10 things you didn’t know about prolapse
Pelvic organ prolapse is when your bladder, uterus or rectum descends into your vaginal wall. It’s classified as a supportive dysfunction, as it typically occurs when there is a loss of nerve, muscular, ligamentous or fascial integrity in your pelvic floor. This condition can occur after a vaginal childbirth, but can also happen regardless of childbirth history. Here are 10 things you may not know about prolapse!
#1 It is more common after a vaginal birth with a long pushing stage or instrument-assisted delivery.
While pelvic organ prolapse can happen regardless of childbirth history, having a vaginal birth with a long pushing stage (>3 hours) or with a vacuum or forceps assisted delivery puts you a greater risk for prolapse postpartum. This is due to tissue damage to the pelvic floor muscles, ligaments and fascia that help to support your pelvic organs.
#2 The actual grade of your prolapse (i.e the appearance), doesn't always correlate with the severity of your symptoms
You can have a very large prolapse without any symptoms, or a very mild prolapse with severe symptoms! So if you were told by your medical provider that you didn’t appear to have a prolapse but your symptoms are telling you otherwise, this is quite common. Find a pelvic floor PT who can properly assess your prolapse and help you with symptom management.
#3 Your only symptom could be low back pain
That’s right, sometimes symptoms are less apparent. 90% of postpartum moms have a pelvic organ prolapse, but symptoms can vary widely. Common symptoms are a heaviness or bulging in your vagina, sensation like a stuck tampon or bladder/bowel dysfunction. Everyone should have a pelvic floor assessment after birth, regardless of any symptoms you may or may not be experiencing. Also, if you have been dealing with low back pain and nothing seems to be working, your pelvic floor may be the culprit!
#4 Prolapse is a pressure management problem
Prolapse is a problem with pressure management and to improve this requires a full body approach, not just kegels! Pelvic floor strengthening is important, but we have to look at how the body manages pressure and absorbs force as a whole.
#5 Just because your OBGYN tells you that you don't have prolapse, you still very well could have one!
When your OBGYN tests you for prolapse, they typically do this when you are laying down. Testing this way can sometimes give a false negative if your prolapse is only apparent when you are standing up. Your prolapse may also be more apparent depending on the time of day or your level of activity. A pelvic floor PT can test you based on when you have symptoms to give you a more accurate diagnosis!
#6 Reducing constipation is the best thing you can do to manage a prolapse
Chronic constipation is a huge risk factor for pelvic organ prolapse. If you are constantly straining to empty your bowels, that puts a lot of downwards pressure on your pelvic floor. Doing this repetitively can cause a prolapse! Also, if you are already dealing with a prolapse, being constipated can make your symptoms worse. Proper hydration, diet, exercise and toileting posture are important for healthy, strain-free bowel movements!
#7 Your posture can impact your prolapse
Does your posture look like the picture on the left? If so, you could be at an increased risk for prolapse. This posture limits your ribcage and diaphragm mobility and causes more downwards pressure in your pelvic floor. Improving your posture can have huge impacts on your pelvic health!
#8 If you have excessive joint hypermobility, you may be at an increased risk for prolapse
Remember when I said that prolapse is a supportive dysfunction? If you have excessive joint hypermobility, that means that your tissues have less tension in them at baseline and therefore can lead to less support in your pelvic floor. Take a look at the self-assessment below, if you score at least 4 out of 5, you have hypermobility!
#9 A pessary is such an under-utilized management tool
A pessary is like a sports bra for your pelvic floor. It is an external support device that is fitted uniquely for you and placed in your vaginal canal to support your organs. As you can see in the picture to the right, there are so many different styles of pessaries. A pessary helps to lift your pelvic organs so they are not resting right on your pelvic floor muscles. Using a pessary in conjunction with PT is an excellent management tool for prolapse.
#10 Pelvic Floor PT can be an effective treatment for reducing prolapse symptoms.
Prolapse looks different on everyone. If you are struggling, work with a pelvic floor PT. We will listen to your story, give you a thorough evaluation and help to form an individualized treatment program to help reduce your symptoms. “Pelvic Floor PT has robust evidence-based support and clear benefit as a first-line treatment for most pelvic floor disorders” (Wallace et al, 2019)