Post-Baby Body Blog Part 4 (Prolapses After Birth)
What is exactly a prolapse?
When we are hear the word “prolapse” we often think worst case scenario – organs falling out, unsightly vaginas, and you can throw the idea of enjoyable sex out the window, right?
If you have been diagnosed with a prolapse recently, this blog is a great overview for what to expect. And most of all don’t worry!
I am here to tell you that more often than not these misconceptions are far from the truth. While a small percentage of individuals can have significant complications related to prolapses, most prolapses can be treated and managed safely with physical therapy. The vast majority of women with prolapses have satisfying sex–and their partner would never know the difference!
In fact, we are finding more and more that pregnancy and delivery are not the only cause of prolapses. It is not unusual to find prolapses amongst nullipara women (women who have never given birth). You may be just as much at risk to develop a prolapse doing crossfit as you would pushing a baby out. Any number of factors can contribute to prolapse risk, including but not limited to: genetics, prior injuries, exercise habits, breathing mechanics, the elasticity of your pelvic fascia/ligaments, length of labor, and more.
What is exactly a prolapse?
A prolapse is the descent of an organ into the vaginal canal or rectum. There are a number of different types of prolapses, but the most common types for women after childbirth include:
Uterine prolapse involving the descent of the uterus into the vaginal canal,
Cystocele involving the descent of the bladder into the vaginal canal, and
Rectocele involving a descending colon into the vaginal canal.
To better understand a prolapse, we can use the “ship on dock” analogy. If there is insufficient water to keep a ship afloat next to a dock, it will stretch the ropes holding it in place. The water is like your pelvic floor–if it is loose or weak, the ropes (fascia/ligaments) holding your organ (boat) in place will stretch past their limit and the boat lowers even further.
This is a prolapse:
There are different Grades of a prolapse depending on how far the organ has descended into the canal.
- Grade 1 is when the organ drops only slightly into the canal,
- Grade 2 is when the organ drops far enough to reach the opening of the vagina,
- Grade 3 is where the organ bulges through the opening of the vagina, and
- Grade 4 is where the organ is completely out of the vagina.
In order to know the grade of the prolapse, a fairly simple manual test can be performed by your OBGYN or physical therapist.
How do I know if I have a prolapse?
Not all women with prolapses experience symptoms. Many will go undiagnosed until symptoms develop, as assessing for prolapses is unfortunately not a standard part of postpartum care in the United States. If you are curious- next time you are being assessed by your OBGYN or pelvic physical therapist, ask them to take a look. Though those who don’t have symptoms generally do not have a severe enough prolapse to require medical intervention.
Prolapse symptoms include:
- pelvic pressure/heaviness/fullness,
- ability to palpate tissues protruding out of the vagina (often while wiping after using the toilet),
- urinary problems (incontinence, constant urge to urinate, or urinary retention),
- trouble attaining full evacuation of bowels (the never ending wipe after a poop),
- feeling like you are sitting on a ball,
- decreased sensation during sex,
- tenderness or bleeding from the vagina,
- feeling like “something is falling out,”
- backache, and/or
- discomfort between the legs while walking.
How can a prolapse be treated?
Physical therapy is your best starting point. At your first visit, we perform a thorough evaluation – usually this will involve an internal assessment upon your consent. Don’t let the thought of an internal exam deter you, it’s far less invasive than a pap smear. We also perform an exam of your musculoskeletal system looking for any muscle imbalances, breathing and lifting mechanics, and postural dysfunctions, to name a few. We also allow plenty of time to hear about your daily rituals and routines, which often reveals pertinent information. This evaluation is very important as it allows us to determine your home program.
Your treatment sessions thereafter may include manual (hands-on) techniques, exercise prescription, modalities (biofeedback, STIM), and almost always we have a strong emphasis on improving education about how your daily routine may exacerbate your symptoms. We get to know you as a whole person.
There are also devices that can be inserted into the vagina to support the pelvic organs called a pessary. Should you be someone that requires this type of device, we will work closely with your MD to find the right option for you.
Not everyone can or should start with kegels. In some cases, kegels are contraindicated (they could make your problem worse instead of better).
If you have been diagnosed with a prolapse, just remember this: always, always, always start with physical therapy. Sadly, women are often recommended surgery without attempting any type of conservative approach (like physical therapy). It has also recently been common for their OBGYN to say, “do kegels” without any guided instruction.
Surgery should only be an option for worst case scenarios and when that patient has finished having babies and exhausted all conservative approaches including at least 6-9 months of physical therapy rehabilitation. The reason we are hell-bent on avoiding surgery is because it often does not fix the problem, can create new problems, and we often see them back in physical therapy years later with a recurrent prolapse.
If your OBGYN does not immediately send you to a pelvic physical therapist, simply request a referral and call you insurance company to find an in-network practitioner. We also have self-pay options for those without coverage.
Life with a prolapse without dysfunction is possible!
After the birth of my first daughter, I was diagnosed with a Grade 2 Cystocele and a Grade 2 Rectocele. My symptoms included urinary and fecal incontinence, pressure in the vagina, and poor pelvic floor control. After just 12 weeks of physical therapy at one year postpartum, I was able to return to my full pre-pregnancy exercise routine and was symptom-free. I am able to run 20-25 miles a week and lift my 32 pound toddler without making any of my symptoms worse. In the process of my rehab, I learned a ton about my body and carry that knowledge forward as I continue to navigate motherhood.
Thanks to google, we often read more horror stories than positive ones. The truth is that many women GET BETTER and achieve wellness, we just don’t hear about it enough. I am here to tell you – you GOT THIS, girl. Let us help you get there!
Written by Jessica Hawley-Gamer, PT, DPT for Rehab Specialists Inc,~ heart-led mother, runner/yogi, Pilates instructor, prenatal/postpartum/pelvic physical therapist living/working in Encino, CA.
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