Understanding and Managing Prolapse After Birth: A Comprehensive Guide

Today I want to get into a bit more depth about managing postpartum prolapse, how prolapse impacts your pelvic floor health, how to properly diagnose prolapse after giving birth, and how YOU can manage the symptoms of prolapse and get back to living your best life.

Prolapse is something I often see in postpartum Mothers, specifically pelvic organ prolapse. This can occur as a result of childbirth and is also referred to as postpartum prolapse. As you read this you may be thinking, ‘great not only is my body recovering from giving birth, my mind wrapping around the stresses of being a new parent, but now I have to worry about postpartum prolapse!!!’ While this is a common condition that is thought to be experienced by approximately 50% of all postpartum mothers, it is manageable and is not something you have to live with.

What is Postpartum Prolapse?

So at this point you may be wondering, what is pelvic organ prolapse, what causes it, and how can I tell if I have prolapse after giving birth?

Simply put, prolapse is when one or more of your pelvic organs slip out of place. Generally, either the anterior or posterior wall of the vagina starts to descend down and out of the vaginal canal. It only takes a small amount of movement inside your body to cause symptoms. Symptoms range, but most often present with a large bulge or protrusion coming from the vaginal opening. Some postpartum Mothers report a feeling of slight pressure or heaviness; often described as feeling like a tampon is falling out, sitting on a golf ball, and/or the inability to completely evacuate your bowels. However, some women who can see a bulge or protrusion also report not feeling bothered by it.

A few of the most common causes and risk factors specific to postpartum prolapse include:

  • baby size
  • individual anatomy of the pelvic floor
  • connective tissue integrity
  • age

Types of Postpartum Prolapse

There are seven types of prolapse, each based on which organ slips out of place into the vagina:

  • Cystocele – Prolapse of the bladder
  • Urethrocele – Prolapse of the urethra
  • Cystourethrocele – Prolapse of the bladder and the urethra
  • Enterocele – Prolapse of the small intestine
  • Rectocele – Prolapse of the rectum
  • Uterine prolapse – Prolapse of the uterus, also known as apical prolapse

The most common types of postpartum prolapse are cystocele, rectocele, and uterine. The mechanism for each type of prolapse is different and as a result each type is treated in a slightly different way. For example, a cystocele prolapse is dependent on various factors such as a levator muscle tear, levator hiatus size, and connective tissue integrity. A cystocele prolapse can be helped by pelvic muscle exercises. In contrast, a rectocele is primarily affected by straining of the pelvic floor muscles when bearing down (such as straining during a bowel movement or constipation) and is most effectively treated through lifestyle modifications.

Stages of Postpartum Prolapse

Pelvic organ prolapse can be broken into four stages based on the amount of descent:

Image used with permission from Pelvic Guru®, LLC as a member of the Global Pelvic Health Alliance Membership (GPHAM)
  • Stage 1 = Prolapse is INSIDE the vagina, most descent is more then 1 cm above hymen (above -1)
  • Stage 2 = Prolapse at the entrance of vagina, most descent is within 1cm of the hymen (from -1 to +1)
  • Stage 3 = Prolapse is OUTSIDE the vagina, most descent is beyond 1 cm outside hymen (>+1)
  • Stage 4 = Full Organ Eversion. Complete eversion of the total length of associated wall

Stages one and two have a high chance to be improved with pelvic floor physical therapy alone. Stage three will need a pessary combined with pelvic floor physical therapy, while stage four will require a pessary or surgery followed by pelvic floor physical therapy correct.

It is very important to maintain your pelvic floor health post-birth. The earlier you identify a prolapse the better your chance of correcting it through pelvic floor physical therapy alone. In addition to prolapse, pelvic floor therapy also helps treat other postpartum symptoms such as urinary incontinence, diastasis recti, endometriosis, and other pelvic pain.

To learn more about how Optimize Pelvic Health can help you with Postpartum Prolapse click here.

How Does Prolapse Impact Your Pelvic Floor Health?

Here, I would like to go over how a prolapse will impact your overall pelvic floor health. First, we will go over the anatomy of the pelvic floor, then we will explore how childbirth effects the pelvic floor muscles, and finally we will explain how to manage postpartum prolapse after birth.

Anatomy of the Pelvic Floor

The pelvic floor muscles are attached from the pubic bone in the front and attaches to the tailbone in the back. These muscles form a hammock-like support for your pelvic organs. However, within the deeper layer, there is a hole called the levator hiatus. This hole is where the urethra, and vaginal canal are. When there is compromised ligament support, pelvic floor muscle laxity, and/or a widen levator hiatus, there is increase chance of a pelvic organ prolapse.

How Childbirth Effects the Pelvic Floor Muscles

Levator hiatus is a factor in prolapse after birth

During vaginal child birth, the baby goes through the levator hiatus, the “hole” in the deep pelvic floor muscle layer. The bladder sits above this hole. When the muscle is stretch, as in postpartum, the bladder and uterus can descend.

Baby going to vaginal canal contributing to prolapse after birth.

The Link Between Prolapse and Pelvic Floor Dysfunction

Depending on the prolapse stage, it will limit pelvic floor muscle function. In a stage 3 or greater prolapse, the organ has descended beyond the pelvic floor muscles. These are the stages that you can visibility see the prolapse. The organ is in a position which limited pelvic floor muscle contraction.

In any of these stages, pelvic floor muscle guarding occurs as a protective response. The tightness can contributing to pelvic pain, urinary leakage and possibly a greater prolapse.

Diagnosing Prolapse After Birth

So… at this point you’re probably saying: All of this information is great, but how in the world do I know if I have a prolapse, especially if its still in the early stages?

First and most important is getting a comprehensive physical exam and medical assessment. After giving birth make sure to prioritize your own health as well. This means scheduling, and attending, all of your medical appointments. If not already done schedule a postpartum medical assessment that includes a pelvic organ prolapse measurement. There are two main measurements to diagnose if you have a postpartum prolapse.

Vaginal measure for postpartum prolapse
  1. POP-Q measurement: This is performed to measure the descent of the pelvic organs. Using a POP-Q measuring stick, your provider will measure multiple points, to include the furthest point of the prolapse into the vaginal canal. This will determine the stage of prolapse severity
  2. Gh+PB measurement: This is directly correlated to levator hiatus size. Using a popsicle stick, your provider will measure the distance between the urethra and anus. This measurement is performed while bearing down.
Measuring GH+PB for postpartum prolapse.

When used in tandem these two measurements give a prognosis for return to fitness, work, activities and possibly the need for a pessary.

At Optimize Pelvic Health our Doctors are trained to perform these measurements, and utilize their results to guide treatments and provide a prognosis. For more information about our services at Optimize Pelvic Health and how we can help you with Postpartum Pelvic Organ Prolapse click here

Managing Prolapse After Birth

Non-Surgical Treatment Options

  • Pelvic Floor Physical Therapy – During physical therapy we address the prolapse specifically. However, many PT clinics commonly overlook how your stress nervous system impacts the feeling of prolapse, and stage of prolapse. Through our clinical experience we see an improvement in the stage of prolapse after providing hands on treatment focused on balancing the stress and relaxation nervous system. Our patients also report a significant improvement in symptoms after these treatments. Pelvic floor muscle contraction with the cue “squeeze the anus” has been shown to improve pelvic floor muscle strength.
  • Pessary – It’s a device that is fitted and placed into your vagina to support the uterus, bladder or other organs. It is a common misconception that you cannot wear a pessary and have pelvic floor physical therapy. Actually you can wear a pessary and perform pelvic floor physical therapy. In fact these two can be complimentary and when done in tandem will maximize results. A reduction in prolapse stage can occur with a combination of pessary and pelvic floor physical therapy.

At Optimize Pelvic Health, we believe the foundation for pelvic health is the stress nervous system.

  • We assess and provide hands on strategies to balance the stress nervous system.
  • We assess your pelvis in various positions and activities to see how each position impacts your prolapse.
  • We provide pelvic floor muscle training to improve the strength of the muscles.

As a result of these methods our patients generally see significant improvement in their symptoms in a much shorter time frame. To schedule an appointment with one of our pelvic floor Doctors click here

Surgical Treatment Options

There are different surgery options depending what ligament structure needs support. Surgical options are to be discussed with your doctor.

Please share this blog with someone you know experiencing prolapse after birth.

At Optimize Pelvic Health our pelvic floor physical therapists have advanced training to how to help those with prolapse. Our doctors of physical therapy will guide to through your recovery from pelvic floor exercises, discussing a pessary and provide a pessary fitting, if needed.

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