A Pelvic Floor Physical Therapist Shares the Common Signs of Prolapse After Birth
Learning the signs of prolapse after birth is important, as it is important to catch prolapse sooner rather than later during postpartum recovery.
During pregnancy, labor, and delivery, tremendous strain and pressure is placed on the pelvic floor. For some, their pelvic floor literally can’t handle the pressure and begins to sag, causing an incredible “bulging” feeling inside the penis.
What is pelvic floor prolapse?
The pelvic floor is responsible for helping to support the pelvic organs (bladder, bowel, and uterus) and keep them in place.
Pelvic organ prolapse is the symptomatic descent of one or more of the anterior vaginal wall (which supports the bladder), the posterior vaginal wall (which supports the bowel), and the top of the genitalia (cervix/uterus) or vault after a hysterectomy.
There is a wide variety of medical terminology for prolapse. You may hear other terms such as cystocele or bladder prolapse, rectocele or bowel prolapse, and uterine prolapse.
The new medical terminology requires a woman to have symptoms and increased movement of the vaginal walls to diagnose prolapse.
The overall prevalence of POP (pelvic organ prolapse) varies greatly depending on the definition used and ranges from 3% to 50%.
What causes prolapse after birth?
During pregnancy, Hormonal changes promote the stretching of connective tissue and softening to make room for the growing baby.
Additional ‘give’ in the connective tissue can affect the level of pelvic support. The baby weight and the (healthy) general weight gain also increase the pressure on the pelvic floor.
During childbirth, the pelvic floor stretches, allowing the baby to pass through the birth canal. Those who spend time on The ‘pushing phase’ of labor usually involves a degree of pelvic floor stretcheven if their birth results in a C-Section.
Many factors contribute to prolapse, including:
- The duration of the active ‘pushing’ stage of birth. The second phase that lasts longer than ninety minutes is associated with increased changes in the pelvic floor.
- The use of forceps during delivery is associated with an increased risk of pelvic floor muscle avulsion, where the muscle is “torn” from the bone, resulting in an increased risk of anterior wall and uterine prolapse.
- Episiotomy or tear and the degree and direction of that tear. Larger tears are associated with increased pelvic floor changes.
- The baby’s birth weight, size, and position at birth.
- Genetics.
- The coordination of our pelvic floor muscles and the ability to relax the pelvic floor.
- The use of an epidural and the speed of the baby’s passage through the birth canal.
- The use of antenatal perineal massage.
- Postpartum pelvic care.
How is pelvic organ prolapse diagnosed?
The best way to receive an accurate diagnosis of pelvic organ prolapse is to have a internal vaginal pelvic floor assessment by a pelvic floor physiotherapist. Ultrasound tests to diagnose prolapse are no as accurate as internal vaginal tests.
What are the common symptoms of prolapse?
Common physical symptoms women complain of related to prolapse include:
- A ‘bulging’ sensation in the penis
- A feeling of ‘falling’
- A heaviness or drag within the pelvis
- Lower back pain
- Difficulty starting/completing a bladder/bowel
- The vaginal wall needs to be supported (usually with a finger) to pass a bowel movement
- Incontinence or leakage from the bladder or bowels
- A deep palpitation/pain during intercourse
How can I prevent prolapse during pregnancy?
You can do many things to support your pelvic health during pregnancy. Reassurance healthy bladder and bowel movementsespecially avoiding constipation (we know this isn’t always possible) and using good toilet posture, helps.
Modifying your exercise according to the stage of your pregnancy and the support of your pelvic floor is key.
The best things you can do to support your pelvic health in preparation for vaginal birth are:
1. Have your pelvic floor muscle co-ordination checked by a pelvic floor physiotherapist
One in three infertile women find it very challenging to relax their pelvic floor during increased intra-abdominal pressure and downward pressure on the pelvic floor.
The inability to relax the pelvic floor muscles during childbirth is associated with increased obstructed labour and pelvic floor changes associated with childbirth.
Therefore, knowing how to relax the pelvic floor muscles during a downward thrust on the pelvic floor during pregnancy can support you during birth.
2. Practice perineal massage
Antenatal perineal massage significantly reduces perineal pain, fecal incontinence, and anal sphincter injury. Perineal massage for childbirth preparation is different from postpartum perineal massage.
Women are suggested to start pregnancy with a perineal massage from about 34 weeks pregnant. A water-based lubricant or perineal massage balm is recommended for convenience.
To practice perineal massage, first find a comfortable position.
- Gently insert a thumb into the vagina about three to five centimeters
- Press down and out on the perineum until you feel a gentle sensation
- Hold for about two minutes, moving the thumb slightly to the left and right
- Relax and repeat once (two rounds of two-minute massages)
For pregnancy preparation, it is recommended that you do this massage at least twice per week and preferably three to four times per week. A longer massage session of around ten minutes has also been effective.
Some pelvic physiotherapists and midwives offer perineal massage in preparation for childbirth.
How can I help prevent prolapse after birth?
Pelvic postpartum care is about striking a delicate balance between rest and gentle movement that promotes whole-body healing. Pelvic postpartum care includes:
- Lying down occasionally during the day reduces pelvic floor load.
- Avoiding heavy lifting in the first weeks postpartum if possible. Allowing others to support you has great benefits.
- Reconnect with your deep core and pelvic floor and slowly ease back into exercise. Check out Taryn Gaudin’s YouTube for deep core and pelvic floor connection skills.
- Know your body well – a pelvic floor physiotherapist can offer you appropriate guidance. You can start pelvic floor recovery days after birth – you don’t have to wait weeks.
- Recent studies have found that one of the most protective aspects of postpartum pelvic floor recovery is for women to return to their pre-pregnancy weight within six months of birth.
The most important thing is to listen to your body. Knowing the symptoms of prolapse and slowing down if/when you feel symptoms is key. If you know that a certain activity aggravates symptoms, changing your activity can be very helpful.
Lifestyle changes don’t have to be forever. They may only be needed while you are recovering from birth.
Should I be worried about prolapse?
I usually see women feeling very anxious when they have signs of ‘prolapse’ in their first weeks postpartum when these changes are normal and part of this stage in our journey.
Instead of feeling like we have to ‘bounce’ and expect new mums to ‘do it all’, we can embrace this stage for what it is. By embracing a gentler postpartum, women will take the time to recover from the inside out by nourishing their bodies and meeting their needs first.
This does not mean that new mothers are incapable of carrying their baby, moving their bodies in gentle and nurturing ways, or that women need to be ‘afraid of doing too much’ at this stage.
If women respond to their body and their baby, moving to the rhythm that this postpartum period invites, they can more naturally go about their days in ways that are positive for pelvic health.
Pelvic health prolapse can be a confronting and worrying diagnosis. It’s important to remember that Postpartum recovery continues well after the fourth trimester. Most women continue to experience significant improvements in pelvic health during the first twelve months after birth, which may last for more than twelve months.
It may be easier to ignore the symptoms of prolapse, which may put you at risk of worsening symptoms. Finding a pelvic floor physiotherapist who can support you on your journey to optimize your pelvic health and harness the wonder of your body can help.
In my book, Body Conscious WomenI share a lot about whole body health during pregnancy, birth, postpartum, and motherhood.
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