What is a Prolapse?
Prolapse is the descent of one or more of the pelvic organs (bladder, uterus or bowel) into the vagina. It is due to a lack of support from the pelvic floor muscles & surrounding tissue.
The different types of prolapse:
- Cystocele: prolapsed bladder
- Uterine prolapse: prolapsed uterus
- Rectocele: prolapsed bowel
The different stages of prolapse depending on severity:
- Stage 1: the organ descends to >1cm above hymen (vaginal opening)
- Stage 2: the organ descends to just above or below the hymen (within 1cm)
- Stage 3: the organ descends >1cm below the hymen
- Stage 4: the organ descends completely out of the vagina
How do you know if you have a Prolapse?
The only way to know for sure is to have an internal pelvic floor assessment with a trained Women’s Health Physiotherapist. Your WH Physio will determine what stage of prolapse you have.
Some women can have a mild prolapse and not have any symptoms at all. Other women can have a mild prolapse and feel really uncomfortable with more obvious symptoms like vaginal heaviness or feeling like a tampon is lodged incorrectly.
The sooner you are diagnosed, the sooner you can start rehabilitation, so don’t put off your 6-week postnatal check with a Women’s Health Physio. If you are past this point, I still recommend having an assessment no matter how many months or years postpartum you are.
What are common Prolapse symptoms?
Here is a list of prolapse symptoms – you don’t have to experience all of these symptoms to have a prolapse. And sometimes, women don’t have any symptoms.
- Vaginal heaviness, pressure or dragging sensation- especially at the end of the day or after prolonged standing/walking.
- Lump or bulge when you wipe yourself
- Feeling like something is “falling out” of your vagina
- Bladder leakage
- Incomplete bladder or bowel emptying
- Constipation
- Backache
- Avoiding sex due to fear of discomfort
One thing is for sure – prolapse is very uncomfortable & can greatly affect a woman’s activity level & confidence.
What should you do if you find out you have a Prolapse?
Try not to freak out! Prolapse can be equally mentally challenging as it can be physically challenging, but please know that there is so much you can do to help yourself, so try to stay positive. Make sure you have a supportive Women’s Health Physio to support you through your recovery journey, physically & emotionally. I am here to help women in Sydney face to face or can provide individualised advice via an online consult to women outside of Sydney. Click here to find out more.
Is it normal for women to have a Prolapse?
Prolapse is very common, but is NOT “normal”. In other words, if you have a prolapse, don’t just put up with it, make sure you get help.
Up to 50% of women will experience a prolapse (symptomatic & asymptomatic) after childbirth – regardless of whether they give birth vaginally or via caesarian.
It is important to note that caesarean sections do NOT protect against pelvic floor dysfunction & prolapse. There can be a delayed onset of prolapse symptoms after birth, which means that the prolapse may occur months or years after childbirth.
What increases your risk of Prolapse?
- Childbirth
- Instrumental delivery i.e. forceps
- Large infant >4500g
- Prolonged second stage of labour
- Multiple births
- Pregnancy- hormones & increased weight
- Returning to high impact exercise too quickly after childbirth
- Chronic coughing
- Chronic vomiting
- Chronic constipation
- Repetitive heavy lifting
- Physically stressful occupation
- Obesity
- Gynaecological surgery e.g. Hysterectomy
- Weak connective tissue
- Genetic link- if other women in your family have a prolapse
- Menopause
- Ageing
Can you prevent Prolapse?
You can definitely help to reduce your risk of prolapse! Read how below.
Can you treat Prolapse?
Stage 1 & 2 are very treatable by following the below advice diligently. Stage 3 & 4 are unlikely to resolve with conservative management.
How can you prevent & treat Prolapse?
Research has shown that conservative measures can help prevent & reduce prolapse, alleviating symptoms. These include:
1. Pelvic floor exercises
As boring as they may be, regular pelvic floor exercises have been shown to both help prevent prolapse by maintaining a strong support for the organs & treat prolapse by improving the position of the prolapse.
Doing pelvic floor exercises religiously during pregnancy & again straight after childbirth can help to prevent prolapse.
But it doesn’t stop here – pelvic floor exercises are equally important after your childbearing years. As women move towards menopause hormone changes can predispose them to prolapse.
To make pelvic floor exercises worth your while, you need to be doing them correctly. Your Women’s Health Physio will teach you this & set you up with an individualised exercise program.
Download my FREE pelvic floor guide & get started on these exercises pronto!
Grab my FREE Pelvic Floor Guide!
2. Prepare yourself for childbirth
You can’t control what happens on the day or how big your baby is, but you can prepare your body & pelvic floor to the best of your ability. This is why strengthening your pelvic floor muscles PLUS learning how to relax your muscles is key during pregnancy.
Learning how to “push” correctly is also a must. The aim of the game is NOT to “push like you’re doing a poo” but instead use the “coffee plunger” technique, which uses your breath & upper abdominal muscles.
I will teach you how exactly to prepare your pelvic floor for birth & postpartum recovery in my Online Pregnancy Program:
Sign Up to The Pregnancy Academy!
3. Start pelvic floor exercises day 1 post-birth
I know there is so much going on post-birth, but do your best to start gentle pelvic floor exercises! This helps to re-activate neural pathways to these muscles to regain strength and motor control over time. I recommend doing 4-5 gentle pelvic floor contractions when you feed your baby. Gradually increasing your endurance & repetitions as you can over the next 1-2 weeks.
Do this regardless if you’ve had a vaginal birth or c-section.
4. Optimise your recovery in the first 6-12 weeks post-birth
Make sure you dedicate the first 6 weeks after childbirth to allowing your body to heal with adequate rest. Your body has gone through 9 months of carrying a baby & then childbirth which places huge strain on your organs, muscles, connective tissue, ligaments & nerves. In addition to this, there are all sorts of hormonal changes which continue to impact the strength of your body & pelvic floor.
Lie down horizontal throughout the day to rest or sleep. Do this when your baby sleeps. Not only does lying down take pressure off your pelvic floor but it stimulates the parasympathetic nervous system, which promotes healing and restores balance in your body.
The first 6 weeks is not the time to be doing housework, running errands or standing up for hours on end making cups of tea for visitors or cooking. Outsource as much as you can, so you can rest.
As well as rest, it’s really important that you start safe core exercises in the first 6 weeks to rebuild your strength & core stability. I teach this in detail in my online postpartum program so you can learn what strategies & exercises you can do to optimise your postpartum recovery:
Sign Up to The Postpartum Academy!
5. Slow & steady return to walking
A common mistake I see women make in the first 6 weeks postpartum is pushing themselves & walking too far. As I’ve mentioned above, your body is going through massive transformation & recovery at this time. Whilst it’s important to start walking 1-2 weeks postpartum, you need go slow & listen to your body.
Start with a stroll around the block & see how this feels. Do this for a few days, and all going well, gradually increase the distance every few days. You should not feel any vaginal heaviness, leakage or pain. If you do, you have pushed yourself too far & need to wind it back.
I also recommend taking the pram for walks rather than the baby carrier, especially on longer walks.
I know most new mums are desperate to get back into exercise but please be patient! These first 12 weeks are critical healing weeks and will set you up for success in the future.
6. Always have a 6-week check with a Women’s Health Physio
At 6-weeks we will do an internal pelvic floor assessment, checking for prolapse & teach you how to do correct pelvic floor exercises. We will also assess your abdominal separation.
With this information, we can give you individualised guidance on returning to exercise safely, plus anything else pertinent to you.
Commonly at this point, it is safe to commence low impact exercise like (more) walking, swimming, cycling, and strength training like Postnatal Pilates, Yoga & light weights.
I recommend this assessment even if you are feeling fine.
7. Do not run before 4 months postpartum (at the earliest)
Women running or doing other high-impact exercises too soon postpartum is another common mistake I see. When you’re >4 months postpartum, have been cleared by your Women’s Heath Physio, have been building your general muscle strength (with Pilates), you do not have any prolapse symptoms, you can walk good distances at a fast pace incorporating some hills, then trial adding a jog into your walk on a flat surface (preferably grass).
All going well, gradually increase the jogging component.
8. Choose appropriate exercise if you have a prolapse
For women with prolapse symptoms, I recommend choosing low-impact exercise options that don’t give you symptoms e.g. walking (within your distance limits), swimming, cycling, Pilates, Yoga & light strength training.
Swimming is an in particularly great way to do cardio exercise, as there is no ground force reaction.
I recommend avoiding high impact exercise or sport (involving running, jumping), excessive abdominal crunches, planks, low squats & heavy weights. Therefore cross fit & boot camps that involve these exercises are not advisable at this stage.
This doesn’t mean you can never do these types of exercise again! It just means that while you strengthen your pelvic floor & improve the prolapse, you’re not adding more intra-abdominal pressure. When appropriate your Women’s Health Physio can guide you back into higher impact exercise safely.
9. Lie down with your pelvis elevated every day
Rest for 10-30 minutes EVERY afternoon/evening with 2 pillows under your pelvis to elevate it. You can do this lying on the floor next to bubs with your feet up on the couch. This position (called inversion position) uses gravity to assist bringing the prolapse back into position. To maximise the benefits of this position, do a set of your pelvic floor exercises as well.
10. Avoid constipation & straining
This is a big one to get right because constipation on it’s own can lead to prolapse. Since it’s such an important topic, I’ve written a separate blog post – Click here to read my post on treating constipation.
I always give individualised dietary advice in consults so make sure you reach out if you can’t get on top of your bowel heath.
11. Avoid heavy lifting
This includes heavy weights, furniture, gardening and trying to minimise unnecessary lifting & carrying of your toddler. Before you call me crazy, hear me out! Encourage your toddler to be as independent as possible, use the pram, give cuddles on the couch, and get your partner to do the lifting when they’re home. Another good idea is to buy a kids table & chairs so you don’t have to lift them in & out of the high chair.
Obviously there’s plenty of times you have to lift your toddler, so make sure you stay strong in your legs & glutes and activate your pelvic floor before you do.
12. Listen to your body
If an activity, exercise or household chore doesn’t feel right in your body or causes any prolapse symptoms, then try to avoid it. These modifications are not forever but important while you strengthen your pelvic floor.
13. Be aware of your posture
Sitting & standing upright helps to activate your pelvic floor & deep abdominal muscles. This in turn helps support your internal organs & provides stability to your pelvis & spine.
14. Weight loss (if you are overweight)
Increased weight, especially around the abdomen places increased pressure on your pelvic floor. Weight loss can be achieved by combining healthy eating habits with 30-60 minutes of moderate intensity low impact exercise a day.
I recommend consulting a Nutritionist for dietary advice.
15. Get treatment if you have a cough or cold
Coughing, sneezing & blowing your nose, places a lot of pressure on your pelvic floor. If you are unwell, be sure to see your Doctor for treatment.
Also try to activate your pelvic floor before you cough/sneeze.
16. Vaginal oestrogen
If you are breastfeeding your oestrogen levels are low, which impacts your vaginal tissue & muscle strength. Speak to your GP about getting a prescription for vaginal oestrogen, which can help to improve the quality of the vaginal tissue & strength.
17. Consider a support pessary
If you have a you’re finding that the above management is not making a significant difference, a pessary may be a good option for you. A pessary is a silicone device inserted into the vagina to support the prolapse & the weakened pelvic tissue. Speak to your Women’s Health Physio or Gynaecologist regarding being fitted with a suitable pessary.
How long does recovery take?
Recovery is different for every woman depending on many factors- the stage of the prolapse, the strength & tone of your pelvic floor muscles, your connective tissue, genetics & diligence with lifestyle modifications & pelvic floor exercises.
Because muscle strength changes take 6-8 weeks, your prolapse symptoms will hopefully start to improve within this time frame. As the muscles continue to get stronger, the organ will be better supported.
Sometimes results can take several months so it’s important to not give up on all the management strategies & keep checking in with your Women’s Health Physio to check you’re on the right track.
Due to the hormone changes that come with postpartum & breastfeeding, strengthening & rehabilitation can take longer. So remember – how your body feels now is not going to be how it feels forever.
The aim is to get you symptom free and back to the activity & exercise you wish. This can be achieved without the prolapse being completely resolved.
I know that prolapse can be all you think about when you have one, but try your hardest to focus on what you are doing to help yourself rather than the symptoms, as they will get better with time.
Is surgery an option for Prolapse?
I am a strong advocate for conservative management but in some instances, severe prolapses require surgery. If this is the case, pelvic floor exercises should be undertaken before & after the operation. This is particularly important seeing as surgery has a considerable failure rate of 30-58% & a re-operation rate of nearly 30%! This is another reason why conservative management & therefore Women’s Health Physio is the place to start in treating prolapse.
I hope you feel more empowered now that you know what action you can take to both help prevent & treat prolapse. I am here for you every step of the way so reach out if you have any questions.
References:
Abrams P, Cardozo L, Khoury S, Wein A (Eds) (2013) Fifth International Consultation on Incontinence. Plymouth: Health Publications.
Braekken IH, Majida M, Engh ME, Bo K (2010) Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. American Journal of Obstetrics and Gynecology 203: 170-177.
Hagen S, Stark D (2011) Conservative prevention and management of pelvic organ prolapse in women (review). Cochrane Database of Systematic Reviews: 1-72.
Maito JM, Quam ZA, Craig E, Dannerq KA, Rogers RG (2006) Predictors of successful pessary fitting and continued use in a nurse-midwifery pessary clinic. The Journal of Midwifery & Women’s Health 51: 78-84.
Persu et al (2011) Pelvic Organ Prolapse Quantification System (POP-Q) – a new era in pelvic organ prolapse staging. J Med Life 4: 75-81.
Rogers and Fashokun (2016) Pelvic organ prolapse in women: epidemiology, risk factors, clinical manifestations, and management. 1-11.
Thakar R, Stanton S (2002) Management of genital prolapse. British Medical Journal. 324: 1258-1262.
Thompson JA, O’Sullivan PB (2003) Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review. International Urogynecology Journal 14: 84-88.
Whiteside JL, Weber AM, Meyn L, Walters MD (2004) Risk factors for prolapse recurrence after vaginal repair. American Journal of Obstetrics and Gynecology. 191: 1533–1538.