body is called Biotensegrity and has been proven through extensive research. We now know that this is how all living creatures are built, all the way down to a cellular level.
Within this kind of structure, things cannot fall. They are not reliant on being held up by the part below them. But they can get pulled out of alignment when there is too much tension somewhere in the system. So because of the way we are built, things cannot fall down within the body. Shoulder blades don’t slip down our back, and our brain doesn’t fall down our neck.
However, in gynaecology, women are still being told that their organs have fallen down into their vagina due to weak pelvic floor muscles.
The old way of understanding the body says that the action of the pelvic floor muscles keeps the vagina closed in standing, and holds the pelvic organs up from below. Injury to those muscles is said to make them weak, and allow the organs to fall.
However, we now know that the pelvic muscles are not holding everything up from below and that injury and scarring actually stiffen and tightens up our tissue, causing a pull through the 3-dimensional connective tissue web. Also, any woman will tell you that we do not hold our vaginas closed all day long. The old way of describing prolapse is 'anatomical nonsense'.
So what really causes the pelvic organs to shift position? They are pulled down within the pelvis or pulled to the right or left of where they should be, by tension and stiffness within the pelvic floor. Often (but not always) that tension and stiffness comes from birth-related scarring to the pelvic floor (episiotomies or tears), which can cause problems soon after childbirth, or it can take years for the tension to build up. This tension is also the cause of back and hip pain which is commonly associated with prolapse.
Pelvic floor strength or ‘kegel’ exercises are often advised, but the truth is they don’t work very well for most women with prolapse. They don’t improve prolapse grade or reduce the numbers of women seeking further help such as surgery, and many women report they can make heaviness, aching, and dragging sensations feel worse. For the women who do see some benefit in their prolapse symptoms with pelvic floor squeezing, usually, those benefits are small and do not last. But as the root cause of prolapse is actually tension, not weakness, that is not a huge surprise.
My research, focused on applying the principles of biotensegrity to the treatment of prolapse, has found that releasing tension within the pelvic floor improves prolapse symptoms and grade, as well as pelvic floor function.
The first step to releasing pelvic floor tension is to stop those repeated vaginal squeezing exercises. Instead, focus on things like deep breathing, reducing stress, relaxing the pelvic floor, gentle stretching, mobilising and alignment exercises, and self-massage to any stiffness or scarring in the perineum, pelvic floor, abdomen, or buttocks. It is also useful to see if that tension or stiffness could be coming from elsewhere in the body. For example, do you limp when you walk due to knee or foot pain? If so, that will cause tension to build up in the pelvis.
There is so much confusing information and misinformation about prolapse, it is difficult to know what to listen to. Essentially, there are two different approaches. The traditional approach where the cause is thought to be a weakness of the pelvic floor allowing things to fall. This way is rooted in science which is now out-of-date. The alternative approach says that it is tightness, stiffness, and tension which pulls the organs down, or out of alignment. This is rooted in the modern way of understanding human structure.
Updating the way that prolapse is described, understood, and treated takes time, but that change is coming.
If you are struggling with prolapse, speak to your GP or book your local Mummy MOT practitioner who can help you find and release tension in your pelvis and abdomen. This could be through movement or breathing exercises, self-massage, and external or internal manual therapy.
You don’t need to grip or squeeze your pelvic floor to hold everything up and in. Instead, try focusing on relaxing and softening the pelvis and belly to reduce stiffness and tension, and so reduce the pull upon the pelvic organs.
Series of Videos on Biotensegrity by Anna Crowle available
The aim of this short series of videos is to provide some information about biotensegrity: what it is, what the evidence for it is, and how understanding biotensegrity affects our understanding of pelvic organ prolapse – https://courses.meps.org.uk/courses/pelvic-organ-prolapse
Find out more about Anna: www.annacrowle.co.uk
Anna is a specialist pelvic health physiotherapist, and an advanced myofascial release practitioner. Her clinical work is focused on using myofascial release techniques to treat gynaecological conditions. Since 2019 she has also written and published research to explain and provide evidence for taking a release focused approach for the treatment of pelvic organ prolapse. Over the last few years she has presented at a wide range of international online conferences and meetings, teaching pelvic health professionals about this approach. She lives in Leeds, Yorkshire, UK and is a mother of 2 daughters.