Prolapse is a scary word.  As women, we are often uncomfortable talking about our bodies, especially our pelvic organs and reproductive systems. So when we hear words like “pelvic organ prolapse,” it’s not surprising that maybe we experience a little wave of panic. It’s not exactly something that is openly and generally talked about amongst the women’s health and fitness fields.  A woman can experience a prolapse at any time during her lifetime, but especially during pregnancy and after childbirth.

If your OB, midwife, or physical therapist has diagnosed you with some degree of prolapse, the assortment of emotions you may be feeling can be intense. You may be wondering what this is going to mean for future pregnancies, for your sexual health, and if you’ve been fit before, you may be wondering what you can do for exercise?

At VixieFit, I have worked with clients who’ve been diagnosed with prolapse (once their doctors and/or physical therapists have cleared them to return to exercise). I strongly believe that any woman who is returning to fitness after addressing a prolapse needs to consult a fitness professional with knowledge on this subject, at least once, to make sure that she is exercising in a way that will support her body.  You can absolutely return to exercise once your symptoms are managed, and we will get into the specifics of that in the next post.

For right now, let’s get into more specifics regarding pelvic organ prolapse because while it’s not a very sexy subject, it’s SO important that we talk about it!  Pelvic organ prolapse (or POP) is not just another condition that we should simply chalk up to having babies.  It can happen…yes…but you can minimize your chances of developing a prolapse by learning more about it and making simple changes to your daily activities.

So What Exactly Is Prolapse? 

Basically, prolapse refers to a weakening of the pelvic floor which allows the organs in your pelvis to begin to bulge or droop down into or sometimes even out of the vagina and/or rectum, causing a variety of symptoms.  There are actually multiple types of prolapses, but for the sake of this discussion I am going to mention the three types of vaginal prolapses (meaning that certain pelvic organs will drop or fall towards the vagina) that tend to affect prenatal and postnatal women: cystocele (prolapse of the bladder), uterine (prolapse of the uterus), rectocele (prolapse of the rectum)

While some experts estimate that as many as 50% of women experience some degree of prolapse after childbirth (read more here), most of the time these prolapses are mild and manageable.  However, there are also times when the symptoms are much more severe and medical intervention is necessary.  There are grading systems used to determine the severity of a prolapse which you can read more about here if you so choose.

It is incredibly important to make sure that you are exercising smartly and safely both during and after pregnancy with activities that support the strength and integrity of your core and pelvic floor. You must monitor your daily living activities, which could be doing more harm than good to this area. You also need to incorporate self-care techniques that can aid in a smoother labor and delivery (e.g. learning to RELAX as well as contract the pelvic floor, perineal massage, using more advantageous birthing positions, pushing during delivery when you feel like you need to and not on someone else’s count, etc.).  It’s also very important to make sure that your doctor checks you for prolapse during your post-delivery and postpartum check-ups or that you find a way to get in to see a physical therapist that specializes in pelvic health.

What Are The Causes of Prolapse? 

As I briefly mentioned earlier, your pelvic floor consists of a network of muscles, ligaments, and connective tissue that acts as a support structure to hold up the pelvic organs, including the vagina, cervix, bladder, urethra, intestines, and rectum. A pelvic organ prolapse occurs when there is weakness or damage done to this support structure and the organs drop down from where they normally should be. This can cause all sorts of trouble.  Some of the reasons why a prolapse can occur include:

• Pregnancy: The increased levels of Relaxin in the body during pregnancy cause all of the soft tissues and joints to become more lax as your body prepares for the birth of your baby.  Increased Relaxin, combined with the additional weight of your growing uterus and baby placing more downward pressure on the pelvic floor organs and pelvic floor muscles, can cause this area to become weakened.
• Childbirth: The strain of pushing a baby out through the birthing canal will certainly stretch and weaken the pelvic floor muscles.  This problem is made worse if a woman has to push for longer periods of time (2 hours or more) and/or if any medical interventions occur (such as the use of forceps, vacuums, and episiotomies). I was lucky enough to experience all of these during the birth of my second child!  Also, any related tearing that occurs during childbirth will also damage and weaken the pelvic floor structure.
• Postpartum: In the early days, weeks, and even months after delivery, the core and pelvic floor will still be vulnerable. Nevertheless, many women will jump right back into high impact/intense exercise way too soon, and they won’t rehab their core and pelvic floor properly before returning to exercise.  It should be noted also that most new mothers are on their feet a lot throughout the day caring for a new baby. This will also stress an already-weakened pelvic floor even more if proper care is not taken.
• Menopause: Estrogen helps to keep the muscles and tissues of the pelvic floor strong. After menopause occurs, estrogen levels will drop and the pelvic floor can weaken as a result.
• Hysterectomy: While in some cases a hysterectomy is done to repair a collapsed uterus, there can be a ripple effect because the uterus is part of the support structure for the top of the vagina.  When the uterus is removed, it takes away support to the top of the vagina. As a result, the vagina may gradually fall down towards the vaginal opening.
• Other risk factors/activities for pelvic organ prolapse include:
  • Strenuous physical activity
  • Advanced age
  • Damage to nerves and tissues
  • Prior pelvic surgery
  • Smoking
  • Obesity

So How Do I Know What Prolapse Feels Like?

Some common signs of a prolapse include:

• Feelings of heaviness and/or downward pressure in the pelvis
• Feelings of pain or pressure in the lower abdominal area and/or in the vagina. You can feel like this at any time, but you may notice it especially both during and after exercise.
• Feeling as if something is actually falling out of the vagina.
• You feel like you can’t fully empty your bladder when going to the bathroom, or you leak urine, or feel the frequent or urgent need to urinate.
• You have trouble with bowel movements (constipation).
• A bulging out of the vagina that you can see and feel.
• Painful or discomfort during sex.
• Lower back pain or a pulling in the groin area.
• Spotting or bleeding from the vagina.

If You Think You Might Have A Prolapse, Get Help!

There’s nothing glamorous about going to your doctor and talking about difficulties with bowel movements, feeling like your cervix is way too low in your vagina (and explaining how you found that out!), or talking about stress incontinence (where you pee yourself a little bit (or a lot) when you sneeze or cough).  As women, we experience a lot of pressure to be beautiful and socially acceptable at all times, even when we’re talking about the ways our bodies function. It can be tough to maintain that self- image when you have to explain to a doctor that it just doesn’t feel quite right down there.

Even if you exercised improperly during pregnancy, even if you did everything wrong during your postpartum period, a prolapse is still not something you should feel guilty about.  Let go of the shame…as best as you can…become informed, and seek out the necessary help you need to get back to feeling more like yourself again!.