Prolapse literally means to fall out and while that is a very simplistic meaning – there are many variations on what can fall out and where it falls.
Prolapse affects around 50% of postnatal women* and the risk factors include pregnancy, childbirth, menopause (the decrease in the oestrogen hormone), pressure in the abdomen (which includes being over weight, lifting heavy objects or straining during a bowel movement) and genetics (if your mother experienced prolapse, you are a higher risk also).
There are 3 kinds of Pelvic Organ Prolapse (you may see it abbreviated it to POP) – bladder, rectum and uterus. Weakening or damage to the ligaments, muscles and connective tissue, which are designed to support the internal organs allows these organs to push into the vagina and sometimes push them completely out of the vaginal opening.
Click here to see short videos explaining the different kinds of prolapses.
Obviously, our knickers were not designed to catch our internal organs and that is why we have our pelvic floor! A healthy functioning pelvic floor that is able to both contract and relax and is vital for keeping the internal organs up and in the right place. A functional pelvic floor is also responsible for enjoying sex and helps avoid lower back pain. Pretty clever huh?
Our pelvic region is designed to keep stuff at all the right angles, in order for them to work correctly. Prolapse in it’s first stages may be difficult to diagnose in yourself and you may not feel anything significant but perhaps experience the symptoms of a weak pelvic floor like stress incontinence or the inability to completely empty the bladder or bowel or on-going urinary infections.
You may not feel this is of major concern. And certainly with the growing euphemisms such as LBL (Light Bladder Leakage), many women believe that leaking a little bit of wee is just a normal and natural part of motherhood and politely ignore it.
Incontinence may be common, but it is not normal.
Many women first discover their prolapse when washing themselves in the shower as a bulge or lump at the vagina entrance or describe a heavy or dragging sensation that generally gets worse at the end of the day (Gee, thanks gravity!). Other symptoms can include painful sex and leaking during sex.
When prolapse exits the body, things start to get a whole lot more complicated. You see, your pelvic floor is quite unable to contract functionally, when there is something hanging in the way! And where a little bit of incontinence here and there can easily be ignored… this is much harder to. In fact, every single one of my prolapse clients say they spend most of their waking thoughts thinking about their prolapse. They have to renegotiate how they do things to accommodate it. Lifting can make a prolapse worse and when you have a baby and perhaps a toddler and performing house chores of washing and shopping, lifting can be very difficult to avoid.
Prolapse also affects self-confidence and many women tell me that they don’t like their husbands and partners to look at them “down there”. And if a new mum didn’t have enough roadblocks, like tiredness to enjoying their mojo and getting their sexy on… this can put a serious spanner in the works.
Can prolapse kill you?
But obesity, heart disease and all the other diseases that are associated with lack of activity and perhaps using food to self medicate, can. We also know that exercising positively impacts on postnatal depression and positive self-image.
So safe exercise options are a vital part of your recovery.
It’s ok! I’ll just get surgery to fix it!
It is not quite as simple as that.
In many cases surgery can make a huge difference… but there are 2 very important things to understand about surgery.
First, it does not last forever. That’s right. Just like getting a knee or hip replacement it lasts for about 8- 10 years. So you may not want to use this option too quickly. Every time there is surgery there is subsequent scar tissue and nerve damage to work with.
Second, it is not as simple as having the surgery and forgetting about your pelvic floor. You will still have to adjust your lifestyle and learn to care for your pelvic floor to maximize the life of the surgery. I have seen many women who have had very little post operative care and have re-prolapsed and had to go in for more surgery. And this is not simple surgery.
Addressing incontinence is often much easier than prolapse.
But what can be done to help my prolapse?
Actually quite a bit. There are pessaries that can be fitted to support the internal organs and even an oestrogen cream that some of my clients call magic cream… but all of this is a specialists’ bag of tricks and a Women’s Health Physiotherapist is an essential start to getting a full picture of what is happening to you.
It does not have to mean the end of living a full and active life. But it does mean you need to choose your exercise options wisely.
Here are my 5 top tips for exercising safely with prolapse:
- Understand about intra-abdominal pressure. Exhaling before you lift or exert effort can be extremely helpful. This includes exhaling as you get out of your chair (which research has shown to have more intra-abdominal pressure than a crunch!), lifting your child or heavy objects.
- Exercise in the morning. Gravity plays a part in pulling your internal organs down, so prolapse symptoms can be much less and your pelvic floor stronger in the morning.
- Train mindfully with your period. Just before you menstruate and the first few days of menstruation your hormones make all of your connective tissue weaker/ softer. This is not the time to go hard or push through. It is the time for more restorative exercise.
- Sitting on a swiss ball, because it forces you to balance it is great for working the smaller core muscles and can also be great support for your pelvic floor too.
- Take time to rest and recover after your work out. Take the weight off your feet. If you feel prolapse symptoms take some time to sit and put your feet up.
Pelvic floor is rarely mentioned in a Fitness Professionals’ education. Prolapse even less. If your exercise professional does not ask you about your pelvic floor / incontinence / prolapse, ask you about possible birth injuries or check your belly for DRAM (diastasis, or the splitting of the abdominal muscles), then they simply are not the trainer for you.
You deserve better. Your body deserves better. Prolapse does not have to mean the end of living a full and active life.
But it does mean you need to choose your exercise options wisely.
At every stage of life.
*Statistics from Continence Foundation of Australia
Michelle Wright (Mish)(B.Ed and Dip. Teach) is the founder of the multi-award winning fitness business mishfit. With over a decade in the fitness industry, mishfit proudly boasts a programme called EVEolution and is passionate about providing safe exercise and education to pregnant and postnatal women. Mish regularly contributes to magazines, online sites and presents internationally on women’s health and specifically about pelvic floor.
You can check out mishfit HERE
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