The other day I was having coffee with a friend who (like me) is in the healthcare industry. She recently found out that she has pelvic organ prolapse, and — frankly — she was pissed off. “I can’t believe no one ever warned me about this,” she said. “I had no idea this condition even existed, let alone what to look for. What gives? How come our midwives and OB/GYN docs aren’t talking about this?”
Although it’s not something that’s commonly discussed, pelvic organ prolapse is a condition that many women develop after giving birth. Although it’s not limited to mamas, childbirth definitely increases the risk. Up to 50% of parous women (women who have given birth) develop some degree of prolapse after pregnancy.
In a nutshell, prolapse is when one (or more) of the pelvic organs “hangs a little low” and presses into the vaginal wall. The uterus can prolapse to the point that it slides down and can even exit the vaginal opening.
What does prolapse feel like?
It varies, but the common thread is that you’ll notice a CHANGE in your pelvic area. You might notice increased pressure on your bowel that’s worse when you’re lifting your kids or going for long walks. You might sense heaviness or pressure in your pelvic area, or a feeling like everything is “falling out” — especially during or after a bowel movement. You might feel like there’s a golfball in your vagina, low back pain and pressure that increases throughout the day (especially if you’ve been standing), or strange sensations during sex.
If your prolapse is advanced, it’s definitely noticeable and can cause physical (and emotional) distress once it’s discovered. Many women I’ve talked to indicate a sense of betrayal both from their bodies, and from healthcare providers who either “blew them off” or didn’t warn them about the condition in the first place.
What does prolapse look like?
If you think you might have prolapse, then schedule a consultation with your gynecologist or with a women’s health physical therapist. Here’s a link to a women’s health PT locator to help you find a provider in your area. These practitioners can give you a solid diagnosis and direct you to the next best steps. However, IT’S REALLY IMPORTANT TO KNOW YOUR OWN BODY, so I encourage you to check yourself, first.
How to check yourself:
Wash your hands. Sit comfortably on a toilet, or on the floor with your hips and knees bent. Make sure you’re in a well-lit room, or grab a flashlight. Gently part your labia (the outer and inner “lips” of your vulva) and use a handheld mirror to look inside the vaginal canal. Do you see anything? If you see a “bulge” that protrudes to the level of — or outside of — the vaginal entrance, then you probably have pelvic organ prolapse (which could be a prolapsed bladder, uterus, vaginal vault, or rectum). Make an appointment with your healthcare provider for further evaluation.
If you DON’T see a significant bulge, then gently bear down. You can try coughing (without contracting your pelvic floor first) and see what happens. If gently bearing down and/or coughing produces a bulge, then you might have mild-moderate pelvic organ prolapse. Finish by checking the same things standing up. After all, we live our life in upright positions… Not lying down on an examination table! It’s important to check for prolapse in functional positions such as sitting and standing.
As for specifics about what prolapse looks like, please note that for all women there will be “texture” on the inside of the vaginal canal. You should note wrinkled or “ridged” looking reddish-pinkish tissues (this is called vaginal rugae). This is okay and totally normal! It’s also normal to feel/see your vaginal wall descend SLIGHTLY when and if you experiment with bearing down or coughing. However, it is NOT normal to see a golf ball-like bulge that goes to the level of — or protrudes out of — your vaginal opening.
Real quick… wondering about “grades” of prolapse? The following (italicized text) is reproduced from WebMD:
Prolapsed bladders (also called cystoceles or fallen bladders) are separated into four grades based on how far the bladder droops into the vagina.
Grade 1 (mild): Only a small portion of the bladder droops into the vagina.
Grade 2 (moderate): The bladder droops enough to be able to reach the opening of the vagina.
Grade 3 (severe): The bladder protrudes from the body through the vaginal opening.
Grade 4 (complete): The entire bladder protrudes completely outside the vagina; usually associated with other forms of pelvic organ prolapse (uterine prolapse, rectocele, enterocele).
How to prevent and/or treat prolapse:
To reiterate, if you think you have prolapse, check yourself and then make an appointment with your midwife or OB/GYN for a full evaluation. In the meantime, the following tips will help prevent progression of prolapse if you have it. Even if you DON’T have prolapse, they are great pelvic health tools for any woman!
1) Make sure you’re staying regular and that you’re not having to strain to have a bowel movement. Keep your stools soft and easy to pass by eating a diet that’s rich in liquids from water and soups, and high in fiber, preferably from fruits and veggies and items such as chia and flaxseeds, since whole grains can be inflammatory for many individuals. Some people also benefit from a daily dose of magnesium, a mineral that many are deficient in, and that can help calm your mind and keep you regular. You also might want to try putting your feet up on a stepstool or Squatty Potty. Straining to have a BM puts a LOT of pressure on an already stressed (via postpartum and/or prolapse-strained) pelvic floor.
2) Learn how to lift. Lifting anything causes an increase in intra-abdominal pressure, which presses down on your pelvic organs and can increase prolapse if your pelvic floor isn’t prepared. The next time you lift your kiddos, “seal off” your pelvic floor muscles with a gentle kegel and then engage the rest of your core like you’re zipping up a pair of high-waisted jeans. Maintain this “zipped up” core as you lift, and don’t forget to EXHALE! Ruffle your baby’s hair with your exhalation; make it a game.
3) Don’t forget about posture! To prevent progression of prolapse you have to be sure that your posture and alignment are spot-on. Align your head over your shoulders, your shoulders over your hips, and your hips over your heels. Don’t tuck your bum under, and pull in your lower ribs if you feel that they’re popping forward.
4) Kegels are (usually) safe as long as you’re able to fully relax/release between contractions. However, if you’re unable to feel the contraction and/or the release, seek the advice of a women’s health physical therapist. She will be able to evaluate you to make sure you’re doing your kegels correctly and also to determine if they are appropriate and helpful for you. For some women with prolapse, the problem is actually short, tight, overly active pelvic floor muscles rather than weak pelvic floor muscles. For these women, kegels are ineffective and potentially harmful!
Want to try a kegel? Corkscrew kegels are a fun place to start!
If you decide to incorporate kegels into your fitness routine, you must ALSO focus on strengthening the rest of your core and MOVING MORE in general. Walk. Do other low-impact exercises such as swimming, dancing, or yoga (inversions are fantastic for people with prolapse). Try my bathroom fitness routine every time you use the potty. Your kids can even do it with you! Safely strengthen your abs, back, hips, and glutes with my my core fitness videos on YouTube, or try hip circles, which strengthen AND lengthen all of the muscles of the core. The Circle Solution is a great place to start!
5) If you feel pressure/strain in the pelvic area at any time during the day, take a few minutes to lay down and rest. I suggest doing so with your knees bent and your bottom propped up on a pillow (i.e. a supported “bridge” position… (See picture below).
This position moves the pelvic organs back into place and takes the pressure OFF of your pelvic floor. Sweet relief! It’s a lovely way to relax and release pelvic tension that can build up, especially in women with prolapse.
6) Avoid “jackknife” type exercises and sitting bolt upright in bed (roll to your side first, and then push yourself up as you exhale).
7) Finally, be sure to also relax and LET GO of your pelvic floor muscles when you’re not lifting or exercising. The goal is to create strong, supple, and responsive pelvic floor muscles… Not to clench them all day long!
If you definitely have prolapse:
A PESSARY is a diaphragm-like device that keeps the prolapsed organ in its rightful place. You need to be fitted by a qualified healthcare practitioner for a pessary, but it can be a good option especially when you exercise your hip, core, and pelvic floor muscles while wearing it.
The most important thing is to remember that pelvic organ prolapse is not a death sentence, and it doesn’t meant that you’re doomed to a future of sitting in an easy chair!
Prolapse can often be managed conservatively, without surgery, especially if its addressed in its early stages. Don’t ignore it or assume there are no alternative solutions; seek the care of a women’s health physical therapist, safely train your pelvic floor and core, watch your posture (don’t hunch! un-tuck your butt!), and exhale on exertion.
Let’s talk about this condition and take it “out of the shadows” so women can understand it, watch for it, prevent it, and seek help for it if needed!
1. Prolapsed Bladder, WebMD. Retrieved from http://www.webmd.com/women/guide/prolapsed-bladder. Last accessed May 7, 2015.
Dr. Brianne Grogan, DPT, is a mom, a physical therapist, a women’s health and nutrition coach, and the author of Lady Bits: Understand Your Body, Elevate Your Health, and Reclaim Your Spark Naturally. Inspired by her clinical experience as a physical therapist and her love of all forms of dance and movement, Brianne developed FemFusion® Fitness in 2009. Today, she teaches internationally, both live and online. Brianne does not believe in “one size fits all” diet and exercise plans, but stands by one simple rule that applies to everyone: For radiant health, eat clean, and move every day! Join one of her FREE women’s health interest groups when you sign up for her email newsletter, and browse the FemFusion Wellness Shop here!
Dr. Brianne Grogan, DPT
Eat clean. Move every day. SHINE BRIGHTER!