Prolapse is one of the diagnoses I have women crying about in my office, because it can be such a scary diagnosis. When women hear “prolapse”, and then search it on the internet, they hear that their insides are falling out. Panic sets in when they think the only solution is surgery. But there is actually a lot that can be done for prolapse conservatively with physical therapy, including specific exercises for your pelvic floor & postpartum organ prolapse.
What is Prolapse?
First let’s go over anatomy, because there are actually three ‘types’ of prolapse.
- Cystocele (bladder is falling)
- Rectocele (rectum is falling)
- Uterine prolapse (uterus is falling)
After child birth, we can expect that the walls of the vaginal canal are going to have some laxity to them as they heal. The bladder sits in front of the vaginal canal and the rectum sits behind the vaginal canal. With this laxity present, the bladder can begin to drop backward and press into the front of the vaginal canal. Similarly, the rectum can begin to drop forward and press into the back of the vaginal canal. This pressure into the vaginal canal can create a sensation of fullness, heaviness, or like something is in the vaginal canal [like a tampon].
Severity - How is Prolapse Graded?
[ LEAST SEVERE ] Prolapsed tissue is >1cm above vaginal opening.
Prolasped tissue within 1 cm of vaginal opening.
Tissue extends to the vaginal opening.
[ MOST SEVERE ] Tissue extends outside of the vaginal opening.
Physical Therapy & Postpartum Prolapse
Our goal with physical therapy isn’t necessarily to make the organs go back into their 'original' position, but to get you to the point of being asymptomatic. We want to get you back to doing all the activities you love without having any symptoms of prolapse.
So how do we treat this? The pelvic floor and core system are going to be integral to treating pelvic organ prolapse. Managing prolapse is all about managing pressure in the abdomen so that we are no longer putting downward pressure on those pelvic organs with our daily tasks. As with all pelvic floor conditions, it is necessary to understand if tension or weakness is driving the symptoms. We often think that it is just pelvic floor weakness that causes prolapse. Although counterintuitive, tension in the pelvic floor can drive prolapse symptoms. Muscle tension can even cause some of that fullness sensation. Additionally, we want pelvic floor muscles to be like a bouncy trampoline and to be able to adapt to stress. If we are holding muscles tight, it will be more of a rigid surface/structure that doesn’t provide as good of support to those organs.
Relaxation Exercises for Postpartum Pelvic Floor Prolapse
When you are dealing with postpartum prolapse, it can be really easy to want to hold tension in pelvic floor muscles. You may want to contract and squeeze your pelvic floor to resist this full sensation. So first things first... tune into your pelvic floor and notice if you are holding unnecessary tension. If so, be mindful of the times when you are holding tension, channel your inner Elsa and ~ Let It Go.
Use some diaphragmatic breathing throughout your day, whenever you are sitting or at rest (like feeding your baby, driving, meals). This can be a good place to start when letting go of pelvic floor tension.
As always, it can be helpful to be assessed by a pelvic floor physical therapist to help determine if you are holding tension or not. If you feel like tension might be part of what is contributing to your symptoms (you hold tension other places, you tend to have anxiety, you are a very fit person) then doing some of the stretches from this stretching playlist or working on some of the mobility tools from this mobility playlist can be a good place to start.
Strengthening Your Pelvic Floor to Improve Prolapse
Once we have either ruled out or treated any tension in the pelvic floor, you can start strengthening. One of the first skills to master with strengthening is the candle breath. You want to think about using your exhale with exertion and then activating your core and pelvic floor. This helps manage the pressure in the abdominal cavity and engages the core muscles to help support the abdominal organs.
You want to practice your candle breath with any strengthening exercises and daily tasks like getting up from the couch (especially while holding babe), lifting baby, lifting a car seat, etc. You can follow along with this strengthening playlist to perform progressively harder exercises to help strengthen your core.
Strengthening around the pelvis, especially the hips & glutes, helps support our pelvic floor as it regains strength and functionality. You can use some of the exercises from this strengthening playlist to help.
If you are active and want to get back to higher activity levels, like running, make sure to incorporate standing and single leg exercises. This will allow you to build the strength you need to return to these activities safely.
Dos & Don’ts if You Have Prolapse Postpartum
There are other lifestyle aspects we want to consider with prolapse to help decrease downward pressure on those organs.
- DO use a squatty potty. It will make bowel movements easier.
- DO wedge to manage symptoms. Practice wedging at the end of the day to take pressure off those pelvic structures.
- DON’T Bearing down [especially when going to the bathroom]
- DON’T Pushing or straining with bowel movements or urination.
- DON’T Constipation [stay hydrated, eat high fiber foods, & incorporate supplements, like magnesium, as needed]
- DO splinting if you have difficulty fully voiding. Use the fingertips to put pressure in the perineum. This helps support the pelvic floor prolapse & gets that last little bit out.
If you have been diagnosed with prolapse postpartum or are having some of these symptoms and suspect this might be the case, just know that this diagnosis doesn’t have to be so scary. There is help, you can feel back to normal, you can get back to doing the things you love, and we can hold your hand and walk you through it.