The truth about prolapse after pregnancy
Even in 2019, we seem to live in a ‘hush hush’ society, where some things are generally not mentioned or are considered ‘embarrassing’ to talk about and consequently many women are suffering in silence. One such subject is prolapse after pregnancy which, according to the US National Institute of Health, as many as one-third of women suffer from pelvic floor disorder after childbirth and menopause.
Photo by CHRISTOPHER MARQUEZ
We may snigger behind our hands at TV adverts talking about those embarrassing ‘oops’ moments; but until you have actually experienced the symptoms of prolapse, you can’t appreciate how distressing this condition can be.
Prolapse is the name used when the organs in your pelvis (uterus, bladder and/or sometimes bowel) drop down into the vagina instead of sitting in their normal position. This causes a heaviness and dragging or aching feeling in the vaginal area, which often gets worse as the day wears on. Some women notice a lower abdominal aching and backache and may even feel a bulge in the vaginal area outside of the vaginal opening. It is often described as ‘feeling like everything is going to fall out.’
Being super fit prior to pregnancy doesn’t make you exempt
New mum Gemma, whose little girl is now seven months old, said: “I was really into fitness before I fell pregnant attending cross fit classes and yoga four or five times a week. I had a reasonably easy pregnancy, although the baby was very big at over nine pounds. My labour was also quite quick and trouble free apart from the last 15 minutes when the baby appeared distressed, so I was given an episiotomy and forceps to get her out quickly.
“Everything appeared fine until around five weeks after birth, then I suddenly started experiencing a ‘heaviness’ and ache in my vaginal region which got worse as the day went on. I used a hand-mirror to look and was horrified to see a small bulge at the opening of my vagina.
What should you do if you think you have a prolapse?
The first port of call should be to make an appointment to see your doctor. However, many women we have spoken to have found it difficult to get their GP to take the suggestion of prolapse after birth seriously. Gemma explains: “When I had my six-week check with my doctor I said that I thought I had a prolapse. She was very reluctant to even look, suggesting that it is much too soon to be concerned after six weeks and that I shouldn’t worry about anything until the baby was around a year old.”
Simone, whose little boy is 11 months has been in a similar position saying: “I have been feeling really uncomfortable with a dragging sensation down below and can actually feel a bulge at the entrance of my vagina with my fingers. I’ve also been having trouble controlling my bladder, which can be really embarrassing. I have been back to see my GP a couple of times and have been advised to keep up my pelvic floor excises (which I have been doing religiously anyway before, during and after birth) and wait until my son is a year. I was a keen runner before my pregnancy and am not sure if it is a good idea to take up this hobby again now – or if running will make things worse? There just doesn’t seem to be help and advice out there.”
Helping your own recovery
During pregnancy, Gemma had attended pregnancy yoga classes and decided to ask the instructor’s advice. “I was distraught about my prolapse – not only the symptoms I was experiencing, but also the possible implications for the future. I hope to have more babies – but will this be possible with a prolapse?
“She recommended that I see a specialist in women’s health and fitness, which I did and this has been one of the best decisions I made. I have been working with this specialist weekly to improve my condition with exercises to tone and lift my core and pelvic floor muscles and also basic everyday life changes to aid my recovery. She recommended that I take Collagen supplements as studies have shown that a decreased collagen level can make women more susceptible to prolapse.
This specialist also recommended that I see a private consultant gynaecologist (as I wasn't having much luck with my own GP) which I did and am eternally grateful for. I had to pay around £250, but the consultant I saw was amazing. He advised that while breastfeeding, a woman’s oestrogen levels remain low, which makes everything more supple than normal. He didn’t want to discourage me from breastfeeding but prescribed me with oestrogen pessaries which after using for just a few months, together with exercise, have made a big improvement. He also referred me back into the NHS system and I subsequently had an appointment to have a vaginal pessary prescribed (a soft removable ring device that helps to support the prolapsed area).
“Most importantly, he reassured me that whilst it is probably better to wait a few years before pursuing another pregnancy (to give my body the chance to recover), there is no reason to not have more children. If the prolapse does get worse, he advised that there are surgical procedures which will improve things in the future.”
Can you reduce the risk of prolapse?
As we have discovered, being super fit doesn’t exempt you from the risk of prolapse. Some woman are at a greater risk if for example: they have one or more vaginal births; give birth to a large baby; are obese; have had prior pelvic surgery; suffer from chronic constipation or have a family history of weakness in connective tissue – and the risk is greater with age.
However, you can also reduce the risk of prolapse by:
Performing kegel exercises regularly. A kegel exercise is like pretending to have to urinate and then holding it – also squeezing your anus muscles tightly together (without sounding crude, as if you are trying hard to hold in a fart!) You relax and tighten the muscles – but it is important to find the right muscles to tighten. If your pregnancy is planned, do these prior to pregnancy, during pregnancy and more importantly, after pregnancy.
Tip – there is a great NHS app in the App Store called SQUEEZY – it is £2.99 but well worth it as it gives guided pelvic floor muscle exercises with reminders throughout the day.
Tip – buy a sheet of coloured dot stickers and pop them around the home (on light switches, mirrors etc) train yourself to perform a pelvic floor exercise every time you see a sticker.
Avoid excessive exercise and lifting for at least the six weeks after birth, particularly if you have had a vaginal birth. Remember – it took nine months to create a baby – it’s going to take at least as long to fully recover. Treat your body as if you have had a major operation (even if you feel fantastic and recovered – don’t forget, your internal muscles have performed a miracle and stretched beyond anything they have ever done before – it will take a while for them to recuperate and strengthen even if you can’t see or feel any pain or discomfort). Try to rest as much as possible (let others do the housework and lift heavy pushchairs and car seats). Seek professional advice before returning to sporting activities.
Treat and prevent constipation. Drink plenty of fluids and eat high fibre foods such as fruits, vegetables, beans and whole grain cereals.
Control coughing – get treatment for chronic coughs or bronchitis – and don’t smoke.
Avoid weight gain. Talk to your doctor to determine your ideal weight and get advice on weight-loss strategies if needed.
If you are worried about prolapse, don’t be embarrassed. Make an appointment to discuss it with your doctor. More information and advice can also be found at https://www.nhs.uk/conditions/pelvic-organ-prolapse/treatment/
Written by Christine Scippo (firstname.lastname@example.org)