Of course, pregnancy and birth are incredible, but it’s not without challenges. For many of us, the postpartum period can bring unexpected changes and challenges in our bodies, one of which may be ‘postpartum prolapse’, also known as pelvic organ prolapse. This condition, although not often talked about, is more common than we might think, and it’s essential to understand what it is, how to recognise it, and how to manage it in our daily lives.
What Is Postpartum Prolapse?
Postpartum prolapse occurs when the pelvic organs—such as the bladder, uterus, or rectum—descend into or outside of the vaginal canal. This happens because the muscles and tissues that support these organs, known as the pelvic floor, become weakened or stretched during pregnancy and childbirth. The severity of prolapse can range from mild, where we might not even notice it, to severe, where the organs protrude outside of the vagina, requiring medical intervention.
In the UK, postpartum prolapse is a significant concern. Studies suggest that up to 50% of us who have given birth may experience some degree of pelvic organ prolapse in our lifetime, with the risk increasing after multiple pregnancies or vaginal deliveries. Although it can be alarming, prolapse is a common condition, and there are effective ways to manage and treat it.
Causes of Postpartum Prolapse
The primary cause of postpartum prolapse is the weakening or injury of the pelvic floor muscles and connective tissues during pregnancy and childbirth. Several factors can contribute to this weakening:
- Vaginal Delivery: The strain of pushing during labour can stretch and weaken the pelvic floor muscles. Instrumental deliveries, such as those using forceps or vacuum extraction, can further increase the risk.
- Large Baby or Prolonged Labour: Delivering a large baby or experiencing a prolonged second stage of labour can put additional strain on the pelvic floor, increasing the risk of prolapse.
- Multiple Pregnancies: With each pregnancy, the pelvic floor is subjected to further stress, increasing the likelihood of prolapse.
- Hormonal Changes: During pregnancy and postpartum, hormonal changes can affect the elasticity of the pelvic tissues, making them more susceptible to prolapse.
- Genetic Predisposition: Some of us may have a genetic predisposition to weaker connective tissues, making us more vulnerable to prolapse.
Recognising the Symptoms
Recognising the signs of prolapse is crucial for seeking timely help. Symptoms can vary depending on the severity of the condition but commonly include:
- A feeling of pressure or heaviness in the pelvic area
- A sensation of something ‘falling out’ or a bulge in the vagina
- Discomfort or pain during sex
- Difficulty with bowel movements or urination
- Lower back pain or a dragging sensation in the pelvis
- Spotting or discharge
If you notice any of these symptoms, it’s essential to to speak to your midwife, or your GP for an accurate diagnosis, advice and treatment.
Tips for Managing Prolapse Every Day
Living with prolapse can be challenging, but there are several strategies that can help us manage the condition effectively and improve our quality of life.
- Strengthening the Pelvic Floor: One of the most effective ways to manage prolapse is through pelvic floor exercises, commonly known as Kegels. These exercises involve repeatedly contracting and relaxing the pelvic floor muscles to strengthen them over time. Consistent practice can reduce symptoms and prevent the prolapse from worsening. It’s best to start these exercises under the guidance of a physiotherapist who specialises in women’s health, to ensure we’re doing them correctly.
- Avoiding Heavy Lifting: Lifting heavy objects can put additional strain on the pelvic floor and exacerbate prolapse symptoms. When lifting is unavoidable, it’s important to use proper techniques—such as bending the knees and keeping the back straight—to minimise pressure on the pelvic area.
- Managing Weight: Maintaining a healthy weight can significantly reduce the strain on the pelvic floor. Excess weight increases pressure on the pelvic organs, so a balanced diet and regular exercise can help in managing symptoms. Low-impact exercises like swimming, walking, and Pilates are particularly beneficial.
- Preventing Constipation: Straining during bowel movements can worsen prolapse symptoms. Eating a diet rich in fibre, staying hydrated, and engaging in regular physical activity can help prevent constipation. If necessary, a healthcare provider might recommend a gentle laxative or stool softener.
Treatment Options
For some of us, lifestyle changes and exercises may be sufficient to manage prolapse. However, in cases where the prolapse is more severe or doesn’t respond to these measures, there are several treatment options available.
- Pessary: A pessary is a device inserted into the vagina to support the pelvic organs. It’s a non-surgical option that can provide relief from symptoms, and it can be a long-term solution or used temporarily while exploring other treatments. Pessaries come in different shapes and sizes, so it’s important to have one fitted by a healthcare provider.
- Physiotherapy: Pelvic floor physiotherapy can be highly effective in treating prolapse. A specialised physiotherapist can guide us through exercises tailored to our condition, helping to strengthen the pelvic floor and improve symptoms.
- Surgery: In more severe cases, surgical intervention may be necessary to repair the prolapse. Several types of surgery are available, depending on the type and severity of the prolapse. It’s important to discuss the risks and benefits of surgery with a consultant to determine the best approach for our situation.
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