Prolapse is the descent of one or more of your pelvic organs (urethra/bladder, uterus/cervix, or rectum) into the vagina. The pelvic organs are held in place by ligaments and fascia and supported by the pelvic floor muscles, which can be compromised if put under too much load.
Pelvic Organ Prolapse affects 50% of women that go through childbirth, although only 15-30% will experience symptoms. It is such a taboo topic, and one that is very hard for a lot of women to speak about. It not only has a physical impact, but also effects the emotional, social and mental well-being. Many mums report feeling alone and like they aren’t able to perform the normal motherly and house duties without being scared they will make it worse.
There are multiple types of prolapse, and the most common are anterior vaginal prolapse (bladder/urethra descending into vaginal wall), posterior vaginal prolapse (rectum descending into vaginal wall), and central vaginal prolapse (uterus/cervix descends down). They can be isolated or experienced together. It is important that if you experience any symptoms or can visibly feel/see a prolapse that you seek professional help to diagnose appropriately.
Prolapse is classified from Stage 1 (very mild) to Stage 4 (complete prolapse). In my opinion it is important not to get too caught up in what stage you have, but more on what we can do to improve your symptoms. It is important to mention that there have been studies who have found women in their 20s who have not gone through childbirth and would be considered to have a stage one prolapse. None of these women experienced any prolapse symptoms, leading us to believe that stage one prolapse should be classed as normal physiological anatomy.
Symptoms may include feeling a heaviness or dragging feeling in the vagina, having a palpable lump inside or outside the vagina that wasn’t there before, or feeling like you have a full tampon in or sitting on a golf ball. It is also commonly reported to have a pulling sensation in the lower abdomen and pain or heaviness before or after sexual intercourse.
Prolapse is commonly accompanied by other pelvic floor dysfunction. You may experience straining to void or stop/start stream, trouble emptying your bowels or feeling like you haven’t completely emptied your bowel, recurrent UTIs, urinary incontinence, or pain during sex.
Although child birth is the largest risk factor for prolapse others include; menopause and hormonal changes, chronic constipation, chronic respiratory illness (lots of coughing), heavy lifting with poor technique, family history and obesity. It is commonly a combination of the above factors that will result in a prolapse.
Some tips on managing your pelvic organ prolapse:
Horizontal rest. In the early post-partum days it can help to unload the pelvic structures and muscles by lying down flat. A lot of people think that sitting is resting your pelvic floor, but being upright or reclined gravity is still there and it is harder for a lot of people to relax the upper abdominals. Lying horizontal for just 10-15 minutes a couple times a day in the early stages post-partum will really help the natural recovery. Ideally at least once mid morning or before lunch. This can be incorporated with breast feeding if you can master the side lying position.
Knowing your limits. It is really easy to feel like you need to get things done while your baby is sleeping or lying on their own, or feeling like you need to get back to exercise by a certain point post-partum. If you start to feel symptoms that is an indication that you have done too much and you need to rest. The task that you are trying to get done isn’t serving you at the point and understand that you will get there but it will just take time. If you try to do a 45 minute walk one day and start to feel heaviness, reduce that to 30 minutes the next time. If you can manage that without symptoms then you know that is okay for your body at that time.
Manage your constipation to reduce straining on the toilet. Straining on the toilet to pass a bowel movement increases the pressure on your pelvic organs and can make your prolapse symptoms worse. Eating a high fibre diet and drinking plenty of water will help, although some people may need laxatives or stool softeners to manage their constipation. Sitting on the toilet correctly and learning how to reduce the pressure through your breath and positioning can help reduce the load on your pelvic floor and organs.
Modifying your exercise. Although many people are too scared to exercise once they have been diagnosed with a prolapse, it is so important that we continue to strengthen our bodies and keep active. Exercise will not only help physically but also mentally and socially which we so desperately need in motherhood. There are certain modifications that can be made so that the exercises are pelvic floor friendly and not increasing your intra-abdominal pressure loading your pelvic floor and fascia.
Healthy weight and full body training. Carrying extra weight will put further load through your pelvic organ support. Another important reason why keeping moving is important when dealing with prolapse. Doing 2-3 general strengthening sessions a week working on your arms, legs, and overall body strength will help take load off the pelvic floor and deep core. For example, when lifting your toddler if you have weak legs, glutes, and arms the pelvic floor will take a lot more of the load than if you were strong in those areas.
Being more mindful when lifting heavy objects. When you lift heavy objects most people will brace and therefore increase the intra-abdominal pressure loading the pelvic floor. Often we lose the co-ordination or strength of the pelvic floor to counteract that pressure. It is important to retrain yourself to lift heavy objects properly, which can include co-ordination of the lower abdominal and pelvic floor, incorporating breathing strategies, and awareness when doing lifting heavier objects throughout the day.
Pessary. Many people are unaware of what a pessary is and how it is used. It is a medical grade silicone device that sits inside the vaginal canal to support the pelvic organs. There are many different shapes and types that can be used but is individual to each client. They can be temporary, short-term (while you run or exercise at the gym) or a long-term solution. If surgery has been mentioned to manage your prolapse, a pessary could be an alternate choice if appropriate.
If you are experiencing any prolapse or pelvic floor symptoms, it is important to get checked by a pelvic health physiotherapist to help guide you on the road to recovery. Although it may seem like it will take forever to recover, remember a postnatal body at 8 weeks is a lot different to where it will be at 12-18 months post-partum. Remember you are not alone, and there are so many little lifestyle changes that can be made to improve your symptoms and recovery.
