What is a Prolapse?
Prolapse bladder and sleep have been associated with each other. This is because signs and symptoms of any kind of prolapse have interrupted their sleep quality.
From the unpredictability of when the symptoms will occur, and improper position in bed. But, what is a prolapse first?
A pelvic organ prolapse (POP), is a condition common in women in their child-bearing ages. This is from the weakness and stretching of the muscles and ligaments of the pelvic muscles.
By not being able to support the position, it slips to the opening of the vagina. This can highly affect a woman’s overall physical and sexual life and can cause bladder weakness.
Stages and Types Of Prolapse
Mainly, there are 4 classifications of the types of prolapse from NIH. Once identified, this can determine what course of action can be done. Many gynecologists now use the Pelvic Organ Prolapse Quantification (POP-Q) system, which refers to an objective, site-specific system for describing, quantifying, and staging pelvic support in women.
The bladder bulges into the front wall of the vagina. This is also known as “cystocele”, the most common prolapse reported in women. Experts estimate that nearly half of women who have given birth have some degree of pelvic organ prolapse.
The other types for a differential diagnosis:
The womb bulging or hanging down into the vagina. It is also described as the uterus falls down towards the vaginal opening. This is described further when the womb itself either protrudes or comes out of the vagina. This often affects postmenopausal women who’ve had one or more vaginal deliveries.
Vagina Vault Prolapse
It is when the top of the vagina sagging down. This happens to some women after they have had surgery to remove their womb. This usually occurs in women who have had a hysterectomy (removal of the uterus). About one-third of women will experience some degree of prolapse during their lifetime.
Posterior Vaginal Prolapse
This is also called “rectocele”. This occurs when the thin wall of tissue that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge. This can be noticeable at the vagina, where a noticeable bulge of tissue on the opening of the vagina. It is uncomfortable, but not painful.
These are the following stages of Bladder Prolapse, according to webMD.
- Grade 1 (mild): Only a small portion of the bladder droops into the vagina.
- Grade 2 (moderate): The bladder droops enough to be able to reach the opening of the vagina.
- Grade 3 (severe): The bladder protrudes from the body through the vaginal opening.
- Grade 4 (complete): The entire bladder protrudes completely outside the vagina; usually associated with other forms of pelvic organ prolapse (uterine prolapse, rectocele, enterocele).
What Causes It?
According to the Better Health channel, the following conditions can cause prolapse.
Most cases report cause is through vaginal childbirth delivery. Especially if the baby was large or delivered quickly, or if there was a prolonged pushing phase.
Moreover, having twins or triplets can also cause prolapse. Also, having multiple pregnancies, and over time it can lead to complete pelvic organ prolapse if left unattended.
The risk of prolapse progression in overweight and obese women compared with normal-weight women is increased by 32% and 48% for cystocele, 37% and 58% for rectocele, and 43% and 69% for uterine prolapse. It is caused by increased intra-abdominal pressure, and weakening of the muscles holding the area.
Straining on the toilet to pass a bowel motion
While straining on the toilet can be normal to push feces, excessive straining can trigger hemorrhoids and prolapse. Prolapse can occur with frequent constipation, wherein voiding is difficult.
By forceful voiding, pressure increases on these areas and can also cause hemorrhoids. Proper hydration and intake of fiber can avoid this occurrence.
Low levels of estrogen after menopause
After menopause, the integrity of muscles, ligaments, and connective tissue weakens. The reduction of levels of estrogen occurs, so does the ability to tolerate weight and activity decreases.
This can affect the tissues that hold the uterus in place. Back, hip, and pelvis pain are the usual complaints of older adults.
This is associated with conditions such as chronic bronchitis or asthma fibroids. In order to perform a cough, expiratory muscles of abdominal muscles, transverses thoracic muscles, and intercostal muscles.
Forceful, and chronic cough can exacerbate intra-abdominal pressure, which affects the muscles, ligaments, and connective tissue holding the pelvis.
In rare cases, prolapse can occur when you have a growing tumor in the area of the pelvis. Vaginal, endometrial, and colorectal cancer are the common case studies.
Further studies are still in the development of whether these are valid. Consulting your oncologist is the best way to confirm any complications involved with your condition.
Symptoms and Problems
The common signs and symptoms vary. Because there are different diagnoses of the types and stages. POP-Q is also a guideline that physicians follow.
But, most women complain of uncomfortable pressure during physical activity or sex. These also vary at the time of the day and standing for a long period of time. Other symptoms are as follows:
- Seeing or feeling a bulge or “something coming out” of the vagina. Protruding of tissue can be felt on the vaginal opening.
- A feeling of pressure, discomfort, aching, or fullness in the pelvis.
- Pelvic pressure that gets worse with standing or coughing or as the day goes on
- Leaking urine (incontinence) or problems having a bowel movement
- Problems inserting tampons
- Unable to empty bladder, and have to urge to continue to urinate
- Rare cases, urinary tract infections.
There is a high prevalence of sleep disturbance in women seeking care for pelvic organ prolapse. Women with POP reported that their symptoms are associated with sleep quality. Leading to disturbances from incontinence, and pain. Also, young and pre-menopausal women are the common patients that are complaining about this matter.
What To Do About It?
For as long it isn’t affecting their day-to-day life, there is no need for treatment. But when the symptoms don’t go away, medical attention is needed.
Whatever stage or level of prolapse they have. Mild cases are advised to do kegel exercises, with lifestyle changes. Moderate cases opt for the same, some with a pessary. While severe cases opt for surgery.
Kegel Exercises (Pelvic Floor Exercises)
Mild to moderate cases benefit from doing this. This will help strengthen their pelvic floor muscles and relieve pain. People who are unable to hold their bladder (stress incontinence) or feeling of pressure on their abdomen can do this exercise. Here are the following exercises to follow.
In some cases, the prosthesis is inserted into the vagina to support its internal structure of the pelvis. There is a support pessary, and space-filling pessary, depending on what their purpose is. As well as the anatomical structure of the woman’s pelvic area. Not everyone opts for the treatment due to discomfort, and misfit.
The repair of bladder prolapse would require an abdominal incision. The bladder and urethra are usually repaired through an incision in the wall of the vagina. This method pulls together the loose or torn tissue in the area of prolapse in the bladder or urethra and strengthens the wall of the vagina.
Sleeping Positions and Precautions
Lying on your back, or supine is comfortable for most patients. Yet, posture and gravity impact pelvic organ position, pelvic floor muscle integrity, degree of prolapse, and symptom severity.
A supported supine position is the best way to do it. Place a pillow under your knees. The pillow relieves pressure from your lower back when and allows you to do ankle pumps.
Use one appropriate-sized pillow to support your head and neck in a neutral position. It is not appropriate to use two large pillows on your head and neck.
This will cause strain on your neck, and even on the upper back. You can also avoid sitting for a long period of time unless medically advised.
You can also sideline with support since this is also a common sleeping position. Whether that’s comfortable for you, you can place a pillow between your legs.
This can prevent misplacing your pelvic unconsciously when sleeping, and keep your hips aligned. Support head with a single pillow to not straining your neck, and on your abdomen.
It is recommended to not do forceful activities when diagnosed with POP. This can trigger pressure on your pelvis and can aggravate your symptoms.
It is also not advised to do long walks and sitting for a long period of time. Changing your positions frequently, and doing light activities can be done. Unless you are medically advised, you cannot sit upright as well. But overall, never do positions that can cause your pain.
One-third of women will experience POP once in their life, either in pregnancy, childbirth, menopause, or even a simple chronic cough. Consult your doctor whenever you experience the following symptoms.
Especially if you underwent these conditions. You can also do pelvic exercises. This is to strengthen your pelvis, and able to tolerate any changes in your body.
Also, avoid straining on bowel movements, constipation, and smoking. Also, maintain a certain weight to be fit, and not be prone to develop POP.