Pelvic Organ Prolapse Postpartum

Pelvic organ prolapse is downward descent of female pelvic organs. These organs include the bladder, uterus or post-hysterectomy vaginal cuff and the small or large bowel, resulting in protrusion of the vagina, uterus, or both.

Most postpartum prolapse is stage 1 or 2 and highly responsive to conservative treatment in the first 12-18 months.

Up to 80-90 % of women with mild–moderate POP become symptom-free or nearly symptom-free without surgery when they do the right things early.

Your Pelvic Floor

Your pelvic floor muscles play a role in holding up your pelvic organs from below. If your pelvic floor muscles are weak, then your pelvic organs might not be held in their right place. And as a result, they may bulge or sag down into the vagina.

The most consistent risk factors include:

1. Vaginal childbirth
2. Advancing age
3. Increasing body-mass index

Patients generally present with several complaints, including bladder, bowel, and pelvic symptoms. However, with the exception of vaginal bulging, none is specific to prolapse.

If you are experiencing any symptoms please seek medical advice as you will likely need a pelvic examination and medical history check.

Step-by-Step Postpartum Prolapse Recovery Plan

Timeframe: 0-6 weeks postpartum

Goal and Actions:
1. Rest and heal the perineum/C-section
2. NO formal exercise except gentle walking
3. Start diaphragmatic breathing and pelvic-floor relaxation (most important!)
4. Avoid constipation (stool softeners OK)
5. No lifting - baby in car seat

Why It Matters: Prevents worsening while tissues are still very soft from relaxin

Timeframe: 6-12 weeks

Goal and Actions:

1. See a pelvic-floor physiotherapist for internal exam

2. Learn correct pelvic-floor contractions and full relaxation

3. Start gentle TA (deep core) and pelvic-floor coordination exercises

4. Begin scar massage (C-section or perineal)

Why It Matters: This is the window when tissues heal strongest - best chance for full recovery

Timeframe: 3-12 months

Goal and Actions:

Daily specific prolapse-safe program
1. Gradual return to exercise with proper pressure management
2. Weight loss if BMI >27 (every 5 kg lost = big symptom relief)

Why It Matters: Maximum tissue remodeling happens in first year

Timeframe: After 12 months

Goal and Actions:

1. Re-assess with physio / urogyn
2. If still symptomatic to pessary trial or surgery discussion

Why It Matters: Most spontaneous improvement plateaus by 12-18 months

Factors for a Higher Risk of Prolapse

There is a strong genetic component so prolapse tends to run in families. It is more likely after menopause or if you are overweight.

Prolapse can also happen in young women right after childbirth.

About 50% all women who have had a child have some level of prolapse. Of this, only one in five women need to seek medical help.

Prolapse can also happen in women who haven't had a baby, mainly if they cough, strain on the toilet or lift heavy loads.

Did you know that even after surgery to repair prolapse, one in three women will prolapse again?

Types of Prolapse

Pelvic organs may bulge:

1. into the front wall of the vagina (cystocele)

2. through the back vaginal wall (rectocele or enterocele) or;

3. the uterus may drop down into the vagina (uterine prolapse). More than one of the pelvic organs may bulge into the vagina.

During the early stages you may not notice the signs of prolapse. This is where it is important to have your routine pap smear test as your doctor will be able to see it when you have this test.

Signs of a Prolapse You May Notice

If the prolapse bulges right outside your body, you may feel sore and bleed as the prolapse rubs on your underwear.

1. your bladder is not emptying completely
2. you have a weak urine stream
3. a heavy sensation in the vagina
4. something coming down' or a lump in the vagina
5. sexual problems
6. a lump bulging out of your vagina
7. recurring urinary tract infections
8. difficulty emptying your bowel.

Causes

By now, you will probably know that 'childbirth' is the main cause of a prolapse. This occurs because as the baby passes through the vagina, it can stretch and tear the supporting tissues and your pelvic floor muscles.

The more vaginal births you have, the more likely you are to have a prolapse.

1. constipation
2. persistent coughing
3. lifting heavy weights

Prevention of Prolapse

Because a prolapse is due to weak pelvic tissues and pelvic floor muscles, you should keep your pelvic floor muscles strong. Now you know why I include a pelvic floor exercises in your workouts every week of your pregnancy!

Treatment of Prolapse

1. Surgery for Prolapse

Surgery can be done to repair torn or stretched support tissues and ligaments. There are different surgical options including:

1. vaginal approach
2. abdominal approach
3. laparoscopic (keyhole)
4. robotic

2. Non-surgical Options

1.Strengthening your pelvic floor muscles.

2. Making necessary lifestyle changes - diet, fluid intake, exercising, losing weight.

3. Avoid straining on the toilet.

Lifestyle Habits

1. Never hold your breath when lifting baby, car seat, toddler, groceries → always 'blow before you go'.

2. Toilet posture every time: lean forward, elbows on knees, gentle bulge at end of poo (no straining).

3. No heavy lifting (>8-10 kg / 18-22 lb) for at least 6-12 months.

4. Treat cough/allergies and constipation aggressively.

5. Lose pregnancy weight gradually (especially if you gained >15 kg / 35 lb).

Takeaway

Prolapse is common for mamas. The key is for you to do your pelvic floor exercises throughout your pregnancy and continue doing them after childbirth. My online program has helped thousands of mamas - let me help you!