Life After a Pelvic Organ Prolapse: Using Therapy To Regain Physical and Sexual Health

Photo Courtesy: Molly Giangreco - Ninety Six Oak

Kristen Watson was pregnant with her second child when she began experiencing some stress incontinence – or urinary leaking during her workouts.

An avid runner and soccer player, Kristen had planned on seeing a pelvic floor therapist after delivery to ensure the leaking she was experiencing wouldn’t worsen or sideline her from staying active. But after giving birth to her son, the busy wife and mother of two put off making the appointment for herself until she experienced another issue she couldn’t ignore.

“I was having a lot more problems with bowel movements,” she said. “Constipation – just feeling like I wasn’t emptying all the way. And it was one day when I was using the restroom – that’s when I felt it happen.”

“It” was a pelvic organ prolapse – or the weakening of the muscles and tissues that support the pelvic organs, causing the bladder, rectum or uterus to drop into or out of the vagina. It’s especially common in older adults and postpartum women.

“Mine was a visual bulge,” Kristen explained. “And there was this heavy kind of pressure feeling – almost like a tampon wasn’t in all the way or correctly. Not painful, but very uncomfortable.”

Her prolapse occurred on a Saturday, allowing plenty of time for her stress and anxiety to mount.

“With it being the weekend, I had to wait until Monday to see anyone,” said Kristen, who quickly became convinced that her days of half marathons and scoring goals were over. “I kind of just shut down. I didn’t want to do anything because I noticed it with every little movement – picking up my youngest or even a laundry basket. It was there all the time, and it felt awkward – almost like I had to keep adjusting myself.”

By Sunday, Kristen had let herself think the worst. She admits slipping into depression, feeling isolated and alone.

“I think just not knowing what the outcome would be made me super anxious,” she said. “Would I be able to have another child successfully? Would it make things worse? And even just having sex – I couldn’t imagine something like that being normal and intimate again.”

Addressing Anxiety First

That following week, Kristen’s OB/GYN, Mark Carlson, MD, with Methodist Physicians Clinic Women’s Center, referred her to physical therapist and women’s health specialist Sherri Castor, MPT, PT, CSCS, PRPC, who specializes in pelvic rehabilitation at Methodist Physicians Clinic.

Castor vividly recalls the anxiety she saw on Kristen’s face. It’s something she often sees in first-time patients.

“One of the first things I do is let them know that they’re not unique – that there are a lot of people out there who have this,” Castor said. “Once I assure them that they’re not the first person I’ve seen with this issue, it’s almost like you can see some of that anxiety fade away.”

“I instantly felt comfortable with her,” said Kristen, who – like many pelvic floor patients – began her therapy journey with internal and external assessments.

Those assessments allowed Castor to analyze Kristen’s muscle contractions, gauging whether she was doing them correctly or whether they needed to be fine-tuned. After giving Kristen a few exercises to work on for strength and endurance, Castor eventually implemented computerized biofeedback into Kristen’s program.

“That’s kind of our mirror,” Castor said. “Like in a gym, a trainer may put you in front of a mirror to see if you’re doing a bicep curl correctly. We use computers that are attached to sensors, which go on the skin next to the rectum. These read the muscle activity, which then gets sent to the computer and draws a picture, if you will.”

And as Kristen continued making progress, that picture gave Castor a better idea of what Kristen needed to work on next.

“She was able to educate me on exactly what I needed to strengthen to get back to running and the sports I love,” Kristen said. “And not that they’re anything Olympic-worthy, but, you know, just things that were part of me – things that were important to me.”

Taking the Awkward Out of the Topic of Sex

Castor knew there were other things, too, that were important to her 34-year-old patient – like the relationship she had with her husband.

“Patients don’t always bring up intercourse, but because I know that it’s a problem, I will bring it up,” Castor said. “I’m pretty comfortable talking about it. I’ll use a pelvic model, and I’ll actually show them what I’m telling them. I’ll offer tools they can use next time as we go over positioning and lubrication – things like that.”

“It took some time, for sure,” Kristen said of the work that regaining intimacy with her husband required. “There was a lot of hesitation, and, of course, it’s not the most romantic thing when you’re trying to figure out how it’s going to work.”

But Kristen’s commitment to making her entire treatment plan work is what made her so successful, Castor said.

“I only saw her four times, which is not very much,” Castor said. “Sure, I think the younger you are, the faster you rehab. But yes, she was very compliant with her exercises, and that made her kind of a dream patient in that respect. She did very well very quickly.”

“The progress I made over the span of a couple months was phenomenal to me,” Kristen said. “I was just blown away at how much of an impact such little adjustments could make.”

Individualizing Care, Normalizing the Conversation

Physical therapy isn’t the only mode of treatment for pelvic organ prolapse. Compared with surgery, it’s a rather conservative approach and involves long-term maintenance.

“The pelvic floor muscles are just like any other muscles in the body,” Castor said. “Just like if you have a gym program, you’re probably going to need to continue that two to three times a week to maintain whatever strength you gain. The same is true for the pelvic floor. They’re muscles. They’ll get weak if you quit using them.”

Kristen, who’s completed therapy and believes she’s “about 90% back to normal,” is determined to make a full recovery with the tips, tools and techniques she’s acquired.

“It’s meant a great deal,” she said. “Especially in terms of not feeling limited in what I can do. I’m back to running. That sense of heaviness is gone. I’m a happier wife and mom. It all just makes me want to educate others and make it a more normal conversation.”

Like Kristen’s was, every patient’s treatment plan is individualized around things like age, activity, goals and lifestyle, Castor said. But her approach to care is always the same.

“I think the most important thing is that you have to listen to the patient – listen to their concerns,” she said. “And again, I don’t think it matters what diagnosis you’re given. People always feel more reassured if they know they’re not the only one out there – that there’s a protocol for whatever healing they need.”