1 in every 2 women will experience Prolapse… Learn how to reduce your risk

Warning: DO NOT google pictures of prolapse.

The current stats tell us that 1 in 2 women who have ever had a baby will experience prolapse sometime in their life.

Now you’re looking at the lady next to you on the train and wondering which of you will be the unlucky one!

Don’t worry.. there are plenty of things YOU can do to both prevent and manage prolapse.

So yes it sounds scary and unpleasant.. but what exactly is prolapse?

Prolapse is when your pelvic organs (bladder, uterus or bowel) descend/drop/bulge/sag down into your vaginal space.

Image credit: webmd.com

This happens because the support structures (fascia and ligaments) that hold them up within the bony pelvis can become stretched or torn.

Imagine a ship in water. Imagine the water is the pelvic floor muscles supporting everything from underneath. The ship is the pelvic organs and the ropes holding the ship to the dock are the pelvic ligaments. If the ligaments are stretched or torn then the ship will drop lower. If the pelvic floor is weak then this will place more pressure on the ligaments which will cause the ship to again drop lower.

So in summary, prolapse occurs as a result of weakness in the pelvic ligaments as well as the pelvic floor muscles.

What can cause this?

Pregnancy. Hormones during pregnancy cause the pelvic ligaments to soften. Combine this with an average of 10-15kgs weight gain during pregnancy and you have stretchy ligaments under a lot of load! This can cause the pelvic ligaments to weaken meaning that they cannot hold everything UP as well as they used to.
Vaginal birth. The stretch and strain on the pelvic ligaments is (understandably) enormous during vaginal delivery.
Having a baby that is >4kgs is also a risk factor due to the extra stretch and strain.
Assisted deliveries with forceps can also increase the risk of prolapse due to the extra pressure and force placed on the internal pelvis.
Active pushing phase of labour is greater than 2 hours long. This increases the time spent with pressure on the pelvic tissues and nerves, leading to further strain.
Heavy weight lifting. Whether it’s from years in a manual labour job, or participating in heavy weight lifting as exercise- the increases in intra-abdominal pressure associated with lifting heavy weights can cause strain on the pelvic ligaments.
Holding your breath. This common mistake usually occurs during exercise, particularly during the “hard” phase ie. when lifting a weight off the floor. When you hold your breath, you increase your intra abdominal pressure even more, and combine this with the effort of lifting a weight and you have a double whammy of pressure on those pelvic ligaments.
Constipation and straining. Pushing to open your bowels can be likened to giving birth to another child! If you have done this regularly for many years, this can place a large amount of stress on the pelvic ligaments.

Whilst we’re on the topic of bowels…

Constipation can be a real issue and even worse, straining to empty your bowels can wreak havoc on your pelvic health.

Never ever ever strain to poo again!

We should aim for a type 4 poo on the Bristol Stool Chart you can see below.

This ensures that your poo is soft enough to get out easily, but formed enough so that we can hold on to it comfortably.

Image credit: gutsense.org

If your poo is from 1-3 this suggests that you are more constipated, and it will be hard to empty your bowels without straining.

If your stool is between 5-7, this suggests that your stools are quite runny and you may have issues with urgency and making it to the toilet in time.

To ensure you get a type 4 poo, make sure to drink 2L water per day, eat a diet rich in fibre and keep your body active and moving.

Now to teach you how to empty your bowels correctly…

Why you should start “moo-ing” on the toilet…

The ideal posture to do a poo is to lean slightly forward and have your feet on a little stool.

Having your knees slightly above your hips adjusts your pelvis so that your rectum (back passage) is straight and not kinked.

If you were to sit straight and upright, your rectum is slightly kinked and this makes it harder for poo to pass through.

Now once you’re in this position… try to bulge your tummy out…like it was a balloon.

This helps to relax your pelvic floor muscles.

If you were to strain and tighten your tummy muscles, this would cause your pelvic floor to tense and would generate a lot of pressure in the pelvis (which we don’t want!).

So we do the opposite.. we relax your tummy muscles by bulging them out.

To help you with this bulge I want you to gently make a “moooooo” sound.

What this does is gently encourages your tummy to bulge outwards. It is very hard to moooo and strain at the same time.

How to poo properly!

Now enough about bowels..

I had a C-section so I shouldn’t have an issue with prolapse.. right?

Wrong. You still carried a baby for 9 months!

The same pregnancy risk factors still apply and therefore you have a slightly increased risk due to the fact that you were pregnant.

Yes, if you deliver vaginally you do have a higher risk of getting a prolapse.. but if you don’t.. you don’t always get out scot-free.

So it is still important to protect your bits and work towards a healthy pelvis.

How would I know if I have prolapse?

You may experience any of the following symptoms:

Incontinence
Sensation of fullness/bulging/dragging/heaviness in the vagina
Trouble emptying your bladder/bowels completely
Discomfort in the lower abdomen
Recurrent urinary tract infections (UTI’s)
Sexual discomfort or reduced sexual sensation

What if I’ve had children and I don’t have any of these symptoms.. am I still at risk?

Yes you are.

You won’t always be aware if you have a prolapse.

They can range from very mild, where the woman feels nothing at all, to quite severe where there is a very obvious bulge and affect on a woman’s bladder, bowel and sexual function.

The stats tell us that 1 in 2 women who have ever had a baby will have a prolapse.

So just because you don’t feel it now.. doesn’t mean it won’t rear its ugly head later in life.

However you can prevent this by working on strengthening your pelvic area and reducing any unnecessary strain NOW.

Do the work now ladies, because once you hit menopause…

Once you transition into menopause, your oestrogen levels start to decrease.

This can cause ligaments to weaken further, possibly contributing to prolapse.

Often women will feel OK after giving birth and will jump straight back into “normal” exercise.

They may be able to continue to do this comfortably for many years. But just because you don’t feel something, doesn’t mean you are strong on the inside.

A lot of women consult with me around the time of menopause because they’ve recently become aware of a bulge/heaviness in the vaginal space.

Menopause has been the trigger to make their prolapse symptomatic, but often that weakness has always been there, they just haven’t known about it.

Even more reason for pregnant women and Mums to make sure you do the preventative work now to ensure that by the time you hit menopause, you don’t need to see a physio!

What can I do to prevent prolapse?

Avoid constipation by maintaining good fluid and fibre intake. Aim for 2L of water each day and 30g of fibre. You can find fibre in brans, wholegrains, nuts, seeds, fruit and vegetables.
Don’t strain to empty your bladder or bowel.. ever again!
Keep your pelvic floor and core strong
Practice good posture. Slouching or being too upright and tense can place extra pressure on your pelvic floor. Practice upright but relaxed posture in both sitting and standing.
Brace yourself well. This means gently contracting your pelvic floor before you bend down to lift something up, or prior to a cough or sneeze.

What if I already have prolapse? Can I do anything to make my symptoms better?

Yes you can!

Pelvic floor strengthening exercises
Core and gluteal exercises. Make sure you exercise with someone who knows about prolapse ie. a women’s health physiotherapist so that you don’t do any further damage
Brace yourself prior to coughing, sneezing or lifting
Avoid constipation/heavy lifting
Use lubricant for intercourse and try a number of different sexual positions as some will be more comfortable than others.
Pace yourself. Don’t try to be superwoman. Include periods of horizontal rest during the day (yes this means lying down!) to give the pelvic ligaments a break
Sit on a rolled up towel to provide short term compressive relief to the perineum
Consult with a women’s health physiotherapist for thorough assessment and management.