Understanding and Managing Prolapse After Birth

Feeling heaviness or a bulge after giving birth? This is how we treat postpartum prolapse without surgery. Up to 50% of moms experience postpartum prolapse, when the pelvic organs shift due to weakened muscles and ligament. The good news? You don’t have to live with it and most cases don’t require surgery. At Optimize Pelvic Health, we specialize in pelvic floor physical therapy to relieve pressure, restores support and help you feel like yourself again, without invasive treatment.

Why Does Postpartum Prolapse Occur After Birth?

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

Common Types of Prolapse After Childbirth

There are six 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. Therefore, a cystocele prolapse can be helped by pelvic muscle exercises. However, 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.

How Severe Is It? Understanding the 4 Stages of Postpartum Prolapse

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

• 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. Meanwhile, stage three will need a pessary combined with pelvic floor physical therapy. A pessary or surgery will most likely be required for stage four followed by pelvic floor physical therapy correct.

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

Worried about postpartum prolapse? Click here to schedule your personalize pelvic floor assessment.

What Prolapse Means for Your Pelvic Floor After Birth

Prolapse isn’t about just the organs, it affects how your muscles work, how much pressure you feel and how confident you feel in your body. Let’s break down what is happening and how therapy helps.

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

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.

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. As a result, 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.

How Do I Know If I Have Prolapse? A Thorough Assessment

So… you might be wondering: All of this information is helpful, but how do I know if I have a postpartum prolapse, especially if in the early stages?

Great question. The first step is getting a comprehensive physical exam and medical assessment. After giving birth, it is just as important to prioritize your own health as it is to care for your baby. Therefore, it is important to attend all your postpartum appointments, especially ones that screens for postpartum prolapse.

To assess for prolapse, your provider will use two main measurements to diagnose if you have a 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.

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

How to Treat Postpartum Prolapse Without Surgery

• 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. As a result, 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. We go beyond pelvic floor training by identifying the muscles that support your body. We assess the glutes, inner thighs and abs during an internal assessment, to determine their impact on your prolapse and create a tailored plan for better support and function.
• Pessary – A pessary is 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. In addition to internal support, we provide 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 and a whole body approach.

• 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.
• We identify the specific muscles in your body that impact your pelvic floor and prolapse.

<<Read more about our whole body approach here.>>

As a result of our 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 specialists click here.

Even though prolapse sounds scary, it is common and treatable.

Surgical Treatment Options

Meanwhile, there are different surgery options depending what ligament structure needs support. Your doctor will discuss different surgical options.

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.

More Reading You May Find Helpful

• Postpartum Recovery Tips
• Can Running Cause Prolapse?
• What is Pelvic Floor PT?
• Learn About Optimize Pelvic Health