Pelvic Organ Prolapse (Part 1)
Let’s talk about pelvic organ prolapse. You might call it a heavy feeling, or a bulge, or say it feels like there’s a “golf ball in your vagina.” You might feel something when you wipe, or you might think stuff is going to fall out. I’ve had more than one woman tell me her vagina is falling out. Oofda.
Well what’s going on? First of all, don’t worry: your organs ARE NOT falling out. I always say I can fix a prolapse 50% in one visit by just telling my patients that fact. Did I change where their organs are sitting in their body? Nope. But I affected their perception, gave some peace of mind.
Prolapse occurs when one or more of the pelvic organs (bladder, rectum, or uterus) drop lower in the pelvic cavity due to a decrease in support. All of these organs are “suspended” inside the pelvic cavity by ligaments around the uterus. From below, they are supported by the pelvic floor, like a hammock. During pregnancy, these ligaments obviously stretch A LOT. In the most perfect vaginal delivery, the pelvic floor also stretches A LOT. Even with a cesarean birth, the ligaments still stretch, so it doesn’t necessarily prevent prolapse.
As I said before, it often feels like a heaviness or bulge in the vagina. Many women feel this immediately postpartum, then it gets better over the first several weeks. Some women notice it all the time, while others don’t notice it at all. Some feel it more after a workout or a long walk. Sometimes it goes away completely when they lie down. Sometimes it interferes with sex, causes urinary leakage, or causes constipation.
The good thing about prolapse? It’s not going to harm you. As professionals in this area, we care more about how much it BOTHERS you than how severe the prolapse looks objectively. Which is why I can fix one 50% in one visit ;). It’s all about perception. No good doctor should recommend surgery if you aren’t complaining about how it feels.
How is it treated? Start with physical therapy. We can’t necessarily tighten ligaments from above, but we can sure work on strengthening the pelvic floor to improve support, provide manual techniques to optimize organ position, and teach you strategies to minimize discomfort. And we can keep reminding you that nothing’s going to fall out. ;)