One of the most common questions I get asked as a Women's Health Physiotherapist is by first time pregnant women asking - will my lady bits be the same after giving birth?
Most often the answer to this is YES, the female anatomy, including the pelvic organs and pelvic floor muscles do amazing things! After all your uterus can stretch to the size of a watermelon!! There are however some important symptoms to recognise and treat in order to ensure your pelvic floor muscles and pelvic organs return to normal.
What is Prolapse?
Pelvic organ prolapse is the slipping down of one or more pelvic organs into the vaginal space. There are four types of pelvic organ prolapse;
- Apical - is the most common where the uterus slips down past the cervix into the vaginal canal.
- Cystocele - the bladder slipping down into the vagina.
- Rectocele - the rectum slipping downward into the vagina.
- Entrocele - where the upper bowel slips down into the vagina.
Contributing factors of a Pelvic Organ Prolapse
Roughly half of all women who have had a child will have some degree of prolapse, the main factor is the severity of your symptoms and how much it bothers you. Approximately one in five women will need to seek medical assistance.
Childbirth is the most common cause of a prolapse. During labour the baby travels down into the vaginal canal and can stretch and tear the supporting fascia and pelvic floor muscles. The weakened structures will then allow the pelvic organs to move downwards. An increased length of labour time and a larger weight baby may also contribute to a prolapse.
Other factors that may result in prolapse include; a chronic cough, constipation, heavy lifting and being overweight.
Signs and Symptoms of a Pelvic Organ Prolapse
- Vaginal pressure - a feeling of heaviness or dragging (most common >90% of women experience this symptom)
- Vaginal pain
- Sensation of tissue protruding from the vagina
- Abdominal pain
- Low back pain
- Dyspareunia (painful intercourse)
- Vaginal dryness (ulceration and/or bleeding)
- Urinary incontinence
- Difficulty starting and stopping urination
- Urine frequency
- A sensation that the bladder is not empty immediately after urinating (incomplete Voiding)
- More frequent bladder infections
Prevention is best!
Pelvic Floor muscles, just like any skeletal muscles in your body, can be made stronger with the correct exercises. Following Perfect Pelvic Floor’s exercise programs during pregnancy will assist in maintaining strength and endurance to prevent any pelvic organ prolapse from occurring. As prolapse is due to weak pelvic tissues and pelvic floor muscles, all women should keep their muscles strong at any age. Ensuring good bowel health, maintaining a healthy weight and preventing illness involving a chronic cough are also necessary to prevent pelvic organ prolapse.
A great place to start is the Pelvic Floor Guide (get yours by clicking here) and gradually progress your strength and then endurance of your pelvic floor muscles.
If you are wanting to return to high impact exercise and heavy lifting after childbirth it is ideal to start your pelvic training in a supine anti gravity position e.g. lying on your back. Once you can master pelvic floor muscle activation in supine, then progress to weight bearing activation and then pelvic floor activation under load of weights.
“It is better to take many small steps in the right direction, than to make a great leap forward only to stumble backward” Chinese proverb
Written by Guest blogger and Women's Health Physiotherapist Rebecca Barr