Prolapse Post Pregnancy
Prolapse following child birth
What causes it?
Prolapse has been shown to occur in up to 75% of Australian women at some point in their lifespan.
Vaginal delivery is a key predictor for a woman having a prolapse. Certain interventions and situations that can happen during a birth increase a birthing mothers’ chance of having a prolapse; forceps or vacuum assist, extended pushing phase of over 2 hours, large baby, chronic constipation, or multiple births.
The 3 pelvic organs of the bladder, uterus and bowel all sit suspended in the bowl of the pelvis. They are held in place with the support of ligaments, fascia and the muscle tissue (the pelvic floor).
During child birth the muscles of the pelvic floor are stretched between 1.5 to 3 times their normal length, to allow baby’s head and shoulders to move through the vagina. This extreme stretching can cause tearing and trauma to the pelvic floor muscles. It means that there may not be as much muscle support helping to support the above organs as well as less strength on contraction post birth. The ligaments and facia of the pelvic cavity are also stretched significantly during birth, in the majority of births these tissues are able to recover to fairly normal lengths in the months following birth. However in some cases these can also become torn or stretched during the delivery process. Our pelvic system is very resilient for what it has to be able to accomplish, however when either or both of the above systems have been injured, it results in less support for the pelvic organs and hence one or multiple organs may sit lower within your vagina.... resulting in a prolapse.
What does it feel like?
Women can identify a prolapse through a number of different symptoms; some feel a lump or bulge sitting in their vaginal opening, some feel a “dragging” sensation, some get an aching (almost like a deep period ache” around the clitoral and front wall of vagina, some feel like “everything is falling out” and a sense they have to try and hold it in. Some women may feel a bulge only when they need to empty their bowels. Some women may only notice it when they go to wipe and they feel a bulge.
What can I do about it?
The female body is an amazing thing and often symptoms will improve in the months following birth as hormone levels return closer to normal, as well as tissue getting a chance to repair and heal. Unfortunately larger tears to the pelvic floor muscle and the fascia are unlikely to repair, other muscles can be strengthening to pick up some of the load and improve symptoms of prolapse.
Hence this is where pelvic floor physio plays an important role. Most women when discharged from hospital are not given the opportunity to see a pelvic floor physio and be taught the correct way to contract their pelvic floor and manage any bladder or bowel concerns post birth.
The pelvic floor can be tricky sometimes for people to get a good effective contraction (even without being sore from childbirth). This is a muscle group that sits 4cm up your vaginal passage. You cant see it, and it can be tricky to feel internally yourself. Hence, a pelvic floor physio is trained to test these muscles and the fascia/ligament support structures for injury, then assess their function and how well you are able to contract them, provide coaching so you can get the best technique started for you, and then ensure you have a structured strengthening program. We are also trained to provide guidance and offer other modalities that help treat and manage prolapse without surgical intervention, with the aim to get you back feeling more like your normal, able to enjoy looking after your new baby and returning to the activities you want to get back to.