Prolapse After Childbirth
A generation ago, women regarded pelvic floor problems like prolapse as an inevitable part of motherhood and silently accepted the consequences. Today, women are more informed and expect more out of life, including life after bearing children. But pelvic floor disorders, pelvic prolapse, or incontinence are rarely, if ever, discussed in any prenatal classes, birthing classes, or pregnancy books.
A woman’s prolapse is described depending on what part of the uterus or vagina is involved in the prolapse. A cystocoele occurs when the front part of the vagina below the bladder is prolapsed. A rectocoele is what the prolapse is called when it involves the back wall of the vagina in front of the bowel. A lot of prolapses involve only a part of the vagina or a combination of the vagina and uterus.
Some women don’t experience any symptoms with their prolapse and only find out during an internal exam. Most women have at least some symptoms though. Many times the symptoms of pelvic prolapse are mild: a sense of “something falling out”, lower back pain, and minor urinary incontinence (usually stress incontinence when small amounts of urine are passed while coughing, sneezing, laughing, or lifting a heavy object).
Many women first experience some of these symptoms, particularly stress incontinence, during pregnancy , when the weight of the baby presses downward, weakening the pelvic floor. Following the birth, the muscles and ligaments surrounding the uterus and vagina can be weakened so full control is not regained until for several months, if ever.
Some symptoms of prolapse are more severe. Urinary incontinence associated with a cystocoele can be constant and embarrassing. A rectocoele can cause constipation, inability to completely void the bowels, or an inability to hold gas or bowel movements. Sexual dysfunction can occur in a woman with a prolapsed uterus as well. Sex can be painful, uncomfortable, and undesirable.
By far, the greatest incidences of prolapsing are after childbirth. Carrying the weight of a baby as it drops lower into the pelvic region; laboring to bring the baby through the birth canal; and the most physically demanding part of it all, pushing the baby into the world. All of these combine to weaken the pelvic floor and create conditions for a prolapsed uterus. Episiotomies (cutting of the perineum during childbirth, usually to facilitate the pushing process) are associated with a greater risk of uterine, bladder, or bowel prolapses.
A so-called “poor fit” where the baby’s head does not easily engage in the pelvis, and usually involves longer, harder labors is another situation that weakens the pelvic floor and can cause a prolapsed uterus. Big babies can also contribute to pelvic floor weakening. Delivering a baby bigger than 8 Ã?½ pounds can carry a risk of pelvic prolapse.
Childbirth is not the only contributing factor to pelvic prolapse, though. A person can have a prolapsed uterus without ever having had a child. Many women develop the symptoms of prolapse around menopause, and it is thought that part of the weakening of the pelvic floor muscles is associated with hormonal changes during menopause, pregnancy, and childbirth. A person who has had a hysterectomy is at the highest risk of vaginal prolapse due to weakening of the muscles surrounding the vagina during surgery. Symptoms of prolapse may not show for years after an event such as hysterectomy or childbirth, but by age 80 many women have some symptoms, especially urinary incontinence.
Exercising the pelvic floor muscles is vital to keeping them from weakening and dropping, or prolapsing. When your doctor tells you to do your Kegels, it’s not just to make labor and delivery easier, or sex more enjoyable. Those are great side benefits, but the overall goal is to strengthen those muscles and ligaments holding the uterus and vagina in place so they won’t prolapse. Kegels are simply the rhythmic clenching and unclenching of the pelvic floor muscles. The exercise is named after Dr. Arnold Kegel who developed this exercise in 1946.
Another way of exercising this girdle of muscle and ligaments is by inserting weighted cones into the vagina and holding them into place. One reason some people prefer this method is that it is easier to know that the right muscles are working. When doing Kegels, it is important to only clench and unclench the proper muscles to strengthen the pelvic floor. Some people report great success with the Kegelmaster. This is a device that aids in the Kegel exercise by using resistance.
It is possible to regain some or all control of prolapsed organs by exercising the muscles surrounding them. For cases where exercise does not help, there is an option called a pessary. A pessary is a plastic ring inserted into the vagina to help support the uterus, vagina, bladder, or rectum after they become prolapsed. Some women find the pessary irritating or uncomfortable. This could be because it isn’t fitted right, so it’s important to let your doctor know.
Surgery is also an option to repair prolapses. The general idea of the surgery is to pull together the weakened muscles of the pelvic floor with stitches to make the pelvic floor stronger. Since being overweight increases the incidence of prolapses, the doctor may ask that you lose weight before considering the surgical option. And of course, if a woman still wanted to carry children, she would likely be told to put off surgery until her child-bearing was over, since the weight and pressure of carrying a baby would make the results of the surgery less successful.
Pelvic prolapses are gaining recognition as problems that can affect women both young and old. Today women are intent on maintaining their active lifestyles without embarrassing incontinence or sexual problems. And there are ways to ensure that women no longer have to suffer in silence.
