During pregnancy and delivery, your pelvic floor — the group of muscles and connective tissues that sit in your pelvis and perform a variety of important functions — face quite a challenge.
These muscles, which act as support for your bladder, bowel and uterus, take on more weight as your pregnancy progresses and your baby grows.[1] At the same time, pregnancy hormones responsible for loosening you up so your baby can eventually come through the birth canal also loosen the ligaments and connective tissues in your pelvic floor. During a vaginal delivery, your pelvic floor muscles can stretch up to three times their normal length![2]
It’s no wonder that childbirth is the number one risk factor for pelvic floor dysfunction, which can include what’s known as pelvic organ prolapse.[3] Here’s what every mom-to-be and new mom should know about this little discussed issue.
What is pelvic organ prolapse?
Pelvic organ prolapse (or POP) occurs when one or more pelvic organs (including the bladder, bowel, uterus or top of the vagina if a woman has had a hysterectomy) descend into the vagina from their normal positions. This can happen when the muscles and tissues of the pelvic floor become weakened or damaged.
Up to 50 percent of women will experience some level of prolapse throughout their lifetimes,[4] though most don’t notice symptoms. It is common in the postpartum period: One study of 987 women who delivered vaginally in the previous year found that roughly one-third experienced “ballooning,” the telltale symptom of prolapse caused by the affected organs bulging into the vagina.
Prolapse is not life-threatening, but it can be distressing, causing discomfort and in some cases, pelvic pain, among other symptoms.
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What are the different types of pelvic organ prolapse?
There are multiple types of prolapse, including:[5]
- Cystocele: When the bladder drops into the vagina
- Enterocele: When the small intestine bulges into the vagina
- Rectocele: When the rectum bulges into the vagina
- Uterine prolapse: When the uterus drops into the vagina
- Vaginal vault prolapse: When the top wall of the vagina drops in a woman who has had a hysterectomy
There are also different levels of prolapse, known as stages,[6] which describe how severe the prolapse is based on how far the organ has descended. Stage 1 is the least severe, and means the organ is still pretty well-supported and inside the vagina. Stage 4 is the most severe, and means the organ is coming out of the vagina.
What causes pelvic organ prolapse?
Pelvic organ prolapse is caused by a weakened or injured pelvic floor.[7] When the muscles and ligaments are weakened or torn, they can no longer support the pelvic organs.
While prolapse can also happen after hysterectomy or due to tissue changes during menopause, pregnancy and childbirth are major culprits behind pelvic floor weakness and injury that can lead to prolapse.
Prolapse most commonly occurs many years after childbirth, with the risk going up after multiple births. But it can also happen in the immediate weeks and months postpartum.
Research suggests that prolapse is more likely if you push for a long time,[8] have a large baby, or if forceps or vacuum are used.[9] Other factors, like obesity and having a chronic cough may also play a role.[10]
Generally, vaginal deliveries are more likely to cause issues that lead to prolapse than C-sections. However, the pressure build-up of pregnancy alone can lead to prolapse. One study, which measured prolapse in women at 36 to 38 weeks pregnant who went on to have cesarean deliveries, found that roughly a third had stage 2 prolapse. (The researchers also examined the participants at 6-weeks, 6 months and one-year postpartum, and symptoms were significantly reduced.)[11]
What are the symptoms of pelvic organ prolapse?
In mild cases of prolapse, there are often no symptoms at all. In those cases, it’s more likely for the prolapse to be noticed during a physical exam. Mild cases might feel like a bulge in the vagina.
In more severe instances, the organs descend to the opening or even outside of the vagina.[12]
Other symptoms of pelvic organ prolapse can include:[13]
- Pressure or heaviness in the pelvic area
- Urinary issues, including leaking urine or feeling like your bladder is still full after you go
- Difficulty inserting a tampon or having sex
- Low back pain
- Constipation or other bowel issues
How is pelvic organ prolapse treated?
If you are experiencing any of the symptoms above immediately after giving birth, bring them up with your doctor at your first postpartum checkup. However, it can take up to six months or longer for your pelvic floor to heal from birth. The good news: Postpartum prolapse can improve with time, especially with physical therapy.
Treatment depends on the severity of the prolapse, as well as the organs affected. Sometimes, treatment isn’t needed. If you have no symptoms and it’s not causing you any distress, then your doctor may take a “watch and wait” approach to make sure the prolapse doesn’t get any worse.
Physical therapy with a women’s health or pelvic floor physical therapist can help retrain your pelvic floor to improve symptoms.
Other treatments might include wearing a pessary, which is a device you insert into the vagina to help provide support. An OB/GYN or urogynecologist can recommend and fit you for a pessary, if needed.
Surgery is also an option, if the prolapse persists and is severe.
Is there anything you can do to prevent pelvic organ prolapse?
Many of the risk factors for developing prolapse are not in your control. These include your family history and how your pregnancy and childbirth unfold.
However, understanding the importance of your pelvic floor and keeping it strong can go a long way. Research suggests that pelvic floor muscle training during pregnancy and the postpartum period — especially with the help of a physical therapist — are key for early interventions that can help prevent prolapse.[14]
For too long, pelvic floor issues have been overlooked. It can be difficult to talk about leaking urine or feeling a bulge, but if you are experiencing these symptoms or other signs of a prolapse, bring them up with your practitioner.
Most importantly, remember that nine months of pregnancy and labor change your body. It takes time to recover! Be gentle with yourself, and never feel ashamed to seek advice from a professional for help.
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