Pelvic Organ Prolapse After Birth

Pregnancy and birth is a wild, transformative experience.  Sometimes it transforms your body in totally unexpected ways. These changes aren’t always discussed or are public knowledge, which can leave postpartum people with uncomfortable, sometimes debilitating symptoms for years. Many pains and problems that happen in the postpartum period are because of the pelvic floor.

What is The Pelvic Floor?

The pelvic floor is an intricate network of muscles, fourteen of them to be exact. These fourteen muscles, along with fascia, a form of connective tissue, work together to create a giant hammock that supports the vagina, bladder, and other internal organs. 

What is Pelvic Organ Prolapse?

A prolapse is when an organ descends and moves from its normal place in the body, causing discomfort and pain. When this happens with the pelvic organs, one or more of the organs in the pelvis slips down from their normal position and begin to bulge in the vagina. For people who experience prolapse after giving birth, their risk is increased if they have had multiple babies, or went through a long and difficult labor. People can develop a prolapse whether they’ve had a vaginal birth or cesarean section. Especially if they labored before an unplanned c-section. 

Symptoms of Pelvic Floor Prolapse

Pelvic floor prolapse may sound scary and almost alien-like, but they aren’t life-threatening. Just because it’s not life-threatening doesn’t mean it’s fun! Pelvic organ prolapse can cause pain and discomfort, along with a whole bunch of other symptoms.

Here are some of the most common ones to look out for:

• A dragging sensation in the vagina.
• Discomfort during sex.
• Numbness during sex.
• Incontinence or other issues with urination.
• A visual lump or bulge coming out of your vagina
• Feeling like something is coming down into your vagina. This sometimes feels like a ball. 
• Heaviness around your genitals or lower abdominal area.
• Lower back pain.
• No symptoms.

You heard that right. Sometimes pelvic organ prolapse doesn’t cause any symptoms at all! That being said, if you’re experiencing any of these symptoms, it’s time to give your healthcare provider a call. 

How is a Pelvic Organ Prolapse Diagnosed?

You may need to be referred to a specialist, but first, you’ll want to see your general OB/GYN. Here’s what to expect when at your OB/GYN appointment:

• An internal pelvic floor exam, where your provider feels for lumps inside the vagina and in the pelvic area.
• Use of a speculum to get a clearer view inside your vaginal wall.
• They might ask you to bear down and tighten your pelvic muscles to assess the extent of the prolapse and the strength of your pelvic floor muscles. 
• A urine test to check for infections if you’re having difficulty with peeing.
• Diagnostic imaging like ultrasounds and a pelvic MRI scan.
• If there is bladder pain, you may need a cystoscopy, this allows your provider to look into your bladder.

If you’re not experiencing any symptoms, you might not know you have a pelvic organ prolapse until a routine gynecological exam. Your provider may discover when they’re checking your cervix. 

How to Treat Pelvic Organ Prolapse

Pelvic organ prolapse is usually rated on a scale of one to four, with four being the most severe.  The extent and type of prolapse help to determine what kind of treatment is needed.

Another factor healthcare providers take into account is your comfort. People with a mild prolapse with minimal or no symptoms may not need treatment or only need maintenance exercises. The first step in treating pelvic organ prolapse is making any necessary lifestyle changes. This may include:

• Weight loss if you are overweight. This is because excess weight puts strain on the pelvic floor.
• Preventing and treating constipation. This may include dietary changes, and looking at any medications that may cause constipation.
• Avoid lifting heavy weights and objects.
• Practicing pelvic floor exercises, like Kegels.

The next phase of treatment would include seeing a specialist who can give you a more in-depth treatment plan. Your go-to specialist for pelvic organ prolapse is a pelvic floor physical therapist. That’s right, there are PTs dedicated to helping people overcome issues with the incredible pelvic floor. They can help diagnose you further, and walk you through exercises and a treatment plan. 

Other ways pelvic organ prolapse is treated is by using:

• Vaginal pessaries: This is a soft, removable device that goes in the vagina to support the organs and surrounding areas affected by the prolapse.
• Surgery: Surgery may be necessary for severe cases of prolapse.
• Hormone treatment: If the organ prolapse is due to a hormone imbalance, hormone replacement therapy may help treat it.

What Else Can Cause Pelvic Organ Prolapse?

It’s not just pregnancy and birth that can lead to pelvic organ prolapse.  Here are some other causes of pelvic organ prolapse:

• Undergoing a hysterectomy 
• Carrying excess weight 
• A condition that causes you to cough a lot
• Smoking cigarettes
• A labor-intensive job, especially one that involves heavy lifting
• Menopause
• Long term constipation

Reproductive health issues are no joke. You deserve the treatment and support you and your pelvic floor need in order to feel good and thrive!