When you give birth you are expecting a baby to come out, and then the placenta. Not many moms are expecting their bladder or uterus to come out – most don't even know this is possible.
Pregnancy and childbirth are risk factors for a condition known as pelvic organ prolapse. Studies show that 50 per cent of women who have given birth one or more times will have some degree of prolapse but it is likely even higher given the low reporting rate and lack of awareness. In simple terms a prolapse is the progressive descent of the internal organs (the bladder, the uterus or the rectum) into and eventually out of the vagina.
It occurs in stages, with the first and second stages often being asymptomatic, so many women don't even know they have a problem until it progresses to stage 3, when the organ is at the vaginal opening and may even bulge out periodically on exertion, or stage 4, when the organ is bulging right out of the vaginal opening.
Early stage prolapse is sometimes reversible and is very manageable. But once the prolapse progresses to stage 3 or 4, it becomes life altering and may require surgery – surgery that can in turn cause other challenges and potentially lead to more operations. Prevention and early detection are key when it comes to pelvic organ prolapse.
Here are some possible symptoms to look for:
- low back pain
- a feeling of heaviness in the lower abdomen
- discomfort with sex
- difficulty starting the flow of urine
- difficulty emptying the bladder
- inability to completely empty the rectum.
As the descent of the organs continues, symptoms may progress to:
- feeling like you are sitting on a golf ball
- feeling like something is falling out
- heaviness that gets worse as the day progresses
- tampons getting pushed out
- difficulty inserting a tampon.
The best thing a woman can do to prevent prolapse (and any pelvic floor dysfunction for that matter) is to see a pelvic floor physiotherapist, ideally prior to conception, then during pregnancy, then at six weeks postpartum and then annually. Visit www.pelviennewellness.com for a list of pelvic floor physiotherapists across Canada. They assess the pelvic floor muscles for function and the internal organs to see if they are where they should be.
If a prolapse is found, a number of lifestyle management options would be presented.
Stand, sit and move with a neutral pelvis
If your posture is such that your pelvis is not aligned with your breathing diaphragm, then you will be given tips on how to stand, move and sit properly which in turn will make the pelvic floor exercises more effective. Most baby carriers encourage poor posture, so ensure your physiotherapist shows you the proper form while you are holding and carrying your baby as well.
Avoid heavy lifting
Heavy lifting causes an increase in intra-abdominal pressure and if your core (pelvic floor) can't manage that pressure, then your organs will continue to move down and eventually out. Generally anything over 15 pounds may be too strenuous for some, and most moms are "heavy lifting" many times a day. Work with your pelvic floor physiotherapist to develop strategies for proper core activation to make lifting safer.
Explore a pessary
A pessary is a device inserted high into the vagina that supports the its walls and the organs. There are many different sizes and shapes, and it may take a few tries to find the right one, but once you do, it can allow the muscles to function better and provide relief from the discomfort of prolapse.
Crunches are the standard "go to" exercise for losing the mummy tummy but they increase intra-abdominal pressure pushing the abdomen outward and the pelvic organs downward. With each crunch, the bulging bladder or uterus is pushed further south.
Having a prolapse does not mean all exercise should be halted, it just needs to be modified. Some great options for prolapse-friendly exercise are:
The hypopresive method
A series of hypopresive postures (meaning "without pressure") done with rhythmic breathing and apneas (pauses in breathing) that improve resting tone in the abdomen and pelvic floor and may even reverse early stage prolapse. Visit www.metodohipopresivo.com.
The buoyancy from water is a welcome relief from the downward draw of being upright against gravity all day. The water also provides resistance, making it a great way to train your muscles without the heavy lifting.
Yoga in general is thought of as gentle but there are some styles that may be too strenuous for unsupported organs. Opt for yin yoga, restorative yoga or gentle hatha when living with prolapse.
Kim Vopni is known as the Fitness Doula and is an authority on helping women get through birth in one piece. Based in Vancouver, she is a certified pre/postnatal fitness consultant, co-founder of Bellies Inc and owner of Pelvienne Wellness Inc offering innovative products for a better birth and recovery. You can follow her on Twitter at @FitnessDoula