Reducing the risk of pelvic organ prolapse postnatally

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Sorry guys, this one is just for the ladies! And ladies…this gets pretty informative, pretty quickly!

First of all, what is pelvic organ prolapse?

Pelvic organ prolapse is the descent of the pelvic organs into or out of the vagina (as I said, very informative, very quickly!) The amount of descent of a prolapse can be graded, and the grade will then determine the type of treatment that is necessary. Pelvic organ prolapse isn’t just limited to women postnatally. It can happen to ANY woman, at ANY time of her life.

Why might I be at risk?

There are lots and lots of reasons, but here are a few of the main ones we see;

Birth type
A vaginal birth does increase your risk of pelvic organ prolapse. This can be because of the change in tissues – muscles, ligaments and fascia – that has to happen for the baby to pass through the pelvis. The opening of the pelvis, naturally, has to widen in order for baby to come through. Having instruments involved in your birth also increases the risk of damage to the pelvic floor, which in turn increases the risk of pelvic organ prolapse. It is really important to have these changes checked by a pelvic floor physio to make sure things have healed well.

Pelvic floor strength
The muscles that make up the pelvic floor (represented as the water in the picture), help support the ligaments and fascia that string the pelvic organs up (represented as the rope holding up the ship). If the muscles don’t have the ability to hold the pelvic floor up, there will be a lot of tension on the ligaments and fascia (or rope in the metaphor), and they can only hold for so long. This is where the guidance of a pelvic floor physio comes in; they need to check to ensure your muscles are activating correctly to support your pelvic organs.

Weight
– body weight
An increase in body weight during pregnancy actually increases the weight that the pelvic floor has to support! The pelvic floor, abdominals and diaphragm make up the walls of the abdominal cavity, so the pelvic floor is like the base of a cylinder. If the base of the cylinder doesn’t have enough strength, the contents of the cylinder is at risk of descending, which is where a prolapse can happen.

– weight of baby on pelvic floor
It is a common misconception that women who don’t have a vaginal birth aren’t at risk of prolapse postnatally; the truth is, women are still at risk even if they have a caesarean. Just as body weight adds more load to the pelvic floor, the weight of the baby on the pelvic floor for the duration of a pregnancy is also load!! You should always still have a check-up of your pelvic floor postnatally even if you have a caesarean.

Age and Genetics
These also play a role in the risk of prolapse. With an increase in age comes changes in the tissues, and an increase in the risk to the pelvic floor during a vaginal birth. Furthermore, some people are just genetically predisposed to prolapse – depending on their ligament laxity etc.

What can I do to reduce my risk of pelvic organ prolapse postnatally?

Return to pre-birth weight: this is actually one of the biggest indicators of reducing the risk of pelvic organ prolapse. With a reduction of weight on the pelvic floor and therefore much less load, we significantly reduce our risk of developing a prolapse!

See a women’s health physio even if you think everything is fine: it’s really common for women to say ‘but everything feels fine’ in the postnatal period. And that absolutely may be the case! But it’s also common for women’s health physios to start to see problems in women a year or so down the track postnatally – this is where (as per the previous ship in the dock metaphor) the ligaments that support the muscles of the pelvic floor no longer have the strength to support the pelvic organs without the support of the muscles.

The moral of the story is…it’s really important that we rehabilitate the pelvic floor postnatally, NO MATTER WHAT!

Lauren Osborne

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