What Is Pelvic Organ Prolapse and How to Avoid It

‍Physical Therapist and author, Marianne Ryan explains how doing too much, too soon after childbirth can cause pelvic organ prolapse and offers advice for avoiding it.One of the complications that can develop as a result of childbirth is pelvic organ prolapse, POP for short.This is a condition where organs such as the uterus or bowels slip down from their normal position inside the pelvis leading to pelvic pain, back pain, incontinence (urine and fecal) and sexual dysfunction. The degree of slippage varies from person to person and can be made worse by certain activities, especially those that increase the pressure inside your abdomen, such as heavy lifting, sit-up exercises, and straining when you pass a bowel movement. The aim of this blog article is not to scare you but to make you aware of Pelvic Organ Prolapse because there are times it can be prevented and, even if you can’t prevent it, it is treatable with the right physical therapy program1.

It can take a long time for a woman’s body to fully recover from the rigors of pregnancy and childbirth. More often than not, women do not realize this and return to activities or exercise that are too challenging, far too soon. To illustrate this, I would like to share a story about a lovely patient of mine who tried to return to her pre-pregnancy exercise routine too early. The Dangers of Doing Too Much, Too Soon − A Case Story Megan was referred to me after her doctor diagnosed her with pelvic organ prolapse, which she developed after her six-week checkup.Before she got pregnant, Megan was very active. She loved “boot camp-style” exercise programs and ran half-marathons. After she got pregnant, severe nausea during her first trimester slowed her down some but after her nausea went away at around 14 weeks pregnant she started using the elliptical machine for cardio and doing lower-impact exercises such as yoga to keep in shape.

Fortunately for her, she had an easy vaginal delivery and sailed right through her first six postpartum weeks, breastfeeding came naturally and she felt pretty good since her baby was sleeping 6 to 7 hours a night. At her six-week postpartum checkup her doctor gave her a “thumbs up” and told her she could return to her normal activities. Megan was overjoyed and decided to start working out the next day.Megan started with what she thought was an easy routine: running a couple miles on the treadmill, working out with some weights, and doing crunches, Pilates-Hundred style. Right after her first workout, she felt something odd, as if she had a “golf ball” in her vagina but she ignored it and kept up her daily workouts.

Two weeks after she started working out, she went straight from the gym to the grocer and carried two heavy grocery bags up three flights of stairs to her apartment. When she got to the top of the stairs, she lost control of her bladder and wet herself. Worse yet, she felt a distinct bulge coming out of her vagina. When she checked herself with a mirror, Megan said she saw “part of her insides poking out of her vagina.”She got in to see the doctor immediately and he told her she had pelvic organ prolapse; her bladder was falling into her vaginal canal and protruding out of it. Yikes! To treat her, the doctor put her on estrogen cream to improve the tone of the pelvic floor muscles as, since she was nursing her baby, her body was producing less estrogen. He also referred her to me for pelvic physical therapy.Fortunately, Megan’s story had a happy ending.

I initially saw her for two and a half months. I taught her the correct way to do a pelvic floor contraction and the exercises in the Baby Bod®Program. I also suggested she use a Pelvic Floor Support Belt during the day to support the bottom of her pelvis (you can find one I recommend by clicking here) and talked to her about protecting her body from injury until it had fully recovered from childbirth. Megan eventually made a full recovery, her prolapse got better and she was eventually able to safely return to all her regular sports.The point I am trying to make here is that Megan returned to activities and exercises that were too challenging, too soon after giving birth. Most moms are not aware that it takes much longer than 6 weeks to fully recover from the stress placed on the body as a result of the changes that occur during pregnancy and from the rigors of delivering a baby.The amount of time it takes depends on how much damage occurred during delivery and how long it takes for the hormones in your body to revert back to their pre-pregnancy levels. The hormones that are produced during pregnancy cause the joints and supportive tissues in your body to become looser and your muscles to become weaker.

Since it can take several months for these hormones to reach a new balance after you give birth (longer if you are a nursing mother) this means your body is less stable for quite some time after childbirth. During this time it is important to try and prevent injuries.My book, Baby Bod® makes it easy to figure out whether your body has fully recovered from childbirth. In chapter 5 there are two tests you can use to measure how well your core muscles, including the pelvic floor muscles, are able to support the pelvic organs and your spine. After completing the tests, you can follow the step-by-step program I have developed to help women to fully recover from childbirth. As a simple starting point, try answering the questions in the chart below.How do I know if I have Pelvic Organ Prolapse?

‍If you have reason to believe you might have pelvic organ prolapse, here are questions I would like you to ask yourself: Pelvic Organ Prolapse Questionnaire

1. Do you feel as if there’s something in your vagina?
2. Do you feel as if something seems to be coming out of or pushing down on your pelvic floor every time you cough, sneeze, or jump?
3. Can you feel something coming out of your vagina, especially after passing a bowel movement?
4. When you urinate, are you able to fully empty your bladder? Or do you have to return to the toilet to empty your bladder shortly after you urinate?
5. Do you leak urine, or have a constant “dribble” of urine leaking from your bladder?
6. Do you have a constant urge to urinate?
7. Are you able to fully empty your bowels in one go or do you need to return frequently to finish making a bowel movement?

If you said YES to any of the questions above, it could indicate that you have a prolapse of one or more of your pelvic organs. If you recently gave birth, it may well be temporary. If you suspect you have pelvic organ prolapse, please don’t ignore it. Get the condition evaluated by a healthcare professional. He or she can tell you whether the prolapse is mild, moderate, or severe and what your treatment options are. The good news is studies have shown that physical therapy treatment can reduce or resolve POP for some women (1, 2, 3). This means that the right physical therapy program can PREVENT SURGERY, so you owe it to yourself to consider going to a physical therapist who specializes in women’s health and has advanced training in pelvic physical therapy.If you would like to make an appointment for physical therapy treatment or get one-to-one advice on how to prevent developing pelvic organ prolapse get in contact with us. The therapists at Marianne Ryan Physical Therapy are trained to provide you with safe and effective exercises and can offer hands-on treatment for pelvic organ prolapse.You can also get a sneak preview of my upcoming book, by downloading a FREE section called “Why You Should NOT Do Sit Ups to Flatten Your Tummy”

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Marianne Ryan
 PT, OCS References 1 Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011 Dec 7; (12):CD003882. doi: 10.1002/14651858.CD003882.pub4.2 Hagen S, Stark D, Glazener C, et al.  Individualised pelvic floor muscle training in women with organ prolapse (Poppy): a multicenter randomized controlled trial. The Lancet. 1 March 2014; 383(9919):796-806. doi:10.1016/S0140-6736(13)61977-7.3 Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011 Dec 7; (12):CD003882. doi: 10.1002/14651858.CD003882.pub4.