Prolapse- Urination Symptoms and Management Tips

Jun 30, 2023

Women's Health, Incontinence, Health tips, Pelvic Health

This is the third installment of our prolapse series. As you may recall, June is pelvic organ prolapse awareness month. Pelvic organ prolapse can be associated with many different symptoms; one of them being incontinence or incomplete emptying of the bladder. Below, we will talk about the different urinary symptoms you may be experiencing and ways to manage them.

Incomplete emptying, nocturia, recurrent UTI

Incomplete emptying is often associated with bladder or urethral prolapse. You can also consider that the anterior (front) vaginal wall no longer has the integrity to hold the organs in front of it. Some people may also experience a post-void dribble. Usually, this is due to an outpouching of the bladder or urethra into the vaginal canal. The urine may get caught in the pouch or in part of the urethra. This prevents the urine from coming out completely due to the residual urine in the pouch. Keep in mind that the bladder can be irritated, so you may not feel completely satisfied after urinating.

So how do we manage this? There are a few ways to do so. First, try rocking back and forth on the toilet when you think you are done urinating. This will help get the urine out of the pouch of the bladder that is protruding through the vaginal wall. You can try rocking back and forth, side to side, or in circles. The placement and degree of your prolapse may affect the direction that is most beneficial.

You can also try pushing in the front of the abdomen just above the pubic bone. Combining this with a forward lean can add pressure to the bladder to push out the remaining urine. Keep in mind that the bladder position is altered, so you may have to experiment where you push in order to find what works best for you.

You can also use a pessary. We suggest a pessary if you have a grade 2 or larger prolapse at the minimum. Most people that would benefit from a pessary are a grade 3. Keep in mind that prolapse usually worsens throughout the day and in gravity-dependent positions, especially if the cause of the prolapse is not being addressed. To see if you would benefit from a pessary, visit a pelvic floor PT who is familiar with pessaries or is trained to fit them.

Surgery, although usually the last resort, can help these symptoms. Usually, patients that have this symptom will have a bladder or urethral prolapse. In this case, the surgeon would “sling” the bladder or the urethra back up. This would eliminate the pouching that either of those structures may have. Keep in mind that surgery has risks. Also, if the cause of the prolapse is not addressed, it may come back even if the patient had surgery.

Stress Incontinence

One of the main causes of pelvic organ prolapse is often the same cause of stress incontinence. Stress incontinence is urinary leakage after laughing, jumping, coughing, sneezing, or any other way that there is an increase in abdominal pressure. Commonly, this is due to pressure mismanagement, pelvic floor muscle tension, pelvic floor muscle weakness, or a combination of these things. Coincidentally, pressure mismanagement is one of the common reasons why people develop pelvic organ prolapse. More pressure is exerted on the pelvic floor due to abdominal gripping, bearing down, and muscle clenching.

The best way to eliminate stress incontinence is to disperse the pressure throughout the abdomen as opposed to pushing toward the pelvic floor. Thinking of the core as a system. The respiratory diaphragm is the top, the abdominals are the front, the paraspinals are the back, and the pelvic floor is the bottom. What is happening is that we are squeezing the top of the can. The pressure in that can have to go somewhere, so it goes down. Eventually, the pelvic floor gets tired from working so hard and gives out. This leads to the leaking of urine and pelvic organ prolapse.

A good way to improve your pressure management is to learn how to breathe with exercise, and how to relax. Sucking your stomach all the time is like squeezing the top of the can. Also, by exhaling while doing any type of difficult muscle contraction, we are maintaining adequate abdominal pressure instead of pushing it all down.

Something else to consider is that stress incontinence is not weakness, it is usually overexertion of overly clenched and tight pelvic floor muscles. Because of this, just doing a kegal is not the answer. First, we have to lengthen the tissue so that when we finally get back to strengthening, we can move through the full range of motion. A shortened muscle is not a strong muscle.

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If these are issues that you are continuously dealing with, visit a pelvic floor physical therapist so they can get you started on the process of muscle lengthening, pressure management, and eventually muscle strengthening.

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Prolapse- Urination Symptoms and Management Tips