I remember the first time I went for a walk along the beach by myself with my newborn baby in his buggy, the sun on my face, the sea breeze in my hair. I recall my sense of achievement as I had finally made it out of the house with my small being without the aid of another person. I must have been feeling a little too ambitious at 3 weeks postpartum as I also remember beginning to feel a strange heaviness in my pelvis whilst walking which felt worrying like another small baby might be about to just fall out of me if I kept moving much further. What I didn’t realise at the time was that I was experiencing the early warning signs of pelvic organ prolapse.
WHAT IS PELVIC ORGAN PROLAPSE?
Well essentially it’s when one or more of your pelvic organs (bladder, womb, bowel) slip out of their usual position and start to push on the wall of the vagina from the outside. This bulge may even extend down the vagina and you may be able to see or feel something ‘poking out’ where it shouldn’t be.
WHY DOES THIS HAPPEN?
The extra pressure of carrying a growing baby puts a huge load on the pelvic floor and surrounding muscles, nerves and connective tissue. Labour and birth can cause further damage leading to less support for the organs within the pelvis. So, they become displaced and often as the day goes by, gravity and fatigue means the organs slip further down into the pelvis causing that bulge (just like during my long beach walk with my 3 week old).
Of course it’s not just pregnancy and birth that can cause POP and in fact the hormonal changes that occur with menopause may also contribute. Different studies have shown that anywhere between 30 and 93% of women may experience a prolapse, so whether you’re having symptoms now or not, it’s worth paying attention.
SYMPTOMS
These can come and go and sometimes are more severe than others.
A heaviness or dragging sensation in the pelvis/vagina.
Leaking urine, wind or faeces.
Not being able to empty your bladder fully, and/or needing to go to the loo A LOT.
A noticeable bulge extending out of the vagina.
Uncomfortable sex or lack of sensation during sex.
TREATMENT
Your first port of call if you think you may have prolapse is a good women’s health physiotherapist (you may be able to get an NHS referral but it’s worth asking around).
Vaginal pessaries are also a great option and your doctor or physiotherapist will discuss these with you.
If the prolapse is severe enough that lifestyle changes and exercise aren’t helping, surgery may be the best option. (The vaginal mesh surgery is currently on hold in the UK due to reporting by patients of some severe problems).
However, there's a lot you can do yourself;
LIFESTYLE CHANGES
I can not emphasise this enough - losing excess weight, quitting smoking (or anything that causes you to cough) and eating a healthy, healing diet will all have a huge positive impact on your pelvic floor function and therefore reduce your prolapse symptoms.
Of course life, especially motherhood, has a way of thwarting your health goals so working with a trainer or other professional, or just buddying with a friend to keep each other accountable is really helpful.
Breathe. Ultimately, your breathing muscles and your core muscles are all part of the same system so if you’re not breathing right, your pelvic floor probably won’t be able to function well either. Instead of taking short shallow – life’s so busy I barely have time to breathe – breaths, aim to fill the lungs fully and expand the rib cage. Practice this during quiet moments like when you go to bed. Take some slow rib opening breaths allowing the pelvic floor to move with the diaphragm in the right way. And always, always, exhale on exertion (breathe out when you move against gravity, push or pull something).
Avoid constipation. Straining on the loo puts a lot of unnecessary pressure on the pelvic floor. So eat plenty of fibre, drink more water, get more movement into your day and reduce your stress to make for better bowel motions.
You may notice that your symptoms become worse at the end of a day, after a long walk or if you try to run or lift something heavy. While keeping active is very important for pelvic health, it’s essential to tune in to your body and only do the activities that feel right for you.
EXERCISE CONSIDERATIONS
Generally anything that makes your body move quickly (eg spin), involves high impact (eg running, boxing) or involves heavy lifting (eg weighted squats – especially deep squats) is not going to be good for a weakened pelvic floor and is likely to make your prolapse worse.
Start slow, small and steady.
Walk, don’t run, at least until things get back on track.
Make your squats, lunges and other lifts smaller and more controlled. Start with body weight exercise and when you have to pick up something heavy, like your toddler, remember to breathe out as you lift.
Do your pelvic floor exercises! Kegels are certainly not the final answer for pelvic organ prolapse but they're an essential part of the picture and easy for you to do at home. Below are some tips to get you started. Aim to practice this every single day, at least once. It may feel like too much, but think of the consequences if you don't (or on a more positive note, think of the potential freedom if you do!).
So essentially folks, if you want a healthy, fully functioning pelvic floor for life, one that does it’s job and doesn’t just hold in the poos and wees but also holds in your actual internal organs, you HAVE to start prioritising your self in these ways. It’s not about building a strong core through sit ups and planks. It’s about starting small, recognising what works for your body and getting the right support.
Drop me a line if you've any questions, and if you're Bristol based why not join me for our fabulous core strength classes for mums? Simply email me at hello@heatherkeats.co.uk for more info, and remember to sign up to the mailing list to be first to hear about the future online courses.
Thanks for reading and have a happy day.
Heather