Pelvic Organ Prolapse is common – very common – for women with the Association for Pelvic Organ Prolapse Support citing it will affect 1 in 2 women during their life time. Women who have had children will be more likely to experience prolapse compared to those who did not give birth. Studies show 30-35% of postpartum women have symptoms of prolapse. If you have or think you have pelvic organ prolapse (POP) know that you are not alone and there are things you can do to correct it.
What is Pelvic Organ Prolapse
Pelvic Organ Prolapse is when one or more of the pelvic organs slip down lower than they should. This downward descent of the organ putting pressure on the pelvic floor and bulge into the vagina. There are several types of prolapse, categorized by the organ which is out of place and each type of prolapse can be further classified into grades.
Types of prolapse
- Cystocele—The wall between the bladder and vagina weakens causing the bladder to bulge into the vagina.
- Enterocoele—The small intestine pushes against the upper wall of the vagina causing a bulge.
- Rectocele—The wall between the rectum and vagina weakens causing the rectum to bulge into the vagina.
- Uterine Prolapse—The uterus drops into the vagina.
- Urethrocele – The urethra (the tub that passes urine out of the body) pushes into the vagina.
- Vaginal Vault Prolapse – The top of the vagina collapses down onto itself.
Cystocele is the most common type of prolapse with rectocele and uterine also being very common.
Grades
Each type of prolapse can be further categorized into grades based on degree of severity from 0-4.
A “0” means no degree of prolapse – no slippage of organs noted – a normal position. A “4” means the organ is bulging completely outside of the vaginal opening. The grades are based on the distance of bulging relative to the hymen 3 being decent just past the hymen, 2 being decent to the hymen and 1 being decent halfway to the hymen.
Risk factors of pelvic organ prolapse
Vaginal births are the biggest risk factor for POP. If you had to have an emergency cesarean birth but spent some time pushing you could be at equal risk. Births assisted with vacuums or forceps could further increase the risk. The risk comes from the pressure on the pelvic floor muscles and structures causing weakness. Also the decent of the baby can cause tugging on the soft tissue connected to the pelvic organs placing them at risk of shifting down. Pregnancy itself regardless of birth process also can increase your risk due to the increased pressure placed on the pelvic floor.
Other risk factors include pelvic surgeries, obesity, chronic constipation, genetics, heavy manual work or heavy lifting with poor pressure management.
Symptoms of prolapse
Many women with mild prolapse have no symptoms at all. Here is a list of common symptoms that could indicate prolapse
- Feelings of pelvic heaviness or dragging sensation which may get worse with increased time on your feet, coughing or sneezing
- Difficulty inserting period products such as tampons and cups
- Pain with intercourse
- Constipation
- Bowel or bladder incontinence – leaking
- Frequent UTI
- Difficulty emptying your bladder
- Urinary frequency- needing to pee more often than usual
Treating pelvic organ prolapse
Treatment depends on what grade you are. Grade 1-2 have tremendous success with exercises and pelvic floor physical therapy. Grade 3 can also have good results with exercise and pelvic PT and PT is often the first course of action here. Grade 4 will require surgical intervention. If you are unsure of the grade ask your doctor at your next appointment and map out a plan from there.
I strongly encourage a team approach to treatment between your doctor and physical therapist, and YOU! You are an important part of the team and there is a lot of lifestyle/behavior adjustments you can do first.
What you can do to help improve symptoms
- Avoid straining when going to the bathroom so a step stool or squatty potty is a must! Prevent constipation as best you can as that can put extra pressure on your pelvic floor and lead to straining. So stay hydrated, warm broths can be an excellent way to increase hydration and are also very nurturing and a good way to ensure lots of nutrients for you this stage in the game. Take over the counter stool softeners as needed.
- Having your bladder be overly full can also place added pressure so try to not wait too long between trips to the bathroom. Think about going ever 2 to 4 hours. I know that can be a challenge with little ones – especially if you get nap trapped but be mindful of it and try to avoid it as best you can.
- Working on pressure management can be very helpful – avoid holding your breath or bearing down when lifting your baby or even going from sitting down to standing up. A gentle exhale on the effort (think blowing out a candle) can help.
- Another way to avoid increased pressure on your pelvic floor is to avoid too tight clothing so stay in your maternity pants for a while. Also skip the abdominal binder right now or make sure it isn’t too tight and is just providing a light feed back.
- While binders might not be the best choice compression garments such as shorts or compression underwear can be helpful to feel more supported. Make sure that it is sized right and not too tight.
- Spend time off your feet. I believe movement is medicine but it needs to be gentle early on postpartum and balanced out with rest. Laying down with your feet up after exercise or increased walking bouts can be beneficial.
- Even though you have a prolapse there often is a lot of tension in the muscles (shortened muscles are usually weak muscles) so working on relaxing (not pushing or bearing down but letting go and relaxing your pelvic floor muscles) can be very helpful in the early stage of mild POP. Constant tightening your pelvic floor can sometimes make symptoms worse.
- Getting support where and when you can from friends/family/community ect can be very helpful and shouldn’t be overlooked. Send your friends this article on ways they can better support you postpartum.
- Gentle exercises can be helpful at this stage with an emphasis on rib cage and upper back mobility. I have a very gentle exercise progression in my 6 Week Survival Guide you can grab it here for $37 if you are interested.
Other treatments
- Sometimes it’s a matter of not doing specific things. Read here for 7 things to stop doing for overall better pelvic health
- After 6 weeks postpartum a pessary (a device you insert vaginally to provide support to the vaginal walls) can relieve symptoms. There are some you can get over the counter but it is ideal and best practice to be fit for one.
- Topical estrogen creams can be helpful as well but will need a perscription.
- Of course I mentioned before and I’ll mention it again seeing a pelvic floor physical therapist is recommended
- Surgery is often last resort and reserved for grade 4 prolapse or grade 3 which did not improve with therapy interventions.
Can I prevent POP from getting worse or coming back with subsequent pregnancies?
While there isn’t a guarantee that a current prolapse will not progress or that you wont develop one with additional pregnancies there are things you can do to help your odds.
- Avoid perineal tearing by performing perineal massage starting at least by 36 weeks of pregnancy.
- Avoid holding your breath while pushing in labor. Pushing on the exhale can help decrease internal pressure while in labor and might be more gentle on your pelvic floor.
- Follow the above tips on what you can do to ease symptoms
- Take time and be mindful of your postpartum recovery. You want to gradually and intentionally progress your pelvic floor and core strength while keeping mobility, muscle relaxation and coordination in mind.
I hope this was helpful. Don’t lose hope and hang in there mama, you are doing better than you know!