Pelvic Organ Prolapse
Let’s talk about pelvic organ prolapse. You might call it a heavy feeling, or a bulge, or say it feels like there’s a “golf ball in your vagina.” You might feel something when you wipe, or you might think stuff is going to fall out. I’ve had more than one woman tell me her vagina is falling out. Oofda.
Well what’s going on? First of all, don’t worry: your organs ARE NOT falling out. I always say I can fix a prolapse 50% in one visit by just telling my patients that fact. Did I change where their organs are sitting in their body? Nope. But I affected their perception, gave some peace of mind.
Prolapse occurs when one or more of the pelvic organs (bladder, rectum, or uterus) drop lower in the pelvic cavity due to a decrease in support. All of these organs are “suspended” inside the pelvic cavity by ligaments around the uterus. From below, they are supported by the pelvic floor, like a hammock. During pregnancy, these ligaments obviously stretch A LOT. In the most perfect vaginal delivery, the pelvic floor also stretches A LOT. Even with a cesarean birth, the the ligaments still stretch, so it doesn’t necessarily prevent prolapse.
As I said before, it often feels like a heaviness or bulge in the vagina. Many women feel this immediately postpartum, then it gets better over the first several weeks. Some women notice it all the time, while others don’t notice it at all. Some feel it more after a workout or a long walk. Sometimes it goes away completely when they lie down. Sometimes it interferes with sex, causes urinary leakage, or causes constipation.
The good thing about prolapse? It’s not going to harm you. As professionals in this area, we care more about how much it BOTHERS you than how severe the prolapse looks objectively. Which is why I can fix one 50% in one visit ;). It’s all about perception. No good doctor should recommend surgery if you aren’t complaining about how it feels.
How is it treated? Start with physical therapy. We can’t necessarily tighten ligaments from above, but we can sure work on strengthening the pelvic floor to improve support, provide manual techniques to optimize organ position, and teach you strategies to minimize discomfort. And we can keep reminding you that nothing’s going to fall out.
Let’s talk more about the physics of prolapse.
Prolapse symptoms are driven by pressure and gravity. It’s no surprise that gravity affects our bodies (hello boobs!), but we don’t always think about how it affects us INTERNALLY. Most women will say their prolapse feels worse at the end of the day, or after activity, and best in the morning, right when they wake up. Here are some reasons why:
First up: pressure. Pressure follows the path of least resistance. When we increase the pressure in our abdominal and pelvic cavity (typically referred to as intra-abdominal pressure), like with a cough or sneeze, the pressure moves downward. It’s important to squeeze the pelvic floor before you sneeze or cough to counter this. This also comes into play with heavy lifting—whether it’s heavy weights or a 40# kid. Remember to engage your pelvic floor and abdominal wall before you lift.
Another place to be aware of and avoid excessive intra-abdominal pressure is on the toilet. When you’re on the pot, RELAX and let your body do its thing. Avoid bearing down with bowel movements—whatever pressure you use to get the stool out is affecting your pelvic organs too. The big hold-your-breath-and-push move that makes your veins pop out and yes, is effective in pushing out stool (or a baby!) is called the valsalva maneuver. While yes, it can be effective, it also puts way too much pressure on the pelvic floor (and other parts, too) to be done frequently. There will be a full post on pooping, so keep an eye out. Trust me, it deserves its own page.
Second factor: gravity. Imagine a rubber band with a penny tied to it. At first it won’t stretch much, but over time the band will keep stretching till it doesn’t have much bounce back. It loses its elasticity. This is called “creep.” Yep, real scientific term. Long, low loads on an elastic structure lead to lengthening. Remember, our organs are suspended by ligaments, which have elasticity. By the end of a day, creep has crept in and our organs are literally sitting lower than they were when we bounced out of bed.
How do we counter this effect? Counter gravity. Make space in your day to get horizontal. Even better? Get anti-gravity with these postures:
-Legs up the wall: Lie with your bum against the wall, and extend your legs up. Bonus: add a pillow or yoga block under your bum. You can also just rest your legs on the couch if that’s more comfy.
-Supported bridge: Lie on your back with your knees bent. Push through your heels to lift your bum, and place a yoga block (any height) or pillow under your sacrum, or the base of your spine. Make sure it’s comfortable!
Rest in either position for 2-5 minutes, or longer. Arms can be by your side, on your belly to focus on your breath, or in a cactus shape to open your chest. Do this mid-day, after a walk, or when you’re feeling heavy down there.
What’s your favorite anti-gravity posture? Have you felt these symptoms? What did you do for it? Share in the comments!