What’s ‘pelvic organ prolapse,’ you say? Well, I was in your shoes just over a year ago. I had never really heard the term before, and I certainly didn’t know it could reference a woman who had just given birth.
Pelvic Organ Prolapse: the descent or dropping of one or more pelvic organs (uterus, bladder, rectum, intestines, vagina, cervix, urethra) into or out of the vaginal canal as a result of weakening or torn muscles or fascia (connective tissues).
I wasn’t told about the possibility of pelvic organ prolapse (or ‘POP’) by any of my providers. Especially because I was a first-time mom, there are a couple of reasons I suspect I was not educated by my providers on prolapse:
From what I was told by professionals since discovering my prolapses, it is fairly uncommon to see prolapse in a a primigravida (a woman who is pregnant for the first time or who has only been pregnant one time).
It can be a scary and stress-inducing topic to bring up to a patient when there’s no way of knowing when/if she will ever suffer from prolapse.
So, when at five-weeks postpartum I discovered a heavy feeling and bulge at the opening of my vagina, I was frightened beyond all measure. I was cleaning myself in the shower when I felt the bulge at the opening of my vagina, so I jumped out of the shower immediately and got a mirror to check things out. I don’t know how else to describe this, so bear with me: it looked like a bald testicle sitting at the opening. Terrifying, I know. But the real terror didn’t begin until I started scoping the
technological-rabbit-hole Internet for possible medical explanations so I could diagnose myself.
Fairly quickly I decided that:
All of my organs were going to fall out of my vagina;
I would never be able to control my bladder again;
I was permanently broken; and
I was going to need invasive and scary surgeries to fix whatever was wrong.
I called the midwife ASAP. She told me to lay down, not to put pressure on my pelvic region, and to get someone to drive me to see her right away. I hung up…and just tears. All the tears. I had to call my husband (who was at work) and, between sobs, tell him I needed him to leave work immediately and come pick us up. When we got to the midwife’s house, she checked me out and told me she suspected I had a cystocele (bladder prolapse). It wasn’t so severe that my bladder was protruding, which would likely have necessitated surgery ASAP, so she told me to come back as scheduled the following week for my six-week postpartum check. She also told me to schedule an appointment with an OB/GYN who would be more familiar with prolapse, the severity, and options I might have to improve my situation.
From that point on, I did as much research as I could in between long crying spells, taking care of my weeks-old son, crying some more, screaming at the Universe about the unfairness of it all, trying to put on a brave face for my son, and, yes, crying still some more.
Here’s the gist of what I found out over time:
- Pelvic organ prolapse (POP) is fairly common in women, especially so in childbearing women and aging women (although not, as I said before, common in first-time moms);
- There is no way to prevent POP from happening, because there are no predictive symptoms;
- Some women have other risk factors that can increase the probability of POP occurring:
- Genetics: you inherit bone, muscle, and tissue strength through your DNA, so if your family is predisposed to any of these it increases your risk of POP (me!);
- Smoking (I haven’t smoked in over five years, but I smoked intermittently for ten years before that);
- Pelvic floor injury from childbirth, surgery, or fractures of the pelvis/back from falls or car accident (I had a completely natural birth and pushed for three hours before my son was born; also, I fractured my pelvis in October 2009 from involvement in a car accident);
- Chronic coughing, constipation, or straining (I suffered from irritable bowels for years before changing my diet);
- Aggressive exercise or heaving lifting (not me!);
- Degenerative muscular or nerve diseases;
- POP cannot ever self-repair back to the organs’ previous state;
- POP can be maintained, but will likely get worse with age and may require surgery at some point during your life.
After my visit with the OB/GYN, I was told I not only had a prolapsed bladder, but a prolapsed uterus and rectum, as well. As you can imagine, I was in shock. I was a fairly healthy, young(ish), first-time mother. From what I had read, this was an almost unheard of occurrence in first-time mothers. I felt like I wasn’t a woman anymore. I felt broken, no longer whole. And my mind flooded with questions: What if I wanted to have other children? Would I have to have surgery right away? Why was this happening to me? Should I have had a medicated birth? Did I not do enough Kegels? How could I have prevented this? How will my husband and I have sex? Will I ever feel whole again?
If this is all new to you, like it was to me, it sounds terrifying. And it was. But it got better. It GETS better, I promise you.
I saw an OB/GYN, I saw a urogynecologist, I went to physical therapy, I continued exercises and core strengthening at home, and I connected with other POP sufferers. I still have bad days, but mostly my prolapses are so well managed I rarely notice them at all.
If you are suffering from prolapse or know someone who is, please know that all is not lost! If your prolapses are not too severe, or do not cause you pain or discomfort, you may be able to self-maintain without needing surgery right away (if ever).
Furthermore, there are several resources and options to help inform you on and manage your prolapse(s):
- As soon as you can, schedule to see a urogynecologist. He/she is an OB/GYN who specializes in pelvic floor disorders. Here are the only two I could find locally (one of whom I saw and with whom I had a very helpful experience): Dr. Robert S. Furr or Dr. Rena Azar. They can help you determine your next course of action (i.e. self-maintenance, fitting for a pessary, referral for physical therapy, or surgical options).
- Next, schedule an appointment with a physical therapist who specializes in pelvic floor disorders. Again, there are only two locally (and again, one of whom I saw and with whom I had a very helpful experience): Erin Shinkle, PT, DPT, at Results Physiotherapy, or Lindsay Johnson, PT, DPT, at Parkridge East Hospital.
- Do Kegels frequently throughout the day, but make sure you’re doing them properly. Here are a couple of good instructional sites: Kegel Exercises 1 and Kegel Exercises 2. Also, here is a good site which lists common Kegel mistakes and tips on how to improve: 8 Common Kegel Mistakes.
- When you cough, sneeze, or lift something heavy (like your 35 pound toddler!), always perform a Kegel ahead of time; it builds up the strength of your pubococcygeus (PC) muscle and reduces strain on your organs.
- Do exercises that strengthen your core (like yoga and pilates). But DON’T do crunches or sit-ups. Those types of abdominal exercises can put excessive strain on your organs and worsen your condition.
- Connect with other women who are dealing with prolapse. I found very helpful words of advice and encouragement on these forums: HysterSisters or Whole Woman Inc..
Lastly, please know that you are not alone. Discovering you have pelvic organ prolapse can be scary and overwhelming, but know that it doesn’t have to define you. You can still have more children. You don’t have to have surgery right away (maybe not ever). You couldn’t have done anything to prevent it from happening. You will be able to enjoy sex with your partner again. And you are still whole. You are a beautiful warrior, and you will keep fighting the good fight.