14 Dec Help, I think I have a vaginal prolapse.

Since I became a mum I have been surprised how often I hear women tell me that they were aware of experiencing prolapse symptoms after they gave birth, but did not know where to seek help for this condition.

A pelvic organ prolapse is when the uterus, bladder or bowel descend into and sometimes out of the vagina. It is very common after childbirth, the continence Foundation of Australia reports the incidence is as high as 1 in 2. And when it happens, it’s devastating for women. Lots of them tell me they did not even know this could happen. Why weren’t they warned? Why aren’t women talking about it more?

So lets start talking about it.

Firstly, let me tell you the signs you need to watch out for. If you experience any of the following, at any time, you should seek some help.

1. A heaviness or dragging sensation in the vagina.
2. A feeling like you need to sit down or something might fall out.
3. A bulge in the vagina.
4. Something protruding out of your vagina.
5. I have heard people say it felt like I had a golf ball sitting in my vagina trying to get out.

So what can you do about it?

Increase the amount of support that the organs are sitting on

• Learn how to use your pelvic floor muscles for support, and start a specific strengthening program for these muscles. Your physiotherapist can provide you with an individualised program.
• “The knack”. When you perform the knack you contract your pelvic floor muscles to provide support when a downward force is being exerted through your pelvic floor eg. During a cough or sneeze, nose blowing, or a heavy lift.
• A vaginal support pessary. The use of a pessary can improve prolapse symptoms and quality of life. They are affordable, easy to self manage and the research is showing good results for their place as a management option. In fact, the Journal of Obstetricians and Gynaecologists Canada stated that pessaries should be considered in all women presenting with symptomatic prolapse (Robert M, Schulz JA, Harvey MA. (2013) Technical Update on Pessary Use. Journal of Obstetrics and Gynaecology Canada. 35(7):664-674). Many pelvic floor physiotherapist’s have now undergone training to fit vaginal support pessaries. We do this regularly in our practice.

Reduce the amount of pressure pushing down on the pelvic organs.

• Practice good bowel habits
• Avoid heavy lifting, pushing or pulling
• Improve your general fitness
• Avoid straining to empty your bowels as this will stretch and weaken the pelvic supports, and can cause your prolapse to progress.
• Ensure adequate fluid intake. Drink 6-8 glasses of water a day.
• Eat plenty of dietary fibre (including fruit, vegetables, wholegrain cereals, beans, lentils etc)
• Respond to a good “urge to go” before you attempt to move your bowels. (This urge usually occurs after a meal – often after breakfast).
• Use a good position on the toilet – sit, leaning forward from the hips with your back straight (not slumped), a footstool can be very useful also. Do not strain.
• Fibre supplements may be helpful if you are still experiencing difficulty – discuss your needs with your doctor or pharmacist.
• These activities can increase abdominal pressure which can push down on your prolapse and make it worse.

Participating in regular general fitness activities will help to improve your overall muscular tone in your body – including the pelvic floor muscles. Daily exercise helps to keep your bowel regular also.

Exercise should be low impact, so as not to place excessive strain on the pelvic supports. Good exercise ideas include walking, swimming, low impact aerobics, bike riding, tai chi or aqua-aerobics.

Some people feel their prolapse symptoms are worse when they go walking. Choose to exercise in the morning when your symptoms are minimal, and start with only 15 to 20 minutes until you build up your muscle endurance through pelvic floor exercises.

Improve your posture

Sitting and standing with good posture (ie a slight curve in your lower back) requires your postural muscles to switch on – this includes your pelvic floor and deep abdominal muscles. So improve your posture and it will improve your support muscles also.

Maintain a healthy body weight

If you are overweight, the higher the load that on the pelvic organs, the more it can make your prolapse worse.

Avoid coughing and sneezing

Smoking causes chronic coughing, now would be a good time to quit. Seek treatment for allergies that cause you to sneeze.

Rest during the day if possible

Lie down in the middle of the day and unload the prolapse (a minimum of 20 minutes is ideal).

Wear supportive underwear

Women with prolapse often feel more comfortable if they wear support briefs or firm bike pants, shapewear type garments can often work well.

The bottom line is that it’s more common than you thing, people just don’t talk about it enough. Don’t put with it, and think it’s normal just because you have had a baby (and this goes for incontinence too!). And you can get help!

If you have any questions, or suspect you might have a prolapse, see your local pelvic floor physiotherapist or Doctor.