Regardless of the type of delivery - vaginal delivery or cesarean - prolapse is a very real possibility. Being told that you have a prolapse after childbirth is scary – what is it? Can it be treated? The good news is YES! There are several effective ways to treat pelvic-organ prolapse.

What is prolapse? Pelvic organs are supported by ligaments above and by (can you say around rather than by?) the pelvic floor muscles and the fascia below. If either structure weakens, it can cause the organ to drop down. Symptoms of prolapse may include heaviness or pressure in your pelvis, something protruding from your vaginal opening or anus, or difficulty evacuating stool or urine. To be properly diagnosed, you should schedule a follow-up appointment with your OB/GYN on or about 6 weeks after giving birth.

The three most common types of prolapse are:

• Cystocele or bladder prolapse - occurs when the bladder falls or presses into the front part of vaginal wall

• Rectocele- occurs when the rectum falls or presses into the back of the vaginal wall

• Uterine prolapse – occurs when the uterus protrudes into vaginal canal

Why do pelvic-organ prolapses occur?

• Weak pelvic floor muscles

  • When pelvic floor muscles are weak, they cannot support the pelvic organs well. A strong but not “tight” pelvic floor can reduce the risk of a prolapse occurring.

  • If you feel that your pelvic floor is weak, contact a pelvic floor physical therapist to schedule an assessment. 

• Body type

  • Genetically, some people have looser connective tissue than others. This may make them more vulnerable to ligament laxity. With ligament laxity, combined with other factors such as constipation/ straining or lifting or long pushing-time during labor, there is a higher chance of pelvic organ prolapse. 

• Pregnancy and postpartum

  • Throughout pregnancy, increased laxity from certain hormones plus the weight of a growing baby puts a lot of downward force/ pressure on the pelvic organs. The laxity can continue when breastfeeding. During this time, it is best to reduce strain on these muscles.

  • Walking a lot, and being on your feet, immediately postpartum, can contribute to downward force on your pelvis. Consult your physician and a pelvic floor physical therapist to determine an activity(exercise?) program to help avoid this. 

• Childbirth

  • During childbirth, pushing and pressure can cause additional stretching of ligaments and fascia. If there is a very long second-stage of pushing, this may inflict more force upon the organs within the pelvis.

• Straining to use bowel or bladder

  • You should be able to empty your bladder or bowels without straining.

  • Straining can cause pressure on your pelvic organs and increase probability of descent downward. Over a long period of time, a pelvic organ prolapse can occur.

  • A Pelvic floor physical therapist can teach you to reduce strain and improve toileting techniques.

• Back-to-sport too soon postpartum

  • Returning to sport too soon postpartum may increase the chance of pelvic organ prolapse. 

  • If the core and pelvic floor muscles have not properly healed postpartum, the supporting ligaments will continue to stretch. 

What should I do if I have pelvic organ prolapse? 

• Minimize lifting

  • Avoid lifting anything heavier than a gallon of milk or your child (if applicable) to avoid pressure and/or symptoms of prolapse.

• Space-out activities

  • Spread activities throughout the day. This will avoid concentrated pressure and fatigue to the pelvic floor. 

Pelvic floor physical therapy is the least invasive of treatment for organ prolapse. A physical therapist will fully evaluate you to assess posture and strength. They will perform an internal examination of the pelvic floor muscles. The primary goal of prolapse physical therapy treatment is to reduce excessive pressure on the pelvic floor. The treatment may include the teaching of breathing techniques for proper bowel movements, body mechanics and proper lifting techniques to avoid straining. Certain positions can help relieve symptoms and strengthen muscles to help prevent the worsening of symptoms.

More invasive treatments include:

• A pessary , a small ring like device that is inserted vaginally to provide support for the pelvic floor muscles, and to keep the prolapse from hanging down further into the vaginal opening. Your doctor will fit this for you.  

• Surgical interventions include fixation or suspension of the tissues that are loose, either vaginally or abdominally. Possible complications with this surgery include difficulty urinating and/or incontinence, as well as pain after sex. A hysterectomy can also be performed if the uterus is severely prolapsed

Usually with time, the prolapse will improve. If you are breastfeeding, symptoms of prolapse may be heightened but lessen once you stop breastfeeding. Your hormones will regulate and therefore reduce ligamentous laxity. In additional the regulation of hormones will help your pelvis stabilize and the pelvic floor will function better. If you still have questions about prolapse, follow-up with your doctor and discuss your possible options for treatment.

The Bottom line: If you have prolapse, there are several treatment options that should reduce your prolapse symptoms. Before considering surgery, physical therapy is a great option for strengthening, education and the learning breathing techniques. If you are experiencing prolapse symptoms, contact Solstice Physiotherapy to schedule a free, 15-minute phone consultation. You can email us at info@solsticept.com or call us at 929 269 2505.