We often see a number of women who have symptoms of prolapse after childbirth. Today we want to focus on what to look for and pay attention to in those early weeks after you had your baby.
A prolapse refers to a condition when a pelvic floor organ slips down from its original positions and bulges down into the vaginal area. The organs were held there with ligaments and other support structures that have weakened post-baby.
Through pregnancy there is a lot of downward pressure onto the pelvic floor as the baby grows. In addition to this, a vaginal delivery involves a lot of push and straining downward onto the pelvic organs. If you had a cesarean delivery, there was still the pressure exerted downward onto your pelvic floor throughout the pregnancy. Women can develop pelvic organ prolapse even if they have never had a baby from things like poor lifting mechanics or repetitive heavy lifting.
The most common pelvic floor organs that “fall” are the bladder, uterus and the rectum. When these organs are “falling” they are pressing into the vaginal wall so it is not the actual “bladder” that is falling out, but instead the wall that is shared between these two that is coming into the vaginal space.
Common signs or symptoms that can be noticed during pregnancy, after delivery or well into the post-partum period include, sensation of pressure, heaviness or fullness in the lower pelvic area. It is common to feel these symptoms in the perineal area, which is the area of skin between your vaginal and anal opening. Basically if you feel like something is falling out or you notice some tissue coming out of the vaginal opening these would be signs of a prolapse. Some other common symptoms that can signify a prolapse also include back ache, painful sex, bladder leakage.
If you are experiencing any of these symptoms, the number one thing to do would be to start by talking to your physician, midwife, or whoever you worked with during your pregnancy and delivery. The sooner you bring this up, the better, no time is too early to have someone check. We recommend not waiting till the next “check in” like the 6 or 8 week post-partum check, as soon as you are having these symptoms, it is best to seek intervention.
The second thing to do would be to seek a referral for pelvic floor physical therapy.Partnering with a pelvic floor physical therapist will give you the best outcome for prolapse management. A pelvic floor physical therapist will do a full head to toe assessment to find areas of weakness to address.There are likely muscles that need to be strengthened or movement patterns that could be improved to better support your pelvic floor.
If you are feeling the symptoms of prolapse, there are some quick things you can already start to do and even if you aren’t sure if you have one or not, these are good things to do in general:
1. Rest – Rest when you can, as a new mom or a mom of multiples, we know rest is far and few between. Take advantage of the help around you.The best position for prolapse symptom relief will be either laying flat on your back or having your hips propped up onto a pillow so your hips are higher than your head. Laying with your legs propped up allows gravity to do all the work in pulling those pelvic organs back up and in. We recommend lying there for 3 -5 minutes at least 3-4 times a day ideally.
2. Avoid constipation – If you are getting constipated, it will add to the pressure in the pelvic cavity increasing the symptoms of pelvic floor heaviness. If you are straining with bowel movements, that is also a huge downward push onto your pelvic floor. Typically early post-partum, physicians prescribe stool softeners, make sure you are taking those as prescribed and ensure adequate water intake so your stools are staying soft. If you start to notice that you are getting backed up a bit, it’s time to call your health care provider and see if they can provide guidance on medication changes or supplements that can be included to keep you regular and ensure your stools are soft.
3. Kegels – Start to gently contract your pelvic floor muscles, squeeze and release gently, imagining you are pulling up through a straw or holding back gas or stopping the flow of urine. Aim for 2-3 sets at time of 10 repetitions. Activating your pelvic floor muscles starts to “wake up” the support surrounding the organs, start with gentle contractions and slowly work your strength up. If you are not sure if you are doing your pelvic floor contraction correctly we strongly suggest partnering with a pelvic floor PT.
4. Avoid all high-impact exercises till you are symptom free. We do not recommend getting into running, HIIT workouts, any repetitive jumping right off the bat especially if you are having to push any tissue bulging outward back up and in. Low impact exercise is great to help heal and strengthen the support surrounding the prolapse. Strengthening is not contraindicated and it’s actually indicated for prolapse but you must go about it the correct way. Here is where partnering with a pelvic physical therapist can help you navigate the right exercises targeted for your body to keep you symptom free.
5. Minimize extra loading pressure on your body especially in the first 4-6 weeks postpartum. Try to avoid standing holding your baby for long periods of time, instead see if you can sit or lay down at times. This will decrease the amount of downward pressure going down onto the prolapse.
Make sure you are lifting properly and trying to “blow before you go”, so if you are going to lift the baby out of the crib, before you go to lift, take a deep breathe in and exhale as you lift the baby up. This can be applied to lifting the laundry basket or sitting up from a chair when holding your baby. This breathing technique alleviates some of the pressure that can be pushing downward onto the pelvic organs.
We see organ prolapse here all the time at Legacy Physical Therapy and it is something we treat commonly. If you are experiencing any of these symptoms and would like to talk to a pelvic floor physical therapist, we are here to help!