Pelvic Organ Prolapse After Birth

Ever wonder why your vagina feels heavy after giving birth? It just might be due to pelvic organ prolapse. What in the world is pelvic organ prolapse anyways? Let’s back up a bit before we answer that question. 

Let’s start with a basic anatomy lesson so you better understand the placement of the things in and around your pelvis.

Anatomy

Your pelvis is made up of 3 major bones that are fused together. Then we have the sacrum and coccyx (tailbone) that attach to the back. This forms a ring all the way from the front to the back. You know when you rush through the kitchen too fast and smack your hip on the counter? That’s the ilium, the bone at the top of the pelvis. The top of the pelvis is called the inlet. The bottom of the pelvis is called the outlet, and that is where most of the action happens. 

The bottom of the pelvis, or the outlet, is where your pelvic floor attaches. The pelvic floor attaches to all 3 pelvic bones (the pubic bone, the sits bones (also called the ischium), and the ilium), the sacrum, and the coccyx. These muscles form a sling, or a hammock, since they are suspended from these bones in sort of a circular fashion. You can think of them like a trampoline, attached to the springs on the outside, and the muscles are the part you jump on.

The pelvic organs are the bladder, the uterus, and the rectum. These organs sit on top of and are supported by the pelvic floor muscles. In women, these organs can bulge in on the vagina and cause what we refer to as pelvic organ prolapse. 

Any one of the 3 organs can bulge and start to descend into the vagina. When the bladder starts encroaching on the vagina, we call it a cystocele, or anterior pelvic organ prolapse. When the uterus descends, we call it uterine prolapse (vaginal vault prolapse if the uterus has been removed) or apical prolapse, and when the rectum moves forward, we call it a rectocele, or a posterior prolapse.

Risk Factors

Giving birth vaginally is the highest risk factor known for developing pelvic organ prolapse (Fonti). Other risk factors include pregnancy, assisted delivery (forceps or vacuum), prolonged pushing phase, babies larger than 8.5 lbs, aging, menopause, smoking, chronic diseases, and chronic constipation (Fonti). 

Symptoms and Grades

Some common symptoms of pelvic organ prolapse are feeling like there is something in the vagina, something is in the way, like a tampon is falling out, a bulge in or outside the vagina, feels like you are sitting on a ball, pressure or heaviness between the legs or in the vagina, or pain. 

We use grades to distinguish how much the organs have descended into the vaginal space. Grade 1 means there is bulging into the vaginal canal, but there is no visible tissue upon examination. Grade 2 means the tissues are still contained within the vagina but are visible from the vaginal opening. Grade 3 is when some of the vaginal wall is protruding past the vaginal opening. Grade 4 is when there is maximal descent of the organs past the vaginal opening.

Pelvic organ prolapse typically develops due to increased pressure from the abdomen to the pelvic floor. When pushing a baby out vaginally, there is an increase in intra-abdominal pressure, and especially if you push for a long period of time (longer than 1 hour), the risk is higher for developing pelvic organ prolapse. Other reasons women commonly develop pelvic organ prolapse after birth include constipation and poor posture and lifting techniques. Constipation is very common post-birth, especially if pain medications or an epidural were used. Constipation contributes to the risk for pelvic organ prolapse because you usually have to strain to get the stool out, which causes increased intra-abdominal pressure. Managing constipation is one important factor to consider when managing prolapse. Poor posture can contribute to prolapse symptoms due to the forces within the abdomen during certain activities, such as lifting your baby out of the crib or off the floor. 

Grades do not necessarily correlate with symptom severity, and many women find that conservative management of symptoms is a better alternative to surgery.

Treatment Options

Pelvic floor physical therapy is a great place to start because pelvic organ prolapse is multi-faceted and no two individuals have the exact same experience. Physical therapy is a conservative management option and should be considered before options such as medications or surgery. If you think you have pelvic organ prolapse and are ready to do something about it, call now for a consultation with a pelvic floor physical therapist to see if you are a good fit for our care at Moms in Motion PT. 612-568-2462

References:

Fonti Y, Giordano R, Cacciatore A, Romano M, La Rosa B. Post partum pelvic floor changes. J Prenat Med. 2009 Oct;3(4):57-9. PMID: 22439048; PMCID: PMC3279110.)