Well, it’s that time of year again - colds, coughs and wishing you didn’t have a prolapse!
What is Pelvic Organ Prolapse (POP)?
Pelvic Organ Prolapse (POP) is a condition in which one or more of the pelvic organs descend into the vaginal canal or rectum.1 Symptoms are often described as feelings of heaviness, dragging, bulging or pressure in the perineum/vagina.2 Women sometimes describe the feeling of a tampon being halfway inserted into the vagina or that something is falling out of their body. There can also be a visible protrusion of tissue from the vaginal or rectal canals. Prolapse can impact urinary, bowel and sexual function.2 There are different types of prolapse and different levels of severity. For the purposes of this article, we won’t get into that here. What I will mention, however, is that the amount of tissue bulge is not necessarily related to the severity of symptoms that a person may experience.3,4 This means that some women with only a minor anatomical bulge can feel completely limited in their day-to-day function while other women who have a larger bulge may not experience any symptoms at all.4
Regardless of where you fall on the continuum of symptoms or severity, it is a common complaint to have symptoms show up or get aggravated when a cold strikes. Coughing is an activity that has been shown to create the largest maximal internal pressure, even more than (for some women!) running or lifting/carrying 40lbs.7,8
Many women naturally adopt strategies to help counter this pressure and the subsequent aggravation. They may do things like squeeze the inner thighs together or, using a hand, manually brace at the perineum or vaginal opening.
Here are some additional tips to help keep symptoms from getting too aggravated when you’re coughing on a regular basis:
Practice good hand hygiene to prevent from getting sick in the first place. Oh wait! Hard stop. If you’re a parent (or grandparent), I forgot that no amount of pristine health practices can counter a sick toddler sneezing directly into your mouth…. All you can do is your best.
Now for some practical tips.
When you feel a cough coming on:
1. “Grow tall” through the spine while keeping your chin gently tucked. As you do this, you should feel your insides (including the pelvic organs) lift upwards. Do your best to maintain this as you cough. Symptoms should be noticeably less aggravated.
2. Add a pelvic floor contraction before you cough. While this is not always possible (those coughs can sneak up fast!), it can provide some additional support from below and help keep things from feeling overly “bulgy”.
If you are coughing primarily as a way to clear phlegm and mucus from the lungs (i.e. this won’t work well for a dry cough):
3. Try an Airway Clearance Technique called “Huffing”.5 Although this technique is traditionally used to help individuals with cardio-respiratory conditions (i.e. cystic fibrosis) or postoperative patients (e.g. heart surgery, abdominal surgery), I find it can be applied well to this coughing scenario. The idea is that you loosen any phlegm/mucus before you cough so that less effort and pressure is required to clear it from the lungs. This can sometimes translate to less noticeable pelvic symptoms.
Here’s how this Airway Clearance Technique might look:
1. Take a deep breath through the nose, allow the abs/ribcage to expand.
2. Hold the inhaled breath for a count of 3.
3. Perform either a slow/forceful exhale OR a quick/forceful exhale, expelling as much air from your lungs as possible.
4. Repeat this 3-5x.
Note: if you have time, it’s often suggested you do ~3 cycles of the slow Huff followed by ~3 cycles of the quick Huff in order to more effectively work the mucus from deeper in the lungs upwards into larger airways. Try cycling through this pattern if you need a little more work to get things loosened. Also note that, this technique can stimulate a cough before you’re ready - that’s ok…just go with it.
Keep in mind these tips are really just quick solutions for managing symptoms “in the moment” and are not intended to replace thorough assessment and treatment ideas specific to your situation. The ultimate goal is that you prepare your body to handle aggravating activities (such as coughing) more robustly. Pelvic physiotherapy is effective in impacting both symptoms and anatomical changes associated with prolapse.6 For a more substantial, long-term solution, let’s connect!
May the winter months be kind to both you and your prolapse.
Jaclyn Seebach, PT
References:
C.B. Iglesia, K.R. Smithling. Pelvic Organ Prolapse. Am Fam Physician. 2017; 96(3):179-185.
S.E. Machin, S. Mukhopadhyay. Pelvic organ prolapse: review of the aetiology, presentation, diagnosis and management. Menopause Int. 2011;17(4):132-6. doi: 10.1258/mi.2011.011108.
D. Ulrich, R. Guzman Rojas, H. P. Dietz, K. Mann and G. Trutnovsky. Use of a visual analog scale for evaluation of bother from pelvic organ prolapse. Ultrasound Obstet Gynecol 2014; 43: 693–697 DOI: 10.1002/uog.13222.
Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol 2003; 189: 372–377; discussion 377–379.
E. Westerdahl, C. Osadnik, M. Emtner. Airway clearance techniques for patients with acute exacerbations of chronic obstructive pulmonary disease: Physical therapy practice in Sweden. Chron Respir Dis. 2019 Jan-Dec;16:1479973119855868. doi: 10.1177/1479973119855868.
S. Hagen, D. Stark. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD003882. doi: 10.1002/14651858.CD003882.pub4.
WS. Cobb et al. Normal Intra-abdominal Pressure in Healthy Adults. Journal of Surgical Research, Volume 129, Issue 2, 231 - 235.
Shaw JM, Hamad NM, Coleman TJ, et al. Intra-abdominal pressures during activity in women using an intra-vaginal pressure transducer. J Sports Sci. 2014;32(12):1176–1185. doi:10.1080/02640414.2014.889845.