Prolapse after childbirth is a topic few women hear about until it happens to them.
Symptoms of prolapse can be so minor or even non-existent.
You may not be aware of it for some time, which can increase the chances of it becoming more pronounced.
Many women believe vaginal birth alone is the sole cause of prolapse, yet women who have c-sections may also experience prolapse after childbirth.
Pregnancy itself, as well as certain interventions during childbirth can affect the stability of the pelvic floor muscles, and the ligaments supporting the pelvic organs.
Most women will experience some form of prolapse after pregnancy and childbirth, and approximately one in five will require medical assistance.
What Is A Prolapse After Childbirth?
A prolapse is the term used when the pelvic organs (uterus, bladder, bowel) are no longer being held in place in the correct position. Tissues called fascia and ligaments, as well as pelvic floor muscles, hold your pelvic organs in place. If these tissues are stretched or even torn, your pelvic organs can bulge or sag. This is known as pelvic organ prolapse.
There are a few different types of prolapse after birth:
- Uterine prolapse, involving the prolapse of the cervix and uterus down toward or into the vagina
- Bladder prolapse, also called cystocoele, which involves the prolapse of the bladder into the front wall of the vagina
- Bowel prolapse, involving the prolapse of the bowel into the back wall of the vagina.
- Bulging of small bowels, called an enterocele, occurs when a space between the vagina and rectum opens and the small bowel bulges through.
Each type of prolapse can happen alone or in combination with each other.
Pelvic organ prolapse is described in stages, indicating how severe the prolapse is:
- Stage 0 – there is no prolapse. The pelvic organs are perfectly supported by the ligaments in the pelvis.
- Stage 1 – there is virtually no prolapse. The pelvic organs are very well supported by the ligaments in the pelvis.
- Stage 2 – there is some prolapse. The pelvic organs are not as well supported by the ligaments and have begun to fall down. In Stage 2 prolapse, the organs are still inside the vagina.
- Stage 3 – the pelvic organs are beginning to bulge to or beyond the opening of the vagina.
- Stage 4 – the pelvic organs are completely outside of the vagina
What Are The Symptoms Of Prolapse?
Depending on the type and severity of prolapse, the symptoms may differ. If the prolapse is mild, you may not be aware of it until you have a vaginal examination or routine pap smear.
- A low back ache/pain or increased pelvic pressure that interferes with your daily activities
- Irregular vaginal spotting or bleeding
- Frequent urinary incontinence (urine leaking), urinary tract infections, problems with urinating, increased urination
- A bulge or lump that can be felt/seen outside the vagina
- Painful or difficult sex
- A heavy dragging sensation in the vagina
- Difficult or changed bowel movements, such as constipation, liquid stools or feeling bowel movements are incomplete.
Signs of a prolapse may be worse at the end of the day, especially if you are on your feet a lot. You may feel some relief after lying down.
What Increases The Risk of Prolapse?
#1: Weak Pelvic Floor
We all know we should do our pelvic floor muscle exercises regularly, in order to prevent problems such as incontinence later on in life. But not doing them can also increase the chance of your pelvic floor muscles becoming weak during and after pregnancy.
During pregnancy, your body produces a hormone called relaxin. This hormone softens the ligaments in the body and the fascia in the pelvic floor. The increased weight of your growing baby further weakens the pelvic floor muscles.
This means your pelvic floor is less able to support your organs, and there is an increase in pressure on the ligaments and fascia. These can stretch and prolapse can occur. While there isn’t much you can do about the amount of relaxin your body produces, a strong pelvic floor before pregnancy can increase the support for your organs and reduce the chance of prolapse.
#2: Vaginal Birth – Especially A Medically Assisted Birth
During birth, the muscles and ligaments in your pelvis and vagina stretch to accommodate your baby. After your baby is born, it’s normal for those muscles to feel weak and stretched. Doing pelvic floor exercises to strengthen and tone the muscles after birth reduce the chances the muscles will remain weak and saggy.
A long pushing stage during labour (greater than two hours), a large baby (more than 4kgs) or an instrumental birth (forceps/vacuum assisted) tend increase the risk of a prolapse after birth.
Read here for more information about vaginal birth and the pelvic floor.
#3: Family History
If your mother or grandmother experienced prolapse after birth, chances are you are more likely to as well. There seems to be a genetic disposition to having ‘softer’ connective tissue which are more likely to stretch during pregnancy and birth.
While you can’t change the way your body is made, having the information ahead of time is useful as a preventative. Ensure your pelvic floor muscles are strengthened before pregnancy and after birth to avoid or reduce the severity of prolapse.
#4: Too Much Too Soon After Birth
In today’s society, women are expected to be on their feet and back into normal life pretty quickly after birth. New mothers can be sent home from hospital within 48 hours of giving birth. Resting your body after birth has a whole host of benefits and an important one is avoiding putting pressure on your pelvic floor too quickly.
After nine months of pregnancy and birth, your body needs to heal and recover. Walking and being on your feet too much means your pelvic floor has the pressure of your organs bearing down while they are weak and tired. Even simple chores like doing all the housework in one day or pushing a heavy shopping trolley for a few hours can be too much in the early recovery period.
During the postpartum period (the first 6 weeks after birth), you should stay off your feet as much as possible to allow your body to recuperate, while strengthening your pelvic floor. In many cultures, women who have given birth take the first 6 weeks to rest and heal following the birth of their baby .
#5: Putting Pressure On The Pelvic Floor
One of the most common problems to occur after birth is constipation which increases the chances of prolapse. Straining to empty your bladder or bowels on a regular basis can increase the strain on your weakened pelvic floor muscles. Pushing to empty your bowel also causes more strain downwards on your pelvic floor. Over time this consistent straining and pressure can cause a prolapse.
Other forms of increased pressure on the pelvic floor might occur from heaving lifting. It is advised that you don’t lift anything heavier than your baby during the post partum period. If your pelvic floor muscles were weak before pregnancy or affected during birth, it is a good idea to avoid heavy lifting at any time after birth or until you have the all clear from your care provider.
#6: Over Exercising
There’s no denying the social pressure on women to regain their pre-baby body as quickly as possible after birth. You may feel energetic and ready to start exercising, but the chances are your internal structure is still healing. While fitness and wellbeing are important parts of our health, increasing exercise suddenly after birth can have detrimental affects.
Relaxin, the hormone responsible for loosening your ligaments for birth, can stay in your body for up to 5 months after your baby is born. This means there is less support from ligaments and fascia for your pelvic organs. It’s not recommended women undertake high impact exercises such as jumping, jogging or bouncing activities, too soon after birth to avoid damaging their joints and potential prolapse.
Being aware of the potential for prolapse is important to help you prepare for pregnancy and birth, ensuring your body has the best chance of recovery afterwards.
Treatment For Prolapse
Pelvic floor exercises are an essential part of preparing for birth and beyond, and don’t need to intrude on your daily routine. If you aren’t sure how to do pelvic floor exercises, see a women’s health physiotherapist for advice.
If you suspect you have a prolapse, see your doctor as soon as possible for confirmation. The earlier your prolapse is detected, the sooner you can begin pelvic floor recovery and avoid further problems.