My Journey with Cushing’s disease
At 30 years old, I was fit, healthy and naturally a size 8–10. I knew my body well, which is why, when it started to
The pelvic floor is a group of muscles that support our spine and pelvis, manage our continence, contribute to our sexual response, and support our internal organs. These are really important jobs but we have unfortunately not been educated about the importance of this group of muscles or how to care for them as we move through life’s stages.
Incontinence is a very common condition affecting close to 40% of women. Many people know about incontinence because of the pad companies telling us that light bladder leakage (incontinence) is “just part of being a woman”. We don’t see ads for prolapse nor have we ever been told about this condition, so many women are caught completely off guard when they receive a prolapse diagnosis and are unsure if they can still conceive and give birth.
Pelvic Organ Prolapse (POP) occurs when the bladder, uterus and/or rectum shift out of their proper anatomical position and bulge into or descend into the vagina. Prolapse affects over 50% of women and early stage prolapse is often asymptomatic. Some of the more common symptoms associated with POP are:
As the descent of the organs continues symptoms may progress to:
There are many factors that can contribute to the development of prolapse. The biggest risk factors are chronic bowel straining and pregnancy and childbirth, especially those with a prolonged second stage of labor and/or those where forceps or suction has been used.
The risk of prolapse also increases with the number of children. Other factors are chronic coughing, occupational heavy lifting, connective tissue disorders, and levator avulsions (a birth injury where part of the pelvic floor muscles tear away from the bone).
In the majority of cases pregnancy is absolutely possible if you have a prolapse. In those who have advanced uterine prolapse it may be a bit more challenging. Sperm thrive in a warm, moist environment like the deeper aspects of the vagina. If the uterus is prolapsed and is at the entrance to or outside of the vagina, the sperm may be pushed outside of the vagina and then exposed to air. This may reduce the chances of getting pregnant. Read this interesting case study of a woman with a severe uterine prolapse who had two successful pregnancies.
Some women may find that their prolapse symptoms improve during pregnancy, especially early stage uterine prolapse. However, many women with prolapse fear that their prolapse will get worse, especially if they have a vaginal birth. This study did not confirm this belief and another study showed the first vaginal birth is the main determinant.
A technique that can potentially reduce some of the risk of a subsequent vaginal birth is called Passive Descent. This can be done with or without an epidural and removes the active pushing from the birthing woman. Some people do choose to have a cesarean birth instead of risking further injury from a vaginal birth. It is recommended to work with a pelvic floor physical therapist and your gynecologist to weigh the pros and cons.
The number one best practice for helping improve prolapse symptoms is to work with a pelvic floor physical therapist. Next would be to have a consistent, whole body pelvic floor fitness routine.
During pregnancy, doing workouts that involve exercises that mimic birth positions is helpful while also adding pelvic floor activation and relaxation reps to the exercises. Wearing a pessary is also helpful for the management of prolapse, whether or not you are pregnant. There are some that are better suited for pregnancy. A pelvic floor PT or your gynecologist can help you find the best pessary for your body.
Once your baby is born, all of the above strategies are equally as important. The hypopressive exercise technique is also a powerful tool to help reduce or sometimes eliminate a prolapse but it is not indicated for use in pregnancy. The final tip is to avoid constipation. Chronic straining is very damaging to the pelvic floor.
It used to be (and sometimes still is) recommended that a woman avoids heavy lifting if she has a prolapse. The challenge with that recommendation is it does not build resilience in the pelvic floor, it increases the risk of osteoporosis and age related muscle loss and it is the most unrealistic piece of advice to have a new mom afraid of lifting her baby or car seat or stroller.
You can absolutely lift your baby and the car seat and the stroller! Learning how to properly activate your pelvic floor with movement and then practicing it and progressing to heavier loads is the best way to train resilience and build capacity. Limiting or removing an activity is not the answer.
Pelvic organ prolapse is very common and is treatable. There are many options available to help minimize the likelihood of developing prolapse and also many tools and therapies available to help manage prolapse if it happens. Pelvic health physical therapy during pregnancy, at eight weeks postpartum, and then annually for life is one of our best lines of defense.
References:
De Vita D, Giordano S. Two successful natural pregnancies in a patient with severe uterine prolapse: A case report. J Med Case Rep. 2011 Sep 14;5:459. doi: 10.1186/1752-1947-5-459. PMID: 21917162; PMCID: PMC3180421.
Dietz HP, Rozsa D, Subramaniam N, Friedman T. Does Vaginal Parity Alter the Association Between Symptoms and Signs of Pelvic Organ Prolapse? J Ultrasound Med. 2021 Apr;40(4):675-679. doi: 10.1002/jum.15437. Epub 2020 Aug 17. PMID: 32870505.
Cattani L, Decoene J, Page AS, Weeg N, Deprest J, Dietz HP. Pregnancy, labour and delivery as risk factors for pelvic organ prolapse: a systematic review. Int Urogynecol J. 2021 Jul;32(7):1623-1631. doi: 10.1007/s00192-021-04724-y. Epub 2021 Mar 11. PMID: 33704536.
Brancato RM, Church S, Stone PW. A meta-analysis of passive descent versus immediate pushing in nulliparous women with epidural analgesia in the second stage of labor. J Obstet Gynecol Neonatal Nurs. 2008 Jan-Feb;37(1):4-12. doi: 10.1111/j.1552-6909.2007.00205.x. PMID: 18226152.
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