Postpartum
Pregnancy is the most common contributor to the development of a prolapse. The hormonal changes, physical stress and strain, and the additional weight of your baby can soften the supportive tissues and muscles in your pelvic floor. This can cause your pelvic organs to shift and move from their normal alignment.
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It is common for many women to experience postpartum complications like a prolapse. A prolapse happens when a part of your body (intestines or tissues) bulges or "falls out" into either the rectum or vagina due to weakened muscles structures and tissues. Prolapse doesn't only affect mothers outside of the advised childbearing age, but can also affect new moms as well. Many young mothers may be surprised or shocked to hear they developed a prolapse, but it is a very common postpartum condition, especially post-vaginal birth. Managing a prolapse - whether it be a vaginal prolapse, uterine prolapse, bladder prolapse, or other kind of pelvic organ prolapse - can add to the emotional and physical stress many new mothers may already be facing.
However, it is possible to heal from a prolapse and make a full recovery! In this article I hope to address postpartum prolapse and how you can experience a full recovery.
During the postpartum period, it is common to experience a pelvic organ prolapse. The tissues and muscle structures that support your pelvic floor may have been weakened over the course of your pregnancy and during delivery. The weakness in the pelvic region can cause some of your pelvic organs (bladder, bowel, uterus) to slip out into the vaginal or rectal walls. Yet, though it is common for women to experience a prolapse post-pregnancy/childbirth, pelvic floor therapy can help improve the condition. In many cases, the initial presentation of prolapse can resolve on its own as you continue to heal - yet, there can still be complications in the future. Some of the most common types of pelvic organ prolapse post-childbirth include:
Uterine prolapse –uterine prolapse involves prolapse of the cervix and uterus down into the vagina
Bladder prolapse (cystocele) -involves a prolapsed bladder into the front wall of the vagina
Bowel prolapse (rectocele) is the prolapse of the vagina into the back wall of the vagina or rectum.
In some cases, these prolapses may coexist. Example: you may experience both a uterine prolapse and bladder prolapse at the same time.
Pregnancy is the most common contributor to the development of a prolapse. The hormonal changes, physical stress and strain, and the additional weight of your baby can soften the supportive tissues and muscles in your pelvic floor. This can cause your pelvic organs to shift and move from their normal alignment.
Along with the hormonal and physical demands pregnancy can place on your body, a vaginal delivery can also contribute to pelvic prolapse as well. The stretching and straining of the pelvic muscles beyond their limits can significantly compromise the strength and functionality of the pelvic region. Over-stretching can leave scarring and nerve damage resulting in damaged tissues and muscle structures - leading to pelvic organ alignment issues and can cause them to shift downward into the vagina.
There are a host of factors that can contribute to various forms of pelvic organ prolapse. Some of the most common include:
There are many options out there to help you recover from postpartum pelvic organ prolapse. It is important that after your delivery (once you've received clearance by your medical professional), to begin a form of postpartum rehab. Offerings can range between physical therapy, physiotherapy, or movement specialists (Restore Your Core). In many cases, you would treat this condition as you would any other physical injury: REST and light movement. You may also need to treat any other underlying conditions that may be contributing to the prolapse. Some options may include:
Pelvic floor exercises are vital to your recovery, especially postpartum. Pelvic floor stretches and exercises are known for reducing the symptoms of prolapse, restoring function to the pelvic floor and core, and realigning organs that may have been affected by the prolapse. If you have discovered you have a prolapse after childbirth, it is important to begin working towards recovery through physical therapy or working out at home. Most women may begin exercising soon after giving birth (within the first couple of weeks), however, if you experienced tearing or delivered via C-section, you may need to wait longer before beginning treatment.
Practicing safe pelvic floor exercises are important for a sustained recovery and preventing further injury during treatment. Inappropriate exercises or moving too quickly can increase the risk of injury, overloading the pelvic floor, or causing long-term damage to the pelvic floor. Practicing safe pelvic floor engagement and workouts will help strengthen your muscles and the surrounding tissues that have been damaged during your pregnancy and childbirth, helping restore the natural support system for your vital organs.
Safe pelvic floor exercises include those which are low impact and light exercises: walking, stationary cycling, and some yoga poses. More safe exercises can include core strengthening techniques and movements as well are pelvic floor strength training exercises: more intensive yoga poses, stretches, and workouts. Although exercising is important for recovery, it is important that you avoid high impact exercises: intense core exercises, heavy-lifting, or extensive cardio training in order to avoid making the prolapse worse or increasing other postpartum symptoms.
To learn more about safe postpartum exercises, read our additional blog on Postpartum Exercises.
Resting can be one of the most difficult things new moms struggle with remembering to do. As you continue caring for your little one, ensuring you are getting exercise and eating nutritiously, can help you make a better transition back into your daily routine. It is extremely important that you remember to rest throughout your postpartum period. Rest is especially vital to your prolapse recovery. As you reach the end of each day (and periods of down time during the day), rest with your feet elevated to help relieve any symptoms you may be experiencing. Rest can significantly promote your overall prolapse recovery.
Straining during bowel movements and constipation can increase prolapse symptoms. Although I am not a dietician, in many cases, changing your diet and eating high fiber foods can help relieve symptoms of constipation that can reduce the amount of straining you have been experiencing.
If you have discovered that a chronic chest condition (asthma, bronchitis, or smoker cough) has been contributing to your prolapse, it is important to seek the proper treatment to manage your symptoms. It is important to consider proper symptom management to help prevent exacerbations or fits of coughing.
Scientifically, there is little evidence supporting a prolapse worsening due to multiple deliveries. That is, if a prolapse is already present, it is not common for the prolapse to get significantly worse after delivering another child. If you have been exercising appropriate maintenance protocols, exercising correctly, and managing symptoms well, you can continue to have children even with a prolapse without worrying about any significant health concerns.
However, if you have been considering repairing your prolapse via surgery, you will need to be sure that you are completely done having children before having the procedure. This is due to an increase in potential risks and complications if you continue to experience a prolapse due to a post-surgery delivery. Talk with your healthcare provider or OB/GYN if you have any concerns regarding a prolapse procedure and delivering future children.
Uterine and bladder prolapse (Cystocele) are the most common postpartum pelvic organ conditions. Surgery is not something we encourage or discourage our clients with pelvic organ prolapse to consider. However, if your doctor has recommended surgery as being your best option, it is better to discuss this solution with a medical professional.
Bladder prolapse surgery is most commonly performed with a mid-urethral sling. This surgery implants a mesh sling around the urethra, connected to the pubic bone, to help properly re-align the urethra to resolve urinary incontinence (leak pee). However, there are known complications with this surgery. If the mesh sling does not resolve your prolapse symptoms, often the surgeon will recommend anterior repair surgery.
Before you do consider surgery, it is always recommended to engage in a rehab with a physical therapist or join a rehabilitation program like Restore Your Core for at least 6 months to a year. This ensures that you have attempted to allow your body to heal naturally before undergoing a very invasive procedure, especially after having recently given birth.
Recovering from prolapse bladder surgery or any other kind of prolapse surgery will depend on the length, type, and invasiveness of the operation. In some cases, recovery will only last for a week or two, in others, months. Before considering surgery, it would be important to discuss procedure length, process, and recovery with your doctor or surgeon.
For many women, postpartum prolapse can correct itself over the course of your postpartum recovery. Lifestyle changes, exercise, proper diet, and avoiding exercises of movements that may prevent your body from healing are the first steps toward prolapse recovery.
After giving birth, your pelvic floor and core muscles will be in the process of healing for at least a year. Although many women may begin being active again after the first 6-weeks postpartum, often women will continue to face pelvic pain and symptoms of diastasis recti for months after delivering their child. Both your core and your pelvic region have gone through significant changes in order to accommodate your baby. Attempting to quickly get back into an exercise or workout routine can add to your pain and place unnecessary pressure and strain on your core and pelvic floor muscles - especially when they are already weakened.
Every woman is different and the recovery length can change depending on many factors. Healing can take anywhere from a few months to over a year, depending on whether or not there are underlying conditions which may be increasing the pain. While there are no overnight success stories, there are many many success stories of women like you who have healed their pelvic organ prolapse by taking these steps slowly and surely.
